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Long-term dependency and maladjustment cases in a family service agency : an exploratory study of data… Marcuse, Berthold 1956

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LONG-TERM DEPENDENCY AMD MftlADJUS'E-IEffi? CASES IN A FAMILY SERVICE AGEHCT An Exploratory Study of Data, and Method BERTHOLD MARCUSE Thesis Submitted i n Pa r t i a l Fulfilment of the Requirements for the Degree of MASTER OP SOCIAL WORK i n the School of Social Work Accepted as conforming to the standard required for the degree of Master of Social Work School of Social Work 1956 The University of Br i t i s h Columbia ABSTRACT So-called "hard core" cases have long been known to wel-fare agencies and to communities; but proper definition and under-* standing i s s t i l l often lacking, while attention has not been s u f f i -ciently directed to the problems of adequate diagnosis, early recog-nition, treatment and prevention and the social or community aspects as well as the personal or single-agency implications. The present study i s an exploratory analysis, examining data and methodology, of such groups i n a particular but strategic setting - the family service agency. After (a) considering popular and more acceptable definitions of "hard core" cases, i t (b) reviews briefly- some of the s t a t i s t i c a l indications of long-term cases i n the Family Service Agency of Greater Vancouver, and proceeds to (c) a de-tailed analysis of a small selected group who manifest a l l the charac-t e r i s t i c s of ehronic dependency and maladjustment. The systematic ex-ploration of a l l the complex elements i n the pattern of multi-problems dependency i s the main theme of this study. Despite gaps i n information- i t proved possible to l i s t these factors within three subdivisions:- (a) Socio-economic factors and presenting problem, (b) physical and mental health, and (c) pre-marriage history. A significant number of common elements were shown to be operating within eaoh family. These elements were studied i n conjunction with family behaviour patterns and a further correlation between them and the behaviour patterns seemed apparent* In spite of the complex inter-relationship of personality and environmental factors, i t i s possible to advance the view that multiproblem families and potentially chronic cases are susceptible of relatively early identification. This would be a major step towards more effective diagnosis and treatment planning for the multiproblem family. Effective treatment planning and possible preventive tech-niques however, raise the essential issue of adequate community and agency resources. A' Family Mental Health Centre i s one special medium, as are some of the environmental services developed i n such countries as Sweden and Great Britain. The' tentative conclusion favours a bal-ance between the American "mental health" approach, and that of co-ordinated social and environment services. As an exploratory study, i t does not minimize the urgent need for further research. ACKnaTfLEDCS-EHTS % deep appreciation i s due Dr. Leonard Harsh and Hr. Douglas Fowler, of the School of Social Work, University of B r i t i s h Columbia, who through-out the course Of this study gave so freely and constructively of their time and their wide ex-perience i n research and social work, Hr. Deryck Thomson, Executive Director of the Family Service Agency of Greater Vancouver, l i k e * wise made an invaluable contribution by his helpful interest i n the subject of this study and by his kind co-operation i n placing the records and f a c i l -i t i e s of the Agency at the disposal of the writer. TABLE OF GOHTgSJTS Page Chapter 1. General Nature of the Problem * Historical  and Contemporary Is. the term "hard core" valid? Constituent factors i n long-term ("hard core") group. Long-term cases at the Family Service Agency. Selection of cases for intensive analysis Maladjustment. Dependency. Multiprdblem families....>.......». 1 Chapter 2. Constituent Elements i n Long-Term Cases Socio-economic factors. Presenting problem as seen by client* Health* Pre-marriage history.«*»•••••••••»*•......... 23 Chapter 3* Behaviour Patterns i n the Family Socio-economic.: Health. Pre-marriage history. Etoerging^ pattern of family behaviour...,• ...,*.,..•»*..**••.•*.*..».• Chapter U. Findings and Implicatioas Basic personality defects: Some parallels. Community Impli-cations. Agency and community resources* Significance of recording shortcomings, Areas for further research and Appendicest A. Some Statistics of Long-Term Cases B. Abbreviated Case Records of Seven Intensively Considered Cases C. Bibliography SCHEDULES AND TABLES IB THE TEXT Schedule A. Socio-economic factors..*........*......... ..... 35 Schedule B. Health factors...................................... 37 Schedule C. Pre-marriage history................................ 39 Table 1. Number of cases or persons receiving service from selected voluntary social work programs^ Detroit 1 9 5 > o . i Table 2* Presenting problems at intake ("split#halves")...... 21 Table 3. Presenting problem(s) k3 CHAPTER I GENERAL NATURE OF THE PROBLEM - HISTORICAL AMD CONTEMPORARY Within recent years there has been increasing evidence of the extent to which a small proportion of maladjusted or dependent families have absorbed a disproportionate share of the time, money and resources of the community, and of the public and private welfare agencies giving service within the community. U n t i l recently there have not been many studies of a community-wide nature, or surveys x-jhich resulted i n defini-tive measurement on a s t a t i s t i c a l basis. David G. French cites one such survey^ the figures for which are taken from a publication of the Council of Social Agencies of Detroit. Table 1. Number of Cases or Persons Receiving Service from Selected Voluntary Social Work Programs, Detroit, 1950 1 Program Number of Cases or persons Family Service (monthly average of active cases) 3*298 Mental Hygiene Clinics (monthly average of patient v i s i t s ) 2,829 Institutional care of the aged (daily average of individuals under care) 3*782 Institutional care of the transient and homeless (daily average of persons cared for) 1 , 5 6 0 (more) 1 Source: Reproduced from French, David G., An Approach to Measuring  Results i n Soeial Works Columbia University Press, New York 1 9 5 2 . Basic Source, S t a t i s t i c a l Bulletin XI, No.5 ( 1 9 5 1 ) Council of Social Agencies, Metropolitan. Detroit. 2 Service to transients and travelers (monthly average of cases served 2*839 Buildings centred group i-jork and recreation (t o t a l membership during year) 112,753 Non-building-centred group work and recreation (total mej&ers&ip during year) 90*373 While the foregoing figures are based upon such different units as "cases" and "patient v i s i t s " and some of the same persons are un-doubtedly included i n the figures for different programs they do give some notion of the day-by-day flow of people to the voluntary social agencies i n this community, i t i s an essential step i n the evaluative procedure. As French said i n his text, quoting Kurt Lewin, "Realistic fact finding and evaluation i s a prerequisite for any learning," Research into this area of human needs on the American con-tinent has been given considerable impetus by the studies of Bradley Buell and his associates. The f i r s t such major study was conducted i n St. Paul. Minnesota i n November 19U8. I t was directed towards i&at Buell has designated as the four major problems toward which community-supported services are directed dependency, maladjustment, i l l - h e a l t h \ and recreational needs. In Minnesota, the survey revealed that a small group of families - 6.1% of a l l the families i n the c i t y , were suffering from such a compounding of serious problems that they were absorbing over $0% of the combined services of the community's dependency, health and adjust-ment agencies. Specifically, these families accounted for 77$ qf the 3 r e l i e f Ipadj $1$ of, the drain on health services, and 5>6# of the load carried by adjustment services i n the mental health, casework and correctional f i e l d s . . A contemporary study, that i n San Mateo County, California, now underway by Community Research Associates, shows that 5»o$ of the families there are also absorbing over 5>C# of the community's public and private r e l i e f and welfare services and resources. This problem i s not confined to isolated communities i n the United States. As yet unconfirmed observation suggests strongly that the same situation obtains i n Vancouver. These long-standing cases, whose chronicity i s characterized by a frequently bewildering aggregate of problems have come to be des-cribed by the term "hard core", by social scientists and social workers, both on this continent and i n Great Britain. At the Symposium held i n October 195!? on the occasion of the 25th. Anniversary of the School of Social Work of the University of B r i t i s h Columbia, particular reference to such cases was made by Dr. Eileen Younghusband, Director of the Social Work Course at the London School of Economics, who instanced cases of families which had been on the records of welfare agencies for two and even three generations. In the panel on "Humanizing the Social Services", Dr. Gordon Hamilton made further reference to the urgency of the problem posed by these "hard core" Oases. I t i s within the family constellation, as Buell has observed k i n bis St., Paul study, that "these destructive forces move continuously to reinforce each others* The evidence, i s that they then become, unable, or unwilling . to maintain themselves independently even i n a period of relative prosperity or relatively high employment such as we have had since the war. Are there such families i n Vancouver? How far are those known to family agencies typical? What kind of causes operate?-I t would appear appropriate that an agency such as the Family Service Agency of .Greater Vancouver j lahose primary focus Is. the-family unit, should be the best starting, point for an exploratory study of this challenging area. F i r s t l y , the existence or otherwise, of a J'hard core" at .the Family Service. Agency must be determined. I f so the data must be ex--, amined i n order to establish some method; for analysis of the facts thereon. If this can. be done, the way i s open for further studies on these lines: Why do some families become and remain dependent upon the social welfare resources of the community? What particular con-stellation of d i s a b i l i t i e s accelerate family deteriroation to the extent that dpeendency and ^ maladjustment becomes chronic? Might any family become chronically dependent, or i s i t only those who are poor, unlucky, inefficient or underprivileged? Do such families have constant needs, or do such needs arise only i n times of c r i s i s such as might be induced by depression, i l l n e s s , death, or special events l i k e desertion, orphanhood, unmarried parenthood? What are these needs and to xahat extent does society meet them? The twentieth century, and more particularly, the l a s t decade, has brought with i t the ever-increasing recognition that many of man's needs must be met by the State. Such needs would include provision for adequate education, minimum health services, insurance provisions for old age and unemploy-ment, and workmen's compensation legislation. These needs, generally accepted as normal, are today being met, either wholly, (although not necessarily adequately), or i n part. But what of abnormal needs - the needs of the mentally deficient, the emotionally disturbed, the physically disabled, the un-employed employable — and the otherwise maladjusted and dependent? To what extent are the needs of this group s t i l l unmet? Western c i v i l i z a t i o n has moved a long way from the punitive, repressive pattern of the old Poor Laws of the 18th century. Yet even today, i n parts of this continent, v e s t i g i a l elements of this harsh and judgmental philosophy remain, and some outmoded institutions continue. The reform of the English Poor Laws following upon the minor-i t y Royal Commission Report of Beatrice and Sydney Webb and their c o l l -eagues, towards the end of the l a s t century ushered i n an important period i n the development of social work. Legislation advanced from i n -adequate provision for poor r e l i e f to contributory or tax-financed social legislation available to a l l . Service to individuals and families developed, during this century, from the Charity Organization Society's concept of self-help to modern oasetrork. This, too, was a period of advancement i n methodology and i n knowledge. I t was a period which saw 6 the social sciences develop new s k i l l s making possible the assembly of an exhaustive body of knowledge about whole generations of mal-adjusted and dependent families* A generation ago there were such studies as those of the irredeemable Jukes and Kallikak families. Today there i s the new experimental approach to the social pathology of entire communities envisaged by such surveys as those of Bradley Buell and his associates. - The present study, as already emphasized, i s an explor-atory study only, of data and methodology with respect to long-term maladjustment and dependency. I t i s an attempt to open up the whole idea of what i s "hard core" and to determine, i f possible, how such cases van be analyzed. This i s the main goal of this particular thesis. The magnitude of this problem does not permit of exhaustive treatment within the scope of this reconnaissance and because of the numerous facets of this question which require further research the conclusions can only be provisional. Is The Term "Hard Gore" Valid? The term "hard core", as has been indicated, i s frequently used within the fields of social work, sociology, and other social sciences to describe the long-standing cases of dependency and .mal-adjustment. By their very nature these are apt to absorb a large amount of community welfare resources and services. While this term has a certain merit, derived primarily from usage, i t lacks precise 7 defii&tion, and from a semantic viewpoint may be subject to serious question. The meaning of F'hard core" has never been precisely defined -apart from i t s original technical definition, which i s hardly relevant without much interpretation. This i s primarily because i t i s only recently that social research has sought to determine tihat factor or . combination of. factors - environmental Or emotional, make for that type of chronic maladjustment whioh the community appears powerless to pre-vent, and for which, thus far , treatment has been largely ineffective. For the purpose of preliminary measurement, a long-term case was defined as any family whose date of referral to the Family Service Agency was 19k9 or earlier, and which was active at any time i n 19$$ (up to the date of the survey. 185> cases at the Family Service Agency were, thus defined* Certainly i t would be incorrect to assume that a l l long-term cases are necessarily "hard core" cases. Thus i n this p a r t i -cular survey, made from Family Service Agency f i l e s , cases were charac-terized as long-term i f they had been referred at least s i x years ago. Had i t been decided to make the criterion for long-term cases 191*6 or earlier, ( i . e . at least.ten years old), only 99 instead of 185 cases would have been classified as long-term. Merely because a case i s long-standing does not mean i t i s characterized by chronic dependency and  maladjustment, or that treatment techniques have not been helpful' to the t family. Among long-term cases i t i s of course l i k e l y that there w i l l 1 'IHard core «* heavy material forming foundation of road." The Con- cise Oxford Dictionary of Current English: Third Edition; Clarendon Press, Oxford 193U. 8 be many tilth such a complex constellation of disabling problems that they render th?i f amPy v i r t u a l l y permanent dependents. ..But i t s t i l l remains to analyse these problems rather than their duration. Moreover, i t should be noted that the problem of chronic maladjustment and. depend-ency i s essentially a coimganity problem. Families or Individuals, are long-term (or "hard core") i n terms of the t o t a l community - not a particular agency* From the point of view of a particular agency, a.... case which has been active for say, lf> years, whether called ''hard core", long-term, or anything else, has, i n fact, absorbed a dispro- . portionate amount of the agency's resources. Yet, i n terms of the t o t a l community, a family active only one month at that agency, may, over a greater number of years, have already absorbed a far greater, amount of the community!s to t a l resources through i t s , r e l i e f giving agencies, medical services or other case-work agencies. Thus* i n this study, while the particular focus i s on the defined 18£ long-term cases i n the Family Service Agency of Greater Vancouver, the findings are ,. subject to the- important qualification that they are susceptible to. broader and more significant interpretation as part of a community-wide survey rather than one focussed on a single agency. The ultimate goal of agency-focussed research into this problem must be that of integration and correlation with the broader research focus of the community. Chronic dependency and maladjustment i s a self-perpetuating mechanism. Although essentially a problem of the vifaole community i t 9 i s appropriate that the task of f u l l diagnosis and co-ordination of services for such groups be undertaken by a family-oriented agency. There exist public agencies which function as primary economic re*« sources for the family such as the Vancouver City Social Service Department. Such agencies perform a v i t a l service i n meeting emerg-ency needs, frequently on very short notice. But there must be agencies such as the Family Service Agency which can take over the essential job of psychosocial diagnosis and treatment planning for the entire family. The importance of the t o t a l faiialy; constellation i n such work i s today so generally recognised as to be almost axiomatic. In our Western C i v i l i z a t i o n the family i s the basic unit of society. unfortunately., practical application of this concept' seems at times to lag behind i t s theoretical acceptance*. Mary Richmond gave cogent expression to this idea t h i r t y -nine years ago when she wrote t. "As society i s now organised, we can neither doctor people nor educate them,- launch them into industry nor rescue them from long de- pendence,, and do these things i n a truly social way without taking their families into account." The paramount importance of broadly focussed and efficient diagnosis for these; long-term cases i s clear i f effective treatment planning ie to be made possible. Social casework seeks to help the Individual 1 Richmond, Mary, Social Diagnosis, Russell Sage Foundation, New York, 1st Edition, 1917, Ikih Edition 1936.. 10 adjust to his environment i n such a way as to achieve both his own. and society's betterment. Diagnosis i s an integral part of the pro-cess and i t must be so ordered that i t takes into consideration a l l the emotional and socio-economic factors within the environment. Every diagnosis i s a configuration, made up of the i n d i -vidual acting on and responding to his environment.. Individual and setting are interdependent and inter-acting. This i s why Gordon Hamilton has said: "--- (casework) makes no pretense that treating each case one by one i s a substitute for changing the environmental 1 systems which may fundamentally cause the unadjustment." This becomes very relevant later i n the present study; when concrete examples of families are given extensive analysis. The analysis of the "hard core" group i e so important that i t i s set out further below i n graphic form. One other aspect of this particular topic warrants consideration. This i s , that to many persons the term "hard core", within the context of this type of survey, has a subtle connotation of moral f a i l u r e . The "hard core" families or individuals are considered somehow morally inferior rather than physically and emotionally deprived or disturbed. There i s a f a i n t l y discernible judgmental quality about the use of the term which would indicate the desirability of finding a more apt expression. Bradley Buell uses the term "disordered behaviour1' i n the San Mateo survey to describe such chronic maladjustment and dependency. But the term may be questioned 1 Hamilton, Gordon, Theory and Practice of Social Casework; New Tork School of Social Work; Columbia University Press; New York; Sec-ond Edition Revised 1951. l a CONSTITUENT FACTORS Ei? LONG-TERM ("HARD CORE") GROUP 1 Applied to Families Only I. TIME • a) Prolonged economi.c and/or emotional dependency on*-.. — the agency the ccsnmunlty H. DEPENDENCY a) What are the:"? — social causes? — social implications? b) Who? — the single individual — each separate person within the family — the family as a unit c) What kind? 1. Socio-economic The community has a prim-ary responsibility for the security of the family. The family i s the strategic unit for diagnosis and treatment planning. The morbid manifestations of these char-acteristics interlock to make up the multiproblem long-term cases with which this study i s con-cerned. — employment *•* housing — education income (training, opportunity) (adequacy, cost, location) (opportunity, cultural factors) (size, s t a b i l i t y , housekeeping, hazards or Interruptions) 2. Emotional (Psychological) .-•» personality behaviour — attitudes *-» intelligence 3. Health (as they affect maturity, work capacity and habits, discipline, marital and parental strengths, etc.) May be cause or effect -•physical — mental k. Mobility acute, intermittent, or emergency Effect on:-a) budget b) working capacity c) morale and re-lationships May be cause or effect 1 Other kinds of cases, (E.g. foster children, delinquents without parents, single men, unmarried mothers, etc.) would require different consideration. 12 on the ground that i t i s somewhat more general than the specific connotation of qhronicity and indeed could be applied to almost airy form of anti-social behaviour or personality disturbance. Thus, a l -though i n some respects a more suitable expression than "hard core" since i t i s relieved of negative connotation, i t nevertheless lacks the definiteness of the term "hard core" - and the sense of chall- . enge to the social researcher evoked by this later term. In the present study the expression "long-term" i s used, as i t i s a means of including a l l types of disordered behaviour, whether acute or chronic, with which this agency and the community must be concerned. Besides a general exploration of the subject, of long-term dependency and maladjustment, this study examines i n de t a i l a group of long-term ("hard-core") cases. As of November 1955» these cases had been' continuously or intermittently active at the Family Service Agency of Greater Vancouver since tjieir i n i t i a l r eferral i n 19k$ or 19U6. Thus, these cases may be. considered, as currently . active, and to have been so, either steadily or at intervals, f o r a period of either 10 or 11 years. Certain c r i t e r i a which w i l l be detailed later i n this chapter were applied to the selection of these cases. Lonft-Term Cases at the. Family Service Agency The f i r s t step i n the investigation was an overall review of the 1955 case-load at the Family Service Agency i n Order to get a more definite idea of what long-term oases are, and how many. 33 This review was conducted i n December 1955* As previously stated, a long-term case i s one which i s now s i s years old or older, as well as being active at any time i n 1955 (up to and including November)* Some of these long-term cases ( i n fact* tho majority of them), ware "closed" at some time during 1955* However, i t i s proper, to include such long-term cases i n the survey even though they may have been ''closed" i n the la s t month surveyed i n 1955* because, as experience at the. Family Service Agency has shown* (and this i s corroborated by the findings of Bradley Buell i n his St. Paul and San Mateo surveys), long-term cases are either con-tinually active, or they, are characterized by a pattern of intermitt-ency* i.eu,. they are continually being re-opened.. In some, ageneies these long-term cases would not. have been closed. At the Family Service Agency* however* i t i s usual to close* even i f only tempor-a r i l y , a l l cases which have been inactive for more, than a month unless imminent reactivisation i s anticipated. The cut-off date of January. 1* 1955 i s arbitrary. Thus long-term cases closed before January 1* 1955 and. which have not been re-opened since are not included, despite the p o s s i b i l i t y Of their re-opening again* In a more exhaustive study than the present one a l l cases which were active over a certain stipulated number of years would have to be taken into consideration. Subject to the foregoing qualifications, this i n i t i a l review showed that a tot a l of 185 cases at the Family Service Agency conformed to the.definition of long-term cited on the preceding page. Of these 1 8 5 long-term cases :«* 27 originated during the period 1931 to 1939 inclusive 37 •* • 1 " " " 19U0 to 19itU " 35 " fl *• " 1 9 U 5 to 19U6 » 8 6 rt . » " * 19U7 to 19U9 n These cases constitute a disproportionately high percentage of the t o t a l ease-load of the Family Service Agency - 2$.8%. The relevant further s t a t i s t i c s and the implications of this finding w i l l receive further consideration i n the appendix to this study* Selection of Cases for Intensive Analysis . . . . . . . . „ ( I t then became necessary, because' of practical consider-ations, to establish additional c r i t e r i a for the purpose of select-ing a manageable number of cases for more intensive analysis. This i s not to suggest that a l l 185 cases were not equally appropriate, especially i f a more exhaustive study of long-term dependency and maladjustment could have been made. But some limits had to be set; and the f i r s t criterion was as follows: 1. The cases should have originated within, and continued active, during a period of relative s t a b i l i t y . Since the only period of relative s t a b i l i t y since 1931 has been the post-war years., this indicated use of cases originating i n the years 19U5 to 191*9 inclusive. Cases originating i n 19U5 and 19U6 (of which there were 35), afforded the most suitable grouping from which to select those for more intensive analysis as such cases constituted 15 those which have remained continuously or intermittently active during the past ten or eleven years of relative economic s t a b i l i t y and relatively high employment. Schedules were f i l l e d for each of these 35 cases, to i n d i -cate for each* the following Agency face-sheet information, where available:-1. Name of client. 2. Name of present caseworker. . . . 3. Status of family. u. Number of children i n family at present time (Dec. 195$) 5. Sex of children. 6. Date of bi r t h of children. 7* Occupation of head of family. 8, Birth-places of husband and wife. 9* Birth-dates of husband and wife. 10. Date of marriage. 31. Religion of husband and wife. 12. Source of application to agency. 33. Social Service Index l i s t i n g s . 1U. Presenting problem(s). Three further c r i t e r i a were then applied to these 35 cases as follows:« 2. Only legal family constellations as of the date of referral to the agency, (19U5 or 1°U6) were to be considered. 3. Only family constellations where the father has been the nominal family head and provider during the ten or eleven year period were to be considered. i 16 U. Only relatively younger families with ohildren at the date of referral, were to be considered, Application of criterion 2 showed that there were 21 legal family units i n the group of 35 cases* Criterion 3 eliminated a l l families where there was no father, tJhere the father died daring the 10 or-11 year period, or where the primary cause of continued dependency and maladjustment was physical, i l l n e s s or handicap. Application of the f i n a l criterion l e f t of the original group of 35 cases, a group of seven families,. ^ i t a f c j&1*^t|gh. they varied with respect to presenting problems, religious and cultural backgrounds* number of children and economic status, had certain characteristics i n common* These wares* 1. Each of them i s a legal family constellation. 2. In each of them the father i s the nominal head of the family, and the nominal provider. 3. In each family there*are ctarrently two or more children. The number of children per family ranges from two to. eight. U. Each family i s , Canadian-Caucasian. 5. In each family but one the husband was bom between the years 1915 to 1923 inclusive. Thus i n 19k5, the ages of si x husbands i n this sample ranged from 22 to 30 years of age. The 7th man was k3 years old* 6. In each family the wife was born between the years 1910 to 192u inclusive. Thus,. i n 19U5, the ages of the wives i n this sample ranged from 21 to 35 years of age. 17 Even within these limits there are many more questions than can be f u l l y answered, But i t i s helpful to set them down. Why have these young families become - and remained, chron-i c a l l y dependent or maladjusted? What kind of. people are they? What kinds of dependency do they have? What patterns of maladjusted ber haviour are found i n these families? Are there any Clues to the causal factors responsible for long term maladjustment and dependency? What types of services do these families require --- what are provided - — and how are they utilized? Finally, what i s the prognosis for these hard core cases? . Analysis of the psychosocial, health and environmental factors influencing, and operating within each of. these family constellations may provide Us with answers to some of these questions. There may be psychogenetic or environmental factors common to a l l , or most, of these families which w i l l provide clues to clearer diagnostic thinking and formulation. Analysis of the characteristics of chronic maladjustment and dependency within this sample of long-term cases, however limited, and although of an exploratory nature only, may help to indicate more clearly the further investigation required, within the f i e l d of social work i f i t i s to arrive at effective techniques for prevention and protection. Essentially, these are the same research goals as Bradley Buell postulates i n his current community surveys. In his text, Community Planning for Human Services, he summarizes the situation i n the foULowing 18 wordss- . "Analysis of the.coramunity^wlde characteristics of the problem^ creating the need has not kept pace with the promotion of resour ces for their remedy. Study of methods to reduce the prevalence of certain problems, has been neglected. Research into the causes Of prob-lems, a move which might produce the key to their pre-vention, has, i n many areas, taken a minor place. Scientific evaluation of the results of service has been by-passed." 1 Before proceeding further with this study we must define the two con-cepts associated with our previously defined term "hard core" or long-term* . These concepts are those of dependency and maladjustment* Maladjustment Buell, i n the St. Paul study, defined maladjustment as based on two main types of evidence of the i n a b i l i t y of people to adjust successfully to the necessities of social l i v i n g . These were:-!•' Evidence of anti-social behaviour as reflected by the formal judgments of society - i.e. records of crime, delinquency, child neglect, and other types of behaviour i n respect to which society takes o f f i c i a l action, , 2* Bia<^no,stic evidence t Mental deficiency, mental disease, emotional disorders of i n s t a b i l i t y as recorded by psychiatrists, and failure to discharge primary social obligations towards home, school or work as identified by sooial workers* In a preliminary report on the San Mateo Survey, Bradley Buell and his associates offered a simpler definition of maladjustment -1 Op c i t . P.S 19 »?.«—-. a relative incapacity to adjust to the requirements of social 1 l i v i n g " . These two definitions of maladjustment have recently been synthesized into another, but essentially similar definition by Buell, i n an article he wrote, for Mental Hygiene. In 'this, a r t i c l e : he states? "The term maladjustment has been used since the beginning of our research, to characterise types of disordered and 'unsuccessful* 2 behaviour about which the community generally assumes responsibility." Here, then.; are three definitions of maladjustanent. A l l are essentially similar and equally v a l i d insofar as our use of the term i s concerned* However, the. f i n a l definition i s worth particular note as i t adds to the earlier definition the important concept that from a survey or research point of view we must necessarily consider maladjustment as "behaviour about which the ccmpinity generally assumes some responsibility." Dependency The concept, "dependency", has been used i n a preceding sec-tion of this chapter i n i t s economic, and not i n i t s casewrk or psy-chological sense of emotional dependency. I t i s used throughout in-the 1 Coirawinity Research associates, The'Prevention_and Control ef Dis- ordered Behaviour in. San Mateo County* California. N.Y. 195>U. P.6. ' 2 Buel, Bradley; ''Preventing and Controlling Disordered Behaviour A Community Experiment", Mental Hygiene, Vol. XXXIX, No.3, July, 1955, Pp. 365-375. 20 material sense defined by Buell i n his i n i t i a l report on the San Mateo Community research project as being " — without the necess-i t i e s of l i f e unless the community made some provision for them 1 food, clothing and other essentials." Emotional dependency comes within the previously cited definition of maladjustment. Multiproblem Families Serious maladjustment, characterized, as Buell*s studies have shown, and our preliminary survey indicates, by chronicity and a multiplicity of problems, combined frequently with economic' depend-ency, accounts for those multiproblem families who absorb the dispro-portionate amount.of the social welfare, health and r e l i e f services we have already referred to. We would observe, however, that the concept "multiproblem" i s not characteristic solely of long-term cases. A uni-problem family would be a rare situation as even under normal, or relatively normal conditions, i t would be unusual to find that a family has only one problem with which to cope. Buell uses the term "multiproblem" i n describing his depen-dent and maladjusted hard-core of cases who use the greater portion Of community services. Nevertheless, we believe that the term multi-problem i s used i n that context i s no more v a l i d than V7hen applied to those other families i n the community with multiple problems but 1 Op C i t , p. 21 which do not result i n chronic maladjustment or dependency.; fable 2 below i s a l i s t i n g of presenting problems at intake for the .18$ long-term cases at the Family Service Agency* The table serves a dual purpose.: I t l i s t s the number of presenting problems within each category and thus i l l u s t r a t e s their nature an multiplicity i n this group of long-term cases. The other purpose, which accounts for the format of the table, i s to i l l u s t r a t e the "split^halves* method of assessing the consistency of samples. I t indicates a high degree of consistency. Table 2. Presenting Problems at Intake • • . problem.. •„',. Sample A. : Sample S ' Total Alcoholism 1 U 5 Economic/Employment Uo 36 76 Housing .• 1 h • $ Intellectual Retardation It 3 7-Legal 7 .11 18 Marital UO Ul 81 . Mental Illness ' k 2 .- 6 Personality 20 26 U6 \ Physical Illness , 15 21 36 Parent-child Relationship 22 20 kz Substitute care of Ohildren 12 15 27 Unmarried Parenthood m 3 3 Old Age • 1 -. 1 Educational/Vocational/Rec. 1 2 3 Total , 168 . 188 356 I t i s proposed now to explore, as far as possible, the way to find the answers to some of the questions posed earlier i n this chapter. 1 See Appendix A ("Some characteristics of long-term family cases") which further i l l u s t r a t e this method. 22 The answers* i t i s hoped, may suggest a methodology which .will lead to the Improvement of present techniques aimed at the prevention, and control of thiB; disabling and costly social phenomenon. . . CHAPTER |I  CONSTITUENT ELB-ffi!HTS III LONG-TERM CASES How are the many Influences at work within the psycho-dynamic and environmental constellation of each of the families to be sorted out? As a beginning an answer has to be found to two basic questions ( 1 ) What psychosocial factors may be seen operating within each of these family groups? ( 2 ) Which psychosocial factors must require consideration i n the interest of accurate diagnosis and effective treatment planning? The f i r s t answer can be sought by analysis of the case records for each family. These original case records varied i n length from as few as 8 to as many as 1 2 0 pages of single-spaced re-cording for each family. Each case record was re-written i n abbrev-iated form, with particular focus on the psychosocial areas which can be distinguished, and the behavioural manifestations which are re-corded for the individuals within each family. Subject to gaps i n information recorded a scheme of classification has been evolved which seems to give room for a l l the known psychosocial factors oper-ating within each family group. The second question i s perhaps the most challenging and per-tinent question applicable to the subject; and i t Is properly a sub-ject for continuing research. 1 See appendix for these abbreviated records* 2U At this exploratory stage i t can hardly be expected that the f i n a l answer can be produced to the question of which psychosocial factors are most significant for accurate diagnosis and treatment plann-ing. As has been repeatedly emphasized, this i s a reconnaissance study. Interest i s centered on at least a first-approximation analysis of those psychosocial factors known to have been operative within the family' groups. Many psychosocial components, some possibly Of great signi-ficance, were not ascertained, or investigated, during the time these cases were active i n the Agency. For example very l i t t l e (or more fre-quently, nothing) has been recorded i n any of these seven Cases about the possible effect upon family and Individual behaviour of such tbhings as cultural t r a i t s or religious beliefs whether i n the past or present, or psychogenetic factors! such as maternal deprivation, orphanhood, etc. which may have radically influenced subsequent behaviour. Such addi-tional psychosocial factors - and there are many, as for example, affectional patterns, patterns of self-esteem, attitudes and patterns of behaviour i n the sexual relationship of the marriage partners, leisure time a c t i v i t i e s , etc. have properly been receiving the careful atten-tion which i s merited x-jithin the soope of the more detailed surveys such as those currently underway by Community Research Associates i n the United States. The prime objective of this reconnaissance i s to make a start i n perceiving causal relationships. Within i t s limitations, the study must be confined to the known elements operating within these family groups. I f these seven cases are examined analytically and the 35 influences operating within them classified, the following grouping seems reasonable: Socie-Economic ( and Presenting Problem) Health Pre-marriage Social History a. Employment b. Income c. Housing a. Physical b. Mental (psychol-ogical) d. Education and training (for each family member) (For husband and wife)' These components or sub-areas are a l l i l l u s t r a t e d by the case material i n the balance of this chapter. 1.iSocio-economic Environment and personality interact upon each other* I t i s vin response .to the strains and stresses of a hostile environment that the pre-existing personality defeats become apparent; or that hitherto adequate defences break down and can no longer .help the individual main-tain emotional s t a b i l i t y . People, or families, do not "crack up" purely by chance. The The tolerance level of individuals varies markedly, but given suffic-ient environmental stress, every individual w i l l break down eventually. The breakdown may be manifest i n many different ways — by neurotic es-cape, by psychotic f l i g h t from re a l i t y , or, as i n the oases under study 26 by regression to long-term dependency and maladjustment. Modify the environment beforehand so as to eliminate i t s ' stresses and most of these breakdowns can be averted. Modify the environment after the breakdown and many of these individuals and families can be f u l l y or pa r t i a l l y rehabilitated. A parall e l with the science of medicine may be drawn here. ' The germs of tuberculosis are dormant within most individuals. Ex-pose anyone to prolonged economic deprivation with i t s attendant un-employment, malnutrition, bad housing, etc. and the latent disease w i l l germinate: to result ultimately i n the death of that individual unless there i s prompt and perhaps radical modification of the en-vironment. Medical science has evolved effective preventive, tech-niques for such diseases as. tuberculosis. Perhaps the science of social work w i l l be able to do the same for social breakdown. Presenting Problem(s) as Seen by Client The presenting problem can be a significant factor i n diagnosis. I t i s brought to the Agency by the client personally or by referral from another source. In practice i t has been found that, for the thirty-five long-term cases originating i n 19k$ and l°l|6 and cited i n the Appendix 7C# of the cases oame to the Agency as a self-referral. Of the seven cases under close analysis, four were self-referred. The presenting problem •-«• and i t i s frequently only a symp-tom, although behind i t l i e s a significant etiology, arises, as already suggested, i n response to precipitating psychosocial elements. The point at which i t becomes a matter of urgent concern to the client or 27 clients — the precise time at which, particularly i f a self-referral, i t i s brought to the Agency, i s not fortuituous. The reason i t be-comes an emergency problem, at that particular time must be closely examined i n the interest of accurate diagnosis. Moreover, there may be a difference between the problems as seen by the cl i e n t and as they r e a l l y are. This i s diagnostically significant for many reasons. Is the client's, perception of r e a l i t y sound?. To what extent does . denial, rationalization, projection, or other indications of repress-ion enter into h i s statement of the-presenting problem? In Schedule A following, the presenting problem as seen by the client, (or more accurately — as stated by the client) i s l i s t e d . The rea l i t y or otherwise of this client statement then becomes readily apparent i n terms of the psychosocial factors l i s t e d i n this and the two following schedules. The presenting problems as they actually are, are l i s t e d on the face sheet pages of the abbreviated records i n the Appendix. 1, Employment In any analysis Of long-term maladjustment and dependency we are inevitabley confronted with the negative aspect of employment — unemployment* To draw a p a r a l l e l from pathology the diagnostician's paramount concern i s with morbidity. But the nature of the hoalthy organisms must also be noted. In the same way the social, scientist can learn much from both the positive and negative aspects of employ-ment. Within the pattern of employment there are. numerous s i g n i f i -cant indicants of the individual's personality structure. These are 28 evidenced through attitudes towards authority, toward peers, and through patterns of mobility. There are other indicants Of causal relationships. Unemployment i s at the same time both cause and effect. I t may be due to economic considerations beyond the pa r t i -cular worker's control to such circumstances as seasonality 3 depression, or war. I t may be influenced by other socio-economic factors such as income, housing and education. In turn i t affects the rest Of the person's environment, leading to both economic destitution and not infrequently, pauperization of the s p i r i t . Un-employment drags men down, destroying both morale and efficiency. The significance of this factor can then, be neither ignored or con-sidered only superificially. {Since these seven cases are being subjected to analysis through the period 19k$ to 1°55>, a period of relatively high em-ployment, any deviation from the norm with respect to this socio-economic constituent may carry with i t significant implications for diagnosis. 2; Income This, l i k e a l l other socio-economic factors, i s part of a larger configuration. The social diagnostician ie concerned with the adequacy of individual or family income per se. He is also concerned with a l l the numerous other facets of income — a b i l i t y to budget; a b i l i t y , whether due to emotional or educational background influences to earn an adequate income; psychological implications of unrealistic attitudes towards money and debts i f they exist. AH these aspects 29 of income i n turn bear directly, or indirectly, upon the emergent sym-ptoms of dependency and maladjustment i n the cases under survey. 3. Housing .The relevance of this sub-classification w i l l be apparent. Shelter i s one of the individual's — and the family's primary needs, i t demands the closest consideration as a component i n competent social diagnosis. Indeed, i t has given rise to a relatively now discipline within the f i e l d of sociology — human ecology, which deals with society i n i t s biological and symbiotic aspectsj that i s , i n those aspects brought about by competition and by the struggle of individuals, i n any social order, to survivo and to perpetuate themselves. The term ecol-ogy i t s e l f , was derived from the Greek word meaning house, abode, dwelling. Not a l l personality problems Or defects come to "term" as a result of bad housing. But a disproportionate number of welfare agency cases do originate i n blight areas*. A housing survey undertaken i n Vancouver i n 1950 refers to "—* the d i f f i c u l t i e s of coping with dis-* tress and social i l l s when they are lodged i n l i v i n g conditions which 1 destroy morale". Within the same context the survey cites a commentary of the City of Vancouver Social Service Department which refers to "the multiplicity of,housing and emotional problems" bred i n such blighted areas. 1 Marsh, Loonard C., Rebuilding a_ Neighbourhood; University of B r i t i s h Columbia, Vancouver, danada, 1956. £.25. 30 Thus, housing, particularly i n i t s broader sens of neighbourhood, recreational and cultural outlets,, and mobility, meshes closely with a l l other socio-economic factors influencing individual and family patterns of behaviour. U. Education and Training This frequently ill-explored socio-economic factor can often throw needed l i g h t upon the reasons for sub-marginal condi-tions and standards xd.th respect to other socio-economic consti-tuents, particularly the three just reviewed. In turn, analysis of this component demands consideration of a wide l i s t of other psychosocial factors. I f education was inadequate, why? Were there cultural factors influencing the extent and type of education? VJhat was the individual's emotional reaction to limited or restricted, edu-cation? . Should education or training have been more specialized, more technical? Can educational lacks be made up? These questions are only a p a r t i a l indication of the very considerable ramifications Of this factor. Charlotte Towle gave succinct expression to the function of education, particularly i n the sense of educational opportunity when she wrote "Public assistance workers frequently have not realized the many implications for both the i n -dividual and society when educational opportun-i t i e s are not commensurate with an individual's a b i l i t i e s . F i r s t , there i s tho lose. to.society of the richer contribution which he might have made; second, the loss to the individual of a more satisfying and productive l i f e work; third 31 the deep frustration which may be experienced when aspirations cannot be attained, a defeat which may lead to embittered rage or to discouraged inertia. Thwarted mental powers, seek destructive outlets. Deep personality disturbance and regressive behav-iour trends of many sorts may be induced when the mind i s obstructed i n attaining i t s f u l l growth." 1 2. Health Health i n t e r r e l a t e s closely with both the socio-economic • and the emotional functions of behaviour. Its effect upon these functions can be marked. Under physical i s l i s t e d both chronic and acute physical illne s s as well as any physical handicap whether disabling or not. The l i s t i n g of health factors under the heading mental (psychological) i s a more complex matter since as Warren G. Lamson . of the National Institute of Mental Health, Public Health Service, Maryland, has saidi " — the term 'mental health 1 resists defini-tion. I t has therefore come to have multiple meansings, including preventive psychiatry, environmental medicine, the psychological, aspect of public vie I f are, applied sociology, social psychology, 2 QGanniunity psychiatry, and so on." Thus psychological health i s a very large area including what some people c a l l "morale", others "adjustment", and others "feeling tone". 1 Towle, Charlotte, Common Human Needs? American Association of Sdcial Workers, New York, 1953. 2 Lamson, Warren C , "Integrating Mental Health Services Into the Community Health and Welf are Program," Journal of Psychiatric* Social  Work. September, 1955. . For each condition l i s t e d the source of the judgment'is cited. This erieompasses a broad range,' from the diagnoses of medi- . cal psychiatrists to the other extreme where tie have nothing but the client's .cum subjective judgment of his or a f&n&ly member's [ condition* Under this heading, then, would be l i s ted the follow- [ ingj-a) Clearly defined mental i l l n e s a : This would include such diagnosed conditions as scMzophrenia or manic-depressive psychosis* b) The neuroses* This would include such conditions as anxiety state, hypochondriasis, etc* usually diagnosed as such by psychiatrists or social workers. e) Other en^tjanal disturbancesx. These are vaguely defined or perhaps inaccurately described emotional disturbances tihich may be indicative of more serious problems or which may be xjithin the nlras although coloured by subjective attitudes of the person con-cerned or of immediate relatives. They may also be behavioural manifestations as seen by the social worker or other professional worker concerned with the case* 'oihile s t r i c t l y speaking; some of these judgments may not be valid, they are l i s t e d as having a greater or lesser degree cf diagnostic significance. Within this group would come such concepts as "emotional immaturity", "violent temper", "ner-vousness", "tenseness" etc. d) Ifontal retardations U»leS3 known to be of organic origin, even i f not proven otherwise, th i s condition has been l i s t e d under mental (psychological) health. 33. c) Pgycho-somatic illness i This condition i s not always sus* ceptlble of accurate diagnosis. "tJhcn a psychiatrist states, follow* ing wfidical end psychiatric exsrr&natibn, that enuresis i s due to a poor home environment i t i s clearly psycho-somatic. Hot rover i f a : client reports to the social worknr that she has asthma or ecssema, then unless the psycho*somatic origin of this condition can be' v a l i -dated,, i t i s l i s t e d under physical. 3. Pre^marrJage History Ho compete&t diagnostician, whether i n soc i a l work, medicine or psychiatry, w i l l neglect the highly 3J«portant background social history of a patient or client. The individual and the family's be-haviour i s determined by environmental and constitutional or heredi-tary factors. And environment too, may be inherited i n a special sense. The adult with .1 c r i s i s problem i n the area of marital or parent*child relationships may have brought to this situation both psychogenetic influences and the influences of socio-economic factors within the family into which he was born— or within preceding gener* ations. By this we do not wish to suggest the belief that the dis-turbed family or parson always comes from "the other side of the tracks^ I t i s none the less important, however, to know which side of the tracks the family comes from. I t w i l l be noted that wc have included i n this table back-ground or antecedent psychosocial history to the dat- of marriage* This has been done for a specific purpose, In many of the long-term cases under review the f i r s t child was bom out of wedlock, or before 3U none months elapsed after marriage. This circumstance i s , however, d i f f i c u l t to validate as the mother w i l l frequently alter ages, b i r t h dates, or marriage dates i n order to conceal this fact from the social, worker, particularly i n the i n i t i a l stages of agency contact. Yet since this situation may have profound emotional connotations for the mother or the couple concerned, i t i s of considerable diag-nostic importance to the social worker or psychiatrist. The three schedules so far described are so important i n themselves that they are appended, with summarized material from the sample records, to round off this chapter. The families are simply described to preserve anonymity as "A", "B", "Crt, etc, Ia places i t i s necessary.to indicate certain kinds of material which are not i n the record. These summaries of course indicate what i s i n the record., net necessarily the optimum or most signif icant kind of information which ought to be there to permit a f u l l diagnosis. SCHEDULE A (Section 1) Presenting  Family ProblemCs) As seen by A Client Marital 35 SOCIO-ECQMCKEC' FACTORS 1. Employment i Man works sporadically as painter. Numerous other jobs* Record not specifio, but appears to have txork-ed about 5C$ of possible time. Wife has interest in cafe. Through-out most of this period works long hours for low earnings. 2. Income Family on relief in Alberta for 12 years during depression. In-come never adequate. Received intermittent financial and other help from agency throughout this period. Unrealistic about money and debts B Marital Reported aS having a poor job record Economic before joining R.C.A.F. At intake Employment interview said he wanted to learn "a trade". Worked at several jobs (unspecified) until 19U9, when hired by Post Office. Quit in 1952 just before he -would have been fired for drinking. Was then em-ployed as bus driver for h months until fired for drinking. Sporadic employment until 195U when hired by refinery. Reported as having heavy debts throughout period. Earnings low until 195U. Received intermitt-ent financial and other help from this and other agencies throughout this period. Un-realistic about money and debts. On Soeial Assistance for several months in 1952. Worked intermittently,chiefly as semi-skilled worker i n shipyards. Constant dissatisfaction with jobs arid numerous changes. (Mo specific details in record).Joined Navy in 195k and s t i l l there. Family worried constantly over expenses and debts. Despite Navy earnings of over $300 a month remained in debt. Unrealistic about money and debts. D Economic Record vague, but indicated man untrained and intermittently em-ployed during part of period. Wife went to i-jork in laundry in 195U for 18 months.Quit "because of children" but later took office . ; . , 3<*>- . -Heavy debts. Clients said they owed bank $2000 in 1955. Unrealistic about money and debts. E Marital Steady job as policeman Income apparently adequate Marital Steady job as electrician and Substitute later elect.inspector. Dissatisfied i-jith earnings. Man kept most of his earnings Gave his wife an inadequate amt. for household expenses. G Marital Illness Parent-child re-lationship. At f i r s t self-employed oil-burner serviceman-low income Later various jobs, much unemployment^record not specific). At end of 1955 had serviceman job at §62 week. Refused to t e l l wife his earn-ings. Heavy debts. Received intermittent financial and other help froa this and other agen-cies throughout this period. Unrealistic about money and debts. SCHEDULE A (concluded) 36 SOCIO-ECONOMIC FACTORS 3. Housing 19U5-»poor. Recorded as "dark, dirty, i n need of paint" undesirable neighbourhood. 1<?U8 - Family moved to somewhat better d i s t r i c t but no description of housing i n record; Later that year the Aes received and eviction notice which offered cancellation of two month's rent owing and §50 to boot. The record indicates that they did not move. U* Education & Training Man - to end of Grade h untrained. Wife -to end of Grade 8 B 19U5 •- Record indicates that couple and their one Ho information i n record, c h i l d l i v e i n a small inadequate suite i n the basement of the man's parents. Some months later they moved to their own suite, the standards of which are not noted i n the record. In 1952 they were threatened with eviction but this was averted. C &9U6 - couple and 2 babies l i v e d i n an inadequate No information i n record, semi-finished basement suite. In 19U7, after the b i r t h of the 3rd, c h i l d they moved into a Wartime House i n North Vancouver (The agency had suggest-ed application). Nothing noted i n record but can be assumed i n -adequate as man came to Agency i n 19U5 request-ing a loan for the purpose of getting adequate housing. No information i n record on subsequent housing situation* Man - untrained Wife probably had average education i n otider to hold office job. E Wife came to Canada i n 19U3 as War Bride. Lived with her husband's relatives at f i r s t but f e l t unwelcome* She then joined her husband where he was stationed. Then moved to Vancouver, where at f i r s t they stayed with friends i n over-eroifded quarters* They' lat e r moved to their own suite. Standards not noted i n record. No information i n record. However i t may be presumed man had at least Grade 10 i n order to obtain his job. F 191*6' - Couple and 2 children l i v e d i n cramped un- Man- to end of Grade U finished squite i n basement of man's parents* A year later they moved into a 2 room shack without Wife- to end of Grade 10 plumbing behind a store he was building. Subseq-uent housing not noted i n record. G Nature of housing not noted i n record. U n t i l 1953 Ho information i n record, man's mother lived with them which, caused discord between her and his wife. SCHEDULE B (Section 1) 37 ,, . ....1 HEALTH FACTORS Family A Physical Man* 19U5 «*• Operation on prostate, I9I46 - Hopsitalized for chronic eczema, this recurs i n subsequent years* Wife; 19U5 •>• H I with pleurisy. Varicose veins. 19U7 - Hospitalized for "trouble with tubes". 19l*7 Hospitalized for gallstones. Children:19U7 «* A l l children have acute skin infections. Recurs i n sub.. sequent years. ....... B Han? 1953 - Operation for chronic hernia. Wife. 1950 *• Treatment for anaemia. (V*G*H.) 1951 - treatment .for. poor vision and bad skin rash On hands (VGH) 1953 - Constant poor health* 195U - Hospitalized for advanced T.B. Children: %9h6 - Baby born with 2 thumbs on one hand. C Man: No.information i n case record. Wife: I9I46 - Had a l l her teeth extracted. Children: 19U6 - New bom twins i l l f i r s t several months with diarrhoea etc. . D Man: No information i n case record. Wife: Shrapnel.injuries to shoulder, arm, and lung. Bad teeth. Children: No information i n case record. E Man: No information i n case record*. Wife: No information i n case record* Children: No information i n case record. F Mans 19U5 ~ Discharged from Navy for "minor heart condition". Wife: 19U7 - Sterilized at b i r t h of t h i r d child at her request. Children: No information i n record. G Man: No information i n case record. Wife: 19U6 - Case record said " i l l " , nature not specified. 1952 ->• Mrs. G said she had a "gynaecological condition". 19$k * Hysterectomy. 1955 - Hospitalised for bladder condition. Children: Record suggests poor health. 1 Schedule 3 concluded on following page wild, mental (psychological) health factors. aCHEDHLS B (concluded) 38 HEALTH FACTORS - mjjy Mental (Psychological) A Mam 19hS - Described as "emotionally immature" at intake. Wife: 19U5 - Mrs. A said that as a child she had attacks "resembling epilepsy". Described by intake worker as 15nervous,tense" 19U6 - "Conversion hysteria" (0*0.0. dia^iosis) 19i>.6 - Threatened suicide when feeling depressed. Child: 19U5 - Wilbur, age 12 found to have I.Q. of 70 (school) I9I+5 - Diane, age 15 "poorly adjusted personality" (C.G.G.) 19k8 - Madine, age 5 found " retarded" by psychiatrist. B Man: 1950 Described by worker as "tense, nervous,: iaamature,; poor health" Wife. 191*3 Schisophreuia - i n mental hospital 3 months *> 19U6 - Threatened suicide when feeling depressed. 1950 Threatened suicide xfoen feeling depressed, 1952 - "Schizophrenic" (V.G.H. O.P.D. diagnosis) Child: 1950 Bon, age U, exMbltionism "assaults" girls.' C Man: 19U6 Headaches and depression. (D.V.A. report) 19it6 - "Psycho-nourotic,. anxiety state, hypochondriasis".* (D.V.A. 19U6 psychiatrist) Wife: - Described by worker as "very upset" Child: Ho information i n record,* D Man? 19U5 ^ i Described by wife as "not very outgoing" Wife*- Very nervous-result of wartime bombing l a England.' 1955 *. Mrs.. D complained of "depression" Child: Mo information i n case record. E Man: 19lj6 - Described by wife as "queer,-peculiar". Wife: 19U6 - "Very emotionally upset" (worker's description) 19U8 - Being treated for "nerves" by her o\m doctor.' 193& - Mrs. E told worker she and husband were planning to see a psychiatrist. Child: Mo information i n case record. F Man: 19lt6 - Described by wife as having "violent temper" Wife: Mo information i n case record. Child: 1951 - Steve, age 9, poor school work, day-dreara.ijig, thumb-sucking etc. Psychotherapy and remedial reading recommended by M.H.C. psychiatrist. Man: Bo information i n case record. Wifet 195U - Threatened suicide. Child: 19U8 - Jack, age 5 diagaosed "mentally retarded" (C.G.C.) 1952 - Harry, age 8, enuresis, crying, etc. said due to poor home situation. (V.G.H. O.P.D.) 195U - Record indicates a l l children to have behaviour problems. SCHEDULE C 39 PRE-MARRIAGE HISTORY Family Paternal A No information i n record. I-Iatemal Mrs. A was oldest of 6 children. Said she was un-happy at home. Her parents divorced when,she was young. At 1$ she was ordered by her father to leave home. Became pregnant 6 months before marriage. B No information i n record. Mrs. B said she had an uncle and an aunt who committed suicide and another uncle i n a mental' hospital., (not confirmed) . • Mr. C*e father also suffer-ed headaches & depression Parents fought over f i n -ances. No. information i n record. B D said her husband unhappy as child, that his mother died when he was few month. Mrs.D gave indications* during interviews of being very elpsely attached to her father. E Mrs.E said Mr.l's mother died when he was 2. Father remarried an alcoholic. ; Family lived constantly i n hotels. When 15 his father committed suicide. Later a brother also suicided. Another brother imprisoned f o r manslaughter at age 19. At the intake interview Mrs.E said that she came from a happy and affectionate family. . Two months later Mrs, E appeared to contradict this state-ment when she told the worker that her father constantly bullied her mother who led a l i f e of misery. Mrs.F claimed Mr.F had poor relationship with auto-cratic, religiously bigoted mother. As youth lived i n converted family garage. "Bitter" and frustrated because of un f u l f i l l e d ambition to become a law-yer. The family found the depression hard. At intake interview Mrs.F said she came from a large family, unhappy because the father was "shiftless". They found the depression hard.. After Gr.10 she l e f t home to work as a domestic. Mrs.F was the 2nd youngest of 6 children* Her parents were Ukrainian but the children did not participate i n the activities of the Ukrainian cconniunity. Her father was brutal and her mother had frequent breakdowns requiring treatment i n a "rest home" She became pregnant before marriage Mr.F suggested child not his.wanted abortion which she rejected. G Mrs. G said Mr.G had "a Mrs. 6 told the worker that she had been an un-poor background" (no happy only child--that her father was "a drunk-amplification i n record) ard" and her mother "insane" for 12 years but that i t had cleared up when she (Mrs*G) had l e f t home. Uo From these schedules taken as a t-Jhole, at least three lines of analysis can be examined:-(a) The xrejght or iimaortanee Of a single influence*, jundged by a l l the cases as a group* (b) Psychosocial and health components influencing the behaviour  pattern of each separate family* .(c) The overall pattern of psychosocial and hoalth factors operat- ing within these seven family constellations. The schedules are of considerable help i n sorting out what i s i n i t i a l l y a complex situation, (a) F i r s t , by following the "grid" 1  vertically^ the extent to which similar aspects of a single influence may be operative within a l l of the seven cases can be determined. Far example, under the socio-economic sub-heading "income" i e the information that i n five of the seven cases the clients were un-r e a l i s t i c about money and debts. Similarly, for each of the i n f l u -ences, the extent to which there i s a common etiology for the emerg-ing behaviour pattern i n a l l seven family constellations may be de-termined, (b) Hext, by fallowing the grid horizontally, the d i f f e r -ent psychosocial and health factors operating within each family can be seen. Then through u t i l i z a t i o n of the abbreviated case records there can be shown the pattern of family behaviour emerging from this aggregate of psychosocial and health factors, (c) For the third purv-pose, the three schedules can be studied as a configuration. That i s , tho findings and implications of both (a) and (b) preceding -the weight or irapor*tance of each single influence; and the com?* bined effect of a i l influences on each family separately - are analysed concurrently. This analysis can be oriented toward three key questions, ( l ) Are there psychosocial and health factors common to a l l of the seven family constellations? (2) Are there such fac-tors coappn to a significant number of them? (3) Are there i n d i -cations of an overall positively correlating complex of psycho* social and health factors which may be diagnostically significant i n terms of the emerging patterns of behaviour i n these seven family constellations? Bach of these lines of analysis can now be considered Separately* a) The Weight of Specific influences. Presenting problem^ a). A number of significant find-ings emerge on analysis of this aspect of eaoh case. Three may be separated immediately. 1. Six of the seven clients reported their presenting problem as marital, either alone, or i n combination with other problems. The next most frequent presenting problems as seen by the clients were illnes s and economic, each cited by two clielrts. 2. Presenting problem(s) as seen by clients ranged from one problem (3 clients), to three problems (2 clients). 3. The total number of presenting problems as seen by the seven clients was thirteen, or approximately two problems per client on the average. U2 There i s a wide and significant discrepancy between tho num-ber and nature of presenting problems as seen by the clients and the more accurate appraisal' of presenting problems by the social worker i n the i n i t i a l stages of the contact* There are other, and some-times more fundamental problems which become apparent to the worker j, and frequently to the client as the case .progresses* Schedules A, B and G along with the abbreviated case records indicate these addl* tional problems, but since they arc not usually presenting problems " they have not been l i s t e d under this heading. I t i s the aggregate of a l l problems which determine or influence the behaviour patterns within the families concerned. F i r s t , what.are the problems? They are of course not neeess* a r i l y the same as seen by the client and as reported by the worker. (Listed i n Table D following).. U3 TABLE PRESENTED PROBLEMfS) Family As Seen by Client As Seen by Social Worker A Marital Marital Illness Personality Substitute chi l d care B Marital Economic Employment Marital Economic Employment Personality Alcoholism c . Marital Illness Marital Illness Economic Personality P Economic Economic Marital Personality E Marital Marital F Marital Substitute care ohildren Marital Substitute care children G Marital Illness Parent-child relation Marital XJlness Parent-child relation Substitute child pare hk 1. In every cose but one, the client f a i l e d to indicate, or was unaware of, from one to three other problems which were apparent to the social worker i n the i n i t i a l stages of the contact* 2. There were 2k presenting problems as seen by the social worker as against the 13 seon by the client *<*• a difference Of 12 or 85$. 3. The following problems as i n i t i a l l y evident to the. social worker appeared most frequently*1* Marital * ? times * lOOSS of the clients Personality ~ £ " - 73$ " " " Illness - 3 « - k3$ " " n Economic - 3 " * k3# " " " Substitute child care - 3 " - k3% " 8 n Retrospective analysis of these seven cases indicate that some of the above problems appear more frequently, Thus, personality problems are also present i n 109$ of the cases. Economic problems also appeared at one time or another during the ten or eleven year period i n six of the seven oases, it,. The workers do not always exercise sufficient care i n l i s t i n g presenting problems. Thus, Client D came to the Agency re-questing a loan, but the purpose was for getting adequate housing. The presenting problem was l i s t e d as "economic" whereas investigation might have shown that the real problem was housing — or i t might conceivably have eve$ been personality. In summary then, there i s a wide discrepancy between the number and nature of presenting problems as seen by th© client and as theya re more accurately seen U5 by the worker. Significantly, the clients most frequently specify their probleme as marital. This i s of note for two reasons, -1. The disturbed or threatened marital relationship i s of most concern to the clie n t . There i s also an indication here that the client may be projecting or rationalising by attaching too i l i t t l e importance to his own role i n contrite ting to the c r i s i s , and undue fojportance to the partner's role. 2. The client's emphasis upon the disturbed or threatened marital relationship i s fundamentally sound. The family i s the basic social unit. Weakening of the marital relationship may endanger may this, structure* Thus, the i n i t i a l referral to the Agency i s moti-vated i n varying degrees either by the desire to strengthen and preserve the family unit, or from fear that i t may be weakened or destroyed altogether. This motivation may not always be a conscious one, but wherever there i s a marital problem there i s a threat to the s t a b i l i t y of the t o t a l family group. 1. Employment t In five of the seven eases the men concerned were, ever most of the 10 or 11 year period, not steadily employed* leeorded employment information i s only sketchy, but i t appears that i n these 5 families the household head was unemployed from 25 to 50$ of the time* Of these, two men were s k i l l e d tradesmen and the other three were semi-skilled. Work habits appear to be poor, and are characterized by irresponsibility and excessive mobility. In two Of U6 of the families the wive3 worked during a l l or part of the time . under review. In the sixth case, while the man did have steady employment at his tra.de> he expressed constant dissatisfaction with his wages even though they were above average for s k i l l e d workers.; This Dissatisfaction was not based on r e a l i s t i c factors i n the en-vironment such as a large family, or heavy medical costs,, but appeared duo to neurotic personality patterns i n the client. By 1955* three of the five' -she hod pr eviously been intermittently jobless,, were i n steady employment. The. overall employment picture for these clients seems* then*, to have been worst at the time of referral i n 19U5 and 19li6f to have eased sl i g h t l y during the period 19U6 to. 1953$ and then to have imporved appreciably during 195U and 1955* 2. Income; Although the Feaaily Service Agency i s not p r i -marily a r e l i e f giving agency, three of the seven families received intermittent financial and other direct assistance throughout much of the ten or eleven year .period. At least two of these families also feceived financial aid from other agencies during that time. Five of the families had continual problems with respect to debts and appeared immature and unrealistic i n their i n a b i l i t y to handle money. In at least two of the families the husband gave his wife an inadequate amount of money for household expenses and also witheld information about his earnings. The case records indicate, without U7 being specific, that this situation also obtained i n at least two other families* In s i x of the seven families money problems were a source of marital f r i c t i o n * These problems did not appear to have been d i s s i -pated by the better general employment situation within these fan&lios i n 195k and 1955. 3. Housing . At the dates of i n i t i a l contact with the Family Service Agency the following conditions existed with respect to housing:* k f s a l l i e s ~ Sub-standard housing, (too small, dirty* undesirable neighbourhood*) 2 families — Lived with relatives or friends. .(Known to have contri-buted to emotional disturbance physical nature of such housing not clear from records), 1 family ~- Known to be inadequate but record does not indicate i n what respect. Thus, i n every ease, the problem or c r i s i s was brought to the agency, that i s , came to a head, at a time when housing was i n -adequate i n some respect. The housing situation appears to have im-proved during the period under review. In the two cases «here the change i s noted specifically i n the record the improvement i s only slight* In the five other eases there i s no information i n the records with respect to changed housing conditions* However i t i s reasonable to assume that had such conditions worsened i t would have been noted U8 i n the record* In the absence of this i t can be assumed that hous-ing conditions for these five families remained relatively static or were improved* U* Education and Training* There i s a pronounced lack of information i n the case records about the education and training of these clients. For five of the seven, no information whatsoever i s supplied i n the record, although some limited assumptions may be made on the basis of employment history* I t i s not possible^ therefore, to assess the eafceirt to which there may be significant correlation between education and training and such factors as ejs^lcymefit and. income* "Set, education, or lack of i t , may play an important role i n many other aspects of the person's emotional and economic l i f e . Industrial psyc&ology provides many examples Of the effect of this lack i n terms of job frustration, unhappinesa, excessive mobility^ and even accident proneness. Health The case records supply only a limited amount of information on health, particularly physical health, for the families concerned* Refer-ence to Schedule B w i l l show the limited amount of such information gathered or recorded. Under the headings "physical 1' and "mental" the health of each family i s considered for husband, wife,, and children separately* That i s # thore are three divisions per family. Since there afe seven families, the"-e are 21 divisions or breakdowns under each of the headings "physical" and "mental". Inspection shows, however*; that US' under "physical" there i s information i n the case record for only 13 Of the possible 21 divisions (of persons). For the other 8, or 38$ of them there i s no information i n the record. Amongst these 8 are four of the seven husbands. Similarly for mental health there i s no information i n the case record for 5 of the 21 groups of people. Therefore, for both physical and mental health factors, of a possible U2 divisions, there i s no information i n the record for 13, or 25$ of them. Moreover, much of the information i s incomplete, dis-continuous, subjective, or unverified. Clearly, nothing could be more jbraportant than i l l health as a cause of dependency, or as one of the facts to be considered i n a social diagnosis. As a result such gaps i n information can seriously militate against the p o s s i b i l i t y of effective diagnosis and treatment planning. Some further aspects of this situation w i l l be noted i n the following paragraphs tahsre health i s dealt with under each separate heading. a) Husband Since physical health faotors have not been recorded for four of the seven men we may assume with respect to them that either*-1. The health of the man was good throughout the period. 2. The social worker was uneJble to ascertain the required information about the man's physical health. 3. Tho social worker .did not attempt to ascertain the re-quired information about the man's physical health. SO Iii. the cases where some facts are recorded' about the man's physical health, they are restricted!, i n each, of the. three eases* to One item of iafornus.1d.on only, Therofore, because inforaation i s either limited or non-existent, i t . i s not possible to assess the sigaifieancej i f any* of physical health factors i n the man upoii the pattern of family behav-iour.* h) Wife '• By contrast, there i s information on physleal health for s i x of the seven women* this reflects to a considerable extent the fact that the social workers i n each of the seven'cases worked exclusively or primarily with the women* For these s i x women fifteen surgical Or medical conditions have been noted. Hot a H these conditions^/however, are verifiable* since i n some instances the ease i s reported by the client i n vague or inhibited language such as "gynaecological conditions t t or "trouble with tubes". This language may suggest psychosomatic i l l n e s s ; but, unless i t i s definitely ascertainable* the condition has been l i s t e d as physical (organic). This same observation also applies to such cendi* tions as skin, rash, eczema, and asthma. Severtheless, whether these conditions are psychosomatic or organic* they aro of dia-.nostic .signi-ficance* Despite the foregoing* about % % of the wives were i n constant or intermittent poor health; and they had a l l undergone at least one temporarily disabling i l l n e s s or operation. 51 c) Children Here again, only a limited amount of physical health i n -formation i s recorded. For three families there i s no information whatsoever, and for the remaining four the information i s too limited or unspecific to permit of concrete findings. I t does not appear li k e l y , that the absence of information indicates ®ood or satisfactory physical health, partictlarly since the somewhat f u l l e r information available indicates that mental health conditions are unsatisfactory. Mental (Psychological) a) Husband Again, as under •physical 1, information with respect to the mental Stealth of the men i s extremely limited* ,.3*n one case there i s no information i n the record and i n three cases the only clues to the mental health of the men i s provided by the wives whose termin-ology "queens peculiar", "violent temper!,t "not very outgoing", i s both unscientific and subjective, providing l i t t l e useful diag-nostic material. Of the three remaining cases one psychiatric report des-cribes the man as a psycho-neurotic hypochondriac, and i n the two other cases, the social workers describe the men as emotionally im* mature. b) Wife Some information with respect to mental (psychological) $2 health i s recorded for six of the seven women. This information i s , for the most part, accurate and based upon professional opinion. One woman was diagnosed by psychiatrists as schisophrenic, another at one point was known to be under medical treatment for "nerves", and a third was diagnosed at the Child Guidance Clinio as having conversion hysteria. These women were also reported by the social vtorkeva9 at -various times, as "tense","depressed", "emotionally upset", and "extremely nervous". One woman was reported to have threatened suicide a number of times, and the case records indicate suicidal tendencies (or threats) i n tso other cases* c) Ohildren For three of the seven families tho case records give no indication of the mental health of the children although i n view of their disturbed environment i t seems unlikely that they would be free of emotional or psychological maladjustment. l a the four families for whom there i s information about the mental health of the children one or more of the children i n each family exhibited behaviour problems i n and/or out of school, Guch behaviour tfas frequently of a neurotic nature such as exhibitionism, habitual truancy, stealing, etc. Cl i n i c a l reports indicated that throe children were mentally retarded, However none of them were so seriously retarded a s to rule 53 out the p o s s i b i l i t y that the retardation was primarily duo to exact* ional stresses i n the enrironmont. I t may be noted that of a t o t a l of 2% ohildren i n these seven families there i s specif i o metnal health information recorded for only seven of them 30$ of the total number of children. Pre-Marriage History v From the pre-marriage social' history (Schedule 0)', can be adduced numerous earlier psychosocial and health factors i n f l u -encing, a generation later i n some cases, the pattern of behaviour 'in these, sevon families. a) Husband There i s . again less information on the paternal background than on the maternal background. Thjasj for two cases there i s no background information and i n a 'third Case there i s merely the un-amplified (and apparently uninvestigated) statement of the wife that hor husband had "a poor background". In the four cases for which there i s information, i t i s clear that the man's childhood was unhappy and disturbed, In two cases the mother died when the client was an infant. In one of those cases the father, and shortly aftenrards*: a brother,, committed suicide vhen. the client was i n his teens. b) Wife Maternal background psychosocial history has been recorded for a l l but one family (C family). Although recorded i n -formation i s incomplete the following facts emerge* (1) Three women, (Mrs, S> Mrs. F and Mrs. G), report drunken or brutal behaviour of 5U their father toward their mother* (2) One wman, (Mrs, B), reports that an uncle and an aunt committed suicide and that another uncle was i n a mental hospital. This was not confirmed. (3) One woman (Mrs. G), reports that her mother was '•insane-". This ws© not con-firmed. (U) One woman, (Mrs* A), whose father divorced when she was young, was ordered by him to leave the house when she w?s 15. (6) l h more general terms five of the x-romea state that their childhood was unhappy. i BEHavTCDB PATTERN TS TBS FAMILY Eong-tona dependency by i t s very nature i s a complex matter. No one influence i s at work, but. many soraetiraos personal, sometimes economic or socials sometimes contributed to by one of the marriage partners, sometimes by tho others end so on. Moreover,,, there are. interactions ~ possibly cycles, which change from time to time. To il l u s t r a t e this further, i t i s now proposed to recapitulate b r i e f l y for each fssaily the material contained i n Schedules A, B, end C, thus showing the behaviour pattern with the family rather than the "factor" as the unit. S5_nce family patterns of behaviour are not fixed or s t a t i c , the pattern of fairily behaviour i s shown i n chronologiQal form. That is,, insofar as tho material i n the case records w i l l permit, the family's behaviour pattern i s charted from the begiiining to the end of the ten or eleven-year period of continuous or intermittent activity of each case* I t i s not always possible to demarcate clearly the l i n e between psychosocial factors such as those l i s t e d under mental (psychological) and.the behaviour which follows. For example, i n Family G, the enur-esis of the child Harry, while an aspect of psychological healthy is*, at the same time, part of the behaviour pattern arising out of his disturbed environment. Thus, there i s a degree of overlapping between 56 etiology and symptoms. This may indicate the need for greater re-finement or more detailed subdivisions i n the research technique i n studies which may follow this one. However, i n an exploratory study such as this we are primarily concerned with the interaction of a l l causal factors. Inevitably these w i l l also be related to the behavioural manifestations, just as i n tuberculosis, loss of weight i s a factor resulting i n further physical deterioration and i s at the same time, i t s e l f a result or manifestation of the primary infection. Family A a) Socio-economic During this eleven year period Mr. A was unemployed approximately 50$ of the time. His work habits appeared poor. Mrs. A bought an interest i n a small cafe and for most of thi s time worked long hours for small financial returns. The income tras never adequate for this large family and direct financial assistance was re-quired from time to time. The attitued to money and debts was un-r e a l i s t i c . Housing was bad to inadequate for the A's through this period. Both partners had l i t t l e schooling, Mr. A having four years and his wife eight, b) Health 1. Physical: Mrl A suffered almost continuously from a dis-abling type of eczema. This may have been due to his trade as painter or have been psychosomatic i n origin. Mrs. A had intermittently poor health throughout this period 57 —varicose veins, pleurisy, gallstones,, and "trouble with tubes", for which she was hospitalized. There are reports throughout the ease records of the children having acute skin infections at various times. 2.. Mental; Very l i t t l e i s recorded about the husband except for clear evidence of emotional immaturity.. Mrs. A i s neurotic. Two of the children ate diagnosed as mentally retarded and the case records indicate that at least two of the other children have serious personality disturbances, c) Pra-marriage Hi story There i s no background information i n the record about Mr. A. Mrs. A came from a family of six children tjhere she was un-happy. Her parents were divorced ishen she was a child and at the age of fifteen she was ordered by her father to leave home. Shortly afteriTards she bmrne pregnant, and six months later, v&ien she was sixteen she married the putative father. Emorging Pattern of Family Behaviour 19&5? Mr* A requests Agency help i n order to get his wife away from from another man (separated from hie wife) with tsfcoxa she i s carrying on an open relationship, claiming he wishes to marry her as soon as he finalises his own divorce. Mr. A. Claims, as he does throughout the period of the ease's activity that he loves his wife. He plans to sue the other aan for alienation of affection but never takes 58 action. He expresses strong resentment of his wife's working i n her cafe despite the fact that he i s unemployed much of the time. Mrs. A oomplaiffls that her husband drinks, gambles and neglects the children. In March Mr. A becomes extremely upset when hi3 wife i s found i n bed with her friend by the children. Diane, age 15 i s pursuing a pattern of delinquent behav-iour which persists throughout the period, She drinks, stays out a l l night, truants from school, associates with prostitutes and i s generally "incorrigible". Mrs. A expresses strong criticism and worry over Diane's behaviour but abandons a l l attempts at control to the point where she seems to be condoning her daughter's delin-quency. Diane herself, expresses admiration for her mother, con-tempt and dislike for her father. At various times she accuses her father of having thrown a knife at her, h i t her with a poker, and t r i e d to "get fresh" with her* In the summer of this year Diane was arrested i n a cafe at 3 a.m* and charged with promiscuity but released. I t was at this tine she to l d the social worker that she had been "raped" — apparently the year before. In July Diane i s charged i n Juvenile Court with "incorrigibility'' and released on probation. Later that year she quit school and went to work but l e f t after a few days— a pattern which feas to become typical of her attitude to work. In December she i s again arrested for being i n the company of juveniles found i n possession of stolen goods and sentenced to an indefinite period at the Gi r l s * Industrial School* $9 Wilbur, age 12 i e f eported as doing poorly at school and found by the Child Guidance Clinic to have an I.Q, of 70. ( I t may be noted that Wilbur i s not referred to again i n the records)* The social worker reports a l l children as neglected, dirty and unkempt. 19k&> Early i n this year Mr. A gives his wife a severe beating. This i s a frequent occurrence throughout the period, Hrs, A i s very depressed. She starts d r i l l i n g heavily, a pattern which continues throughout the record. Her relationship with her friend i s terminated by him and Mrs. A threatens suicide because of this and her other problems. Both she and her naaband neglect the children, again part of a continuing pattern of behav-iour. Mrs. A t e l l s tho social worker that she i s "sexually repelled" by her husband, Diane i s reported as making a "good adjustment" at the G i r l s ' Industrial School and i n October i s released but immediately resumes her former pattern of delinquent behaviour. l?l f f : Diane steals money from her mother, She marries an iafliature man with a very poor social history i s sentenced to a year i n prison almost immediately after the marriage, for theft. 19ltS: Hadine, age 5, exhibits behaviour problems. She i s examined by a psychiatrist who finds her "retarded". Lorraine, age 12, apparently following the example of her older sister, i s staying out a l l night and associating with un-desirable companions. She i s later charged i n Juvenile Court for 60 'drinking. Diane i s charged with theft and sentenced to prison* A psychiatric report states that Mr. and Mrs. A are un-l i k e l y to respond to service from any health or social agency, and that Mr. A would not leave his wife as she i s "his source of -support". 19k9» Mr. A has another of his frequent "reconeiliatiohs" with his wife* Diane i s released from prison. 19508 Diane i s again sent to prison. 19Sl-55t The relationship between Mr. and Mrs. A continues i n the usual patterns of qnarrels,, brutality and periodic "reconciliations". In 1953 Mrs* A has her 7th, child and i n 1955 her 8th* The only information on the children for this period i s that they remain problems both i n and out of school* Family B a) Socio-economic Mr. B* s job record was very poor prior to, and throughout this eleven year period. He held numerous jobs and i s known to have been obliged to quit or discharged for drinking on the job on two occasions. In 195U, he obtained a better job i n a refinery and as far as i s known i s s t i l l employed there. Low earnings and heavy debts required that this family be given direct financial aid from the Family Service Agency and other agencies at various tim?s during this period. 61 The attitude to money and debts was unrealistic. In 19li5 housing was inadequate. The family later moved* but the record does not indicate the adequacy of this housing although i t i s known that i n 1952 they were threatened with eviction. No information i s avail-able as to the education of Mr. and Mrs. B. b) Health 1. Physical Mr. B, was operated on for chronic hernia condition i n 1953. Other than this nothing i a known of his physical health. Mrs.. B. had anaemia, poor vision, and a bad skin rash at various times. In 195U she was hospitalized with- "•advanced T*B." but returned home after less than two months on her own recogniz-ance. Nothing i s recorded about tho physical health of the children except the faet that a baby born.in 19U6 had two thumbs on one hand — a circumstance which greatly disturbed Hrg. B,' 2*; Mental Mr, B. was described by the worker as "feense, nervous, immature and i n poor health. w Mrs. B. was hospitalized i n 191*3 for schizophrenia, ?4r. B. removed her from the hospital after three months. In 191*6, and again i n 1950* during periods of deep depression Hrs. B. threatened suicide. In 1952 she was again diagnosed as schizophrenic but re-fused to take treatment. There i s no information about the children oaccept for Bon 62 who at the age or U showed indteatioris of exhibitior&sm and was alleged to have "assaulted" and "stripped" l i t t l e g i r l s , c) Pre-marrjqge History There i s no background information about Mr. 8 i n the ease record. Mrs. B stated that she had an uncle and.an aunt who committed suicide, and an uncle i n a mental hospital. Emerging Pattern of Family Behaviour 19h&: In the early part of the year, Mr. B. i s s t i l l unemployed four months after his discharge from the airforce* Mrs. B i s described by the social worker as haying "an odd,, furtive look and mumbling voice". The couple oTJarre! a great deal. Mrs. B does not got along tilth her motiier-in-law who i s l i v i n g with them and i s depressed to the point of threatening sui-cide. In February the B*s move back to Ontario. 19&8? The B*s return to Vancouver and are reported as being with-out resources* They are given an appointment with the Family Service Agency but do not keep i t . ipJOf The Case i s re*opened when Mrs. B phones the Agency asking-help i n speeding a coal delivery. He i s now working at the Post office at §li*0 per month. Twins are bom to Mrs. B. Complaints are received by tho Agency alleging that the h year old son engages i n ex-hi b i t i o n i s t i c a c t i v i t i e s such as "stripping" l i t t l e g i r l s and "expos-ing" himself. r 63 After a v i s i t to the agency Hirs. B i s described as "iia* mobile, confused and very upset". She expresses great worry about debts. She also indicates fondness and concern for the children* Mr; B i s interviewed i n the agency and complains about their heavy debts. He blames hie wiffe for her last pregnancy, com-plains about their present unsatisfactory relationship and refers to the insatiable sexual demands of his wife early i n their marriage. ', Later i n the year Mrs, B beeomss very depressed and again threatens suicide, partly because she thinks she i s again pregnant, Tiie family also requires assistance with their budget, a problem throughout the period, 19J&: Mr. B's brother, juet released from prison* moves i n with them. Mr. B i s arrested for non-payment of a b i l l , i s jailed* but released on b a i l the following day. This episode greatly upsets both Mr, and Mrs. B. The Agency receives anonymous letters complaining that the B'w are neglecting their children, Mr, B claims that his wife refuses to use the pessary supplied by the hopsital and that she neglects the house and cliildren. Mrs, B i s i n constant poor health but frequently f a i l s to keep her appointments at the out-patient department of the hospital. She expresses worry over how hard her husband works. Mrs* B also states that her mother i s now i n a mental hospital. (Later found to be untrue)* 6k 19523 ISrs. B continues to express concern about her husband*s health and says he works too hard. Her health remains poor and she seems to become, increasingly dependent upon her husband. After the diagnosis of schizophrenia i n A p r i l Mrs. B refuses treatment, expressing strong fear of shock treatment. Mr. B nevertheless attempts to commit his wife to the mental hospital. He also continues to be unrealistic about debts and budgeting. In June Mr. B quits his post office job, claiming he had been refused a lighter job he requested because of his hernia, (In r e a l i t y ho quit just before he would have been dis-charged for drihlcing on the job). Following this Mr.B obtains a job as a bus.driver* but . after three months i s f i r e d for being drunk on the job. After this Mr. B announces that he i s going to Kitiraat. For three months he sends his family small sums of money at infrequent intervals. I t was later learned that Mr. B did not leave Vancouver but obtained a job as taxi driver* gambling and drinking heavily during this period. This i s followed by a lengthy period of unemployment, 1953; Mrs, B continues to resist treatment for her poor health. Mr* B beats his wife. He continues to show considerable h o s t i l i t y towards the Agency, Later i n the year he joins a fundamentalist church and announcesthat he has Preformed". 195J+J Mre* B i s hospitalised for T.B. but after s i x seeks returns home on her own recognizance. At th i s time the case i s referred to 65 another agoncy. 1955? Case i s re-opened when Mrs. B phones the Agency; She says that things are much better now that her husband i s working steadily i n the refinery but request financial aid. Family C a) Socio-economic Mr. C*s job record was very poor u n t i l he joined the Navy 'In 195U* He was constantly dissatisfied with his work and made numerous changes. The family worried constantly over debts, and,, u n t i l 1951** their inadequate income. Their attitude to money and debts was unrealistic* Housing was inadequate u n t i l 1.91*7 when they moved into a wartime house. There i s no information i n the record about education* b) Health 1, Physical; There i s no information i n the record shout Mr,, C, The only information about Mrs, 0 i s that i n 191*©$, at the age of 29 she had a l l her teeth removed* The twins, born i n 19U6 were intermittently i H with diarrhoea, etc* for several months during their f i r s t year* 2, Mental; Mr. C suffered from headaches and general de-pression and was diagnosed as a psycho-neurotic Hypochondriac. Mrs* C was described by the social worker as "very upset" (l$h6) 66 There i s no information i n the case records about the children, o) Pre-marrjage history Mr. C's father, suffered from similar headaches and de-pression. His parents fought over money matters. There ie no i n -formation i n the record about Mrs, C s background. Himerjging Pattern of Family Behaviour 191*6. Hr. 0, i r k i n g i n the shipyards at $150 a month, i s worried over heavy family expenses and debts. Ho complains about his i l l -health, his wife's incompetence, and expresses the wish that one Of the twins, the.sickliest, wonld die, 'Mr, C has gui l t feelings, about this wish. The couple quarrel frequently over handling of money. A preliminary psychiatric exaidnation at tho Bepartanerit of veterans Affaire rspprts that Mr. 0 i s over anxious and wants to be mothered. Mr, C claims that his wife talked him into marriage and says that i n 19k3 they separated f o r an 18 month period* Mrs, C soys she has d i f f i c u l t y handling the tiriins. and ex-presses continual fear of "doing the wrong thing". After a second psychiatric examination at D.7.A. Mr. C i s diagnosed as a psycho-neurotic Ir/pocbondriac, "pitigaosis guarded". He quits the shipyard job, i s unemployed for a period, then i n quick succession obtains and quits two other jobs expressing strong dissatisfaction with them. Mrs. C expresses continual concern over P7 her husband's i l l - h e a l t h and the fact that ho "overrorks?' and i s unhappy and fearful about the general family situation and the fact that she i s again pregnant* 191^ 78 Mr. and Mr3. C continue to have worry over debts. Mr.. C quits another job to go commercial fishing* In August lies. C reports that she and her husband are new most happy and discoa* tinues nor Agency contact. 19fe&* Mr. 0 comes to Agency because of irorxy over debts, 1955>t Mr. C contacts the Agency saying that he i s now i n the Navy and sending his wife $lhP every two weeks but that she keeps running up b i l l s and he wants to knot; where the money i s going* He i s asked to contact the North Vancouver branch of the Family Service Agency for casework s ervlaes but does not do so. Family, g., a) Socio-economic The record indicates that Mr, D who i s untrained has only ijfrbeisriittent er^loyment during part of this period. Mrs. D went to work i n a laundry i n 195U -where she remained for .18 snqnths. She quit "because of the children 1* but soon afterwards took an office job. Debts were heavy and the D*s attitude toward money and debts appeared unrealistic. Nothing i s noted i n the record about housing but since Mr, D f i r s t approached the Agency to request a loan for 68 the purpose of finding adequate housing i t may be assumed that housing was not satisfactory. There i s no information i n the record about education, b) Health 1 . Physical! There i s no information about the physical health of Mr. D or the children. Hrs. D had shrapnel injuries to her shoulder, arm and lung as a result of wartime bombing i n Eng-land, She also had poor teeth, 2. Mental, There i s no information about the children and nothing about Mr. D except his wife's description of his as "not very outgoing" Mrs, D i s extremely nervous and depressed at times. e) Pre-marriage history Mr. D's mother died when he was a few months old and he was said to have been unhappy as a child. Nothing i s known of Mrs. D's background Other than an apparently close relationship with her father. Emerging Pattern of Family Behaviour 1 9 U 5 : A few days after being discharged from the Army i n Keglna, Mr. and Mrs* D move to Vancouver and Mr. D requests a loan from the Family Service Agency i n order to get permanently settled i n Van-couver* He i s vague about his future plans other than to say he wants to take a D.V.A. course i n "building", Mrs. D i s unhappy. She feels that she i s not accepted by her husband* e relatives who 69 are none Jewish* She wants to return to England with the baby* 19U6: Mrs* D complains to the Citizen's Rehabilitation Council that her husband i s constantly drunk and neglects the family* She i s given an appointment with the Family Service Agency but does not keep i t * Iffi?: Mrs. D appears at the Agency office. She complains of her unhappiness i n Canada, of their heavy debts and of her husband's physical abuse of her. She says she i s depressed and expresses resentment over the fact that her husband dislikes going out with her. Mrs. D i s offered further interviews with the Agency but despite several phone cal l s f a i l s to return. Family E a) Socio-economic Mr. E has steady employment as a policeman. Unlike the situation i n the s i x other families income appears adequate. At the time of referral to the Agency the E*s were l i v i n g with friends i n over-crowded quarters. They later moved to their own suite. There i s no information about their education, b) Health 1, Physical; There Is no information i n the record about the physical health of any of the E family, 2. Mental; There i s no direct information about Mr, E 70 other than his wife*s description of him as "queer, peculiar*'. At intake Mrs.-E was described by the social laorker as "very •apset emotionally". In I9I18 Mrs. E was being treated by her own doctor for "nerves" end i n 195k she advised the worker that she and her husband wer<> planning to consult a psychiatrist. There i s no i n -formation ebout the children. °} ^ts^aQTriase. history Mr, E's mothsr died when he was two. His father remarried an alcoholic. The family lived constantly i n hotels. When Mr. E was 15 his father coiae-itted suicide as did one of his brothers a l i t t l e later. Another brother was imprisoned for manslaughter at the age of 19, "Mrs, E came from a home t-jhare her father constantly bull-* le d her mother who led a l i f e of misery. Barging Pattern Of Family Behaviour 19jj6: Mrs, E telephones the Agency requesting help because of d i f f i c u l t i e s with her in-laws and constant bullying from her hus-band.; She says she has no friends and wishes to return to England. She t e l l s the social worker that she married bar husband after knowing him for five months. In 19li3 they returned to Canada aad moved in. with Mr* E*s relatives. Quarreling hatf started almost right after their carriage. Shortly after arriviag i n Canada she l e f t her husband but returned to him ttoough the intervention of a clergyman. In 19lth they decided to have another chi l d believing 71 this might improve their relationship. However fighting began again, Hrs, 1 saying that even during the pregnancy her husband beat her severely* Mrs. E t e l l s the worker that she cries a great deal and that her husband considers her hysterical* She Says he i s a heavy drinker and i s nice to her only when he wants money or Inter-course* Mrs. E resents the idea of the viorker seeing her husband, saying i t might upset him. She proposes going to England to see i f a 6 months1 separation \THX help her husband learn whether or not he loves her. Mr. E beats his wife frequently a common pattern being to spank her u n t i l she i s black and blue, Then Mr, E cries and for a while the relationship i s improved. Mrs* £ says she gets no pleasure out Of intercourse, but because her husband becomes annoyed when she f a i l s to reach a -climax, she feigns one. Mr. E claims that he does not beat his wife, but merely slaps her to calm her hysteria* He accuses her of being a poor cook and housekeeper. He also t e l l s the worker that he had not i n -tended to marry her u n t i l they arrived i n Canada but that she had thrown such a tantrum that he had had to marry her i n England* He complains also that sex relations have been unsatisfactory since the birth of the children. • In August of that year Mrs. E leaves for England for the 72 alleged purpose of helping her and her husband decide whether or not they w i l l seek a divorce* 19U7: The City Police Department telephones the Agency with respect to a let t e r from Mrs. E alleging that Mr. E i s -failing to send her money for support as he had agreed* 19U8: The case i s re-opened when Mrs. E taho had returned from Eng-land comes into the Agency saying that she had l e f t home with the children f©Hewing an assault by her husband. She claims he hstd begged her to return from England. Mrs. E expresses considerable ambivalencd about her feelings on divorce. She also requests that the Agency arrange a psychiatric examination for her husband. An appointment i s given Mrs. E for a further interview at the Agency, However* she phones to say that she does not wish to keep i t as things seem to be better* Accordingly the case i s again closed. l95?Ui Hrs* E telephones the Agency. She i s crying and near* hysterical. She t e l l s the worker that she had been to a psych-i a t r i s t about Mr. E and had been told that she must either accept her husband's behaviour or leave him. She herself i s under a doctor*s care f o r "nerves". Mrs. E comes into the Agency a few days later* She app-ears under considerable tension and the worker comments that she gives "an impression of dullness". She complains about her husband's i r r i t a b i l i t y and brutality as well as his excessive demands which 73 appear perfectionistic. She states that she cannot leave, him for. fear of losing her security. The social -worker proposes that Mr. E also come i n for interviews. Mrs. E agrees to this and SJ^TS she w i l l phone the worker. When she does she says that Mr. E refused to come to the Agency but did agree to see a psychiatrist. Mrs, E says she i s hopeful about this plan and sees no further need for Agency ser-vices.* Family F a) Socio-economic . Mr..F had steady work as an electrician and later as an elec t r i c a l inspector throughout this period but was dissatisfied xiith his earnings. Be kept most of his wages and gave his wife an inadequate amount for household expenses* For the f i r s t several years of this case's ac t i v i t y housing was very poor. The record does not indicate the standard of later housing. Mr. F completed high school and his wife completed tirade 10. b) Health 1* Physioal: Nothing i s known of Mr, F*s physical health except that he was discharged from the Navy for "a minor heart condi-tion". Mrs. F seemed to be i n mormal health although She was s t e r i -liaed at her own request at the birth of the third child. There i s no Information about the children, 2. Mental: Ho thing i s known about Mr. F olher than his wifefe Ik statement that he had "a violent.temper*'. There is.no concrete information i n the record about Mrs. F's mental health and nothing about any of the children except Steven who, at the age of 9 was examined by a psychiatrist because of poor school work, d^-dreaming, thumb-sucking, etc* The doctor recommended remedial reading and psychotherapy, e) Pre-marriage history Mr. F had a poor relationship with his autocratic and religiously bigoted mother. In his teens he b u i l t quarters for him-self i n the family 'garage* The family found the depression hard and Mr, F was bi t t e r and frustrated because of his u n f u l f i l l e d snjbi-tion to become a lawyer. Mrs* F came from a large depression* impoverished family where she was one of s i x children. She said she was unhappy and insecure there. In her late teens she l e f t home to become a domestic. She described her father as "shiftless and brutal" and said her mother had frequent "breakdowns!' which necessitated treatment i n a "rest home". Mrs. F became pregnant before, her marriage at the age of 21, The father denied his paternity and suggested an abortion, an idea which she rejected. However, he married her before the ch i l d was bom* Emerging Pattern of Family Behaviour 19k6i Mrs* F telephones the Agency saying she wishes to discuss placement of her two children because of marital conflict. At i n -75 take she shows l i t t l e ©notion and the worker describes her as "self-contained"... Mrs. F describes a relationship with her bus-* band characterized by frequent quarreling and brutality inters spersed with periods when her husband expresses contrition and relations are improved for a while. She i s very ambivalent about her feelings towards her husband and despite severe beatings which required police intervention refused to Jay charges* She says she thinks her husband s t i l l loves her and says she i s very much i n love with him. She says also^ that i n between arguments her hus-band i s considerate and a gopd provider. She i s defensive about her husband being "a l i t t l e b i t on edge" because of bard work. Mrs* F agrees to the worker's suggestion about bringing Mr, F i n for interviews, • Mrs. F phones, later to say fthat she had talked the matter over with her husband, that he had admitted his responsibility and promised to change* She thinks^ therefore, that things w i l l improve* A month later Mrs* F has another fight with her husband and moves to her mother's house taking the oldest child with her. Mr, F takes the child back and his mother looks after beta children* Mrs. F soon after returns to her husband* I9U7 i There i s further quarreling between the couple and a lawyer i s consulted about separation* Mrs* F coaplains about her husband's unpleasantness and jealousy and his heavy expenditures at drinking 76 and gambling, She says that she considers him brutal with respect to sex and feels that many of his demands are abnormal and indecent. She says she feels he views her as a prostitute, (Mrs, F i s later loaned a book on sex by Tyrer and acknowledges that she was wrong i n this judgment). '••v The pattern of brutality continues. Mrs* P becomes preg-nant again and expresses a wish to have the child adopted at birth. She says that after a discussion she and her husband have decided to have no more children and that her doctor agreed to s t e r i l i z e her. In December the baby i s born but Mrs* P makes no further reference to adoption, 19U8: Mrs, P, says that Mr. P i s showing greater interost i n the children and that things are going much better. The case i s there-fore closed. 1951: The case i s re-opened as Steven, now age 9# i s showing evidence of emotional disturbance. He i s given a psychiatric examination and remedial reading and psychotherapy i s recommended* The case i s referr-ed to the Metropolitan Health Committee and i s therefore again closed* 1955: The ease i s re-opened after a c a l l from the Family Court. Mrs* F had been to see thorn following another assault by her husband Mr. P admits having been ibugh with his wife and the children and seems to wish help because of drinking and financial problems ( a l -though he i s now earning §360.00 per month). A let t e r i s sent to Mr. P offering Agency services but he 77 does net reply* Family G a) Socio-economic Mr. G was a self-employed o i l burner serviceman at 1&e tiaae of f i r s t contact with the Agency. He only worked intorroitt*. ently and earnings were low. Later he had a variety of jobs and was unemployed a great deal Of the time. By th© end of 1955 he had what appeared to be a steady job as a serviceman at §62 per week* Mr. G refused to t e l l his wife his earnings, The family had heavy debts which required, that they be given financial help from this and other Agencies. Their attitude to money and debts was unrealistic, the record did not indicate the adequacy of housing but i t i s known that Mr. G*s mother lived with them u n t i l 1952 which resulted i n considerable discord between her and Mrs* G. There i s no information about the education of the G's. b) Health 1. Firffaical. There i s no. information i n the record about My, G* Early i n the record Mrs* G is. said to be i l l but the nature of the illness i s not specified. In 1952 Mrs. G said she had a "gynaecological condition". In 195U she .underwent a hysterectomy and the following year was hospitalized for a bladder condition. 78 Although not specific about the matter the record suggests that the children did not enjoy normal health* 2. Mental J There i s no information about Mr. G. In 1951* Mrs. G threatened suicide. Iii 191*8 Jack, age 5 was diagnosed as mentally retarded at the Child Guidance Cl i n i c , i n 1952 the Vancouver General Hosp-i t a l reported that Harry, age 8, owed behaviour disturbances such a s enuresis, crying, etc. to a poor home situation. In 1951* the record indicates that a l l four children are behaviour problems, c) Pre-marriage history Nothing i s known about Mr. G's background other than Mrs. G's unamplified statement that he had "a poor background" Mrs. G said that she was an unhappy only child, that her father was & driuakard and that her mother had been "insane" for 12 years but that this had cleared up when she (Mrs* G) l e f t home, Emer^^ Pattern Of Family Behayjoi^ 19li6t A request i s received for a supervised homemaker as Mrs. G i s i l l and Mr. G i s unemployed. 19h?» Jack, age U, showing evidence of emotional disturbance rec* elves treatment at the Child Guidance Cli n i c . 1?U8» Another request i s received for a supervised homemaker $hils Mrs. G i s i n the hospital after the bi r t h of her third child. 19521 Tho Agency receives a referral from the Social Service Depart-ment of the Vancouver General Hospital because of 8 years old Harry's 79 symptoms of emotional disturbaneo. The V.G.H. reports that they have seen Mrs* G four times* She complained about her moaies-in^ law being jealous of her and siding with Hr. G against her. She also complained about her husband beating her up and being puni-tive towards the children. She said he kept late hours, drank heavily and was unfaithful to her; also that he had a violent temper and witheld household expense money from her* Mrs. G ex-pressed considerable concern about idle children's emotional health She also said that she got considerable support from her Christian f a i t h as a member of a fundamentalist Gospel group. She claimed that she did not wish to leave her husband despite his interest i n another woman as she was no longer interested i n men, Mrs* G also complained about her "gynaecological condition" 'which she said was glandular. During subsequent interviews at the Agency, Mrs. G con-stantly b e l i t t l o s herself. She describes a row with her husband when he became angry at her taking away a gun he had been hiding. She t e l l s th® worker how, on one occasion he had l e f t her for s i x weeks to l i v e with a young g i r l , during which time he returned home periodically for meals. She says that Mr. G has never asked for a divorce but that i f he did she would give him one. She seems to have guilt feelings about the children, blaming herself for their behav-iour. At the same time she requests a ehild for foster care, (This do request i s not granted). Buring the year anonymous letters are received by both the Family Court and the Family Service Agency alleging that Mr. G was not supporting his family, that he had threatened them with a gun, and that he was an "atheist" and a "play boy" * -i?fi3: Hr* and Mrs. G appear i n Family Court, Mrs. 0 claiming that . Mr, G i s not providing adequately for the family. Mr. G has a succession of low wage jobs during the year. logkt Mrs. G says her husband i s contemplating divorce and that i f she loses the children she w i l l commit suicide. She also states that this i s not the f i r s t time she has contemplated suicide, i n June Mr, G goes to work at Kitimat. Mrs. G f a l l s i l l . . She i s very worried about the children. Mr* 6 sends very l i t t l e money home and the family i s given further aid from the Agency. 19j>£t A l l the children appear to have acute behaviour problems, the oldest i s caught shoplifting, Mr. G continues his heavy drinking, provides ogly minimally for the family and enters into a relation-ship with another woman. - Mrs. G expresses herself as feeling trapped. CHAPTER IV FINDINGS AHD IMPLICATIONS I t i s now possible to hazard answers to the major ques-tions posed at the outset of the study. F i r s t , what can be said Of the overall pattern Of psychosocial and health factors Operating within these family constellations? Second, what are the important implications for diagnosis, treatment planning, and prevention? And thirdly, what are the implications for family agencies and for the community generally? Clearly, there are some psychosocial and health factors common to a l l these seven family units. They reveal their sign! ficance i n an emerging pattern of family behaviour. These patterns appear f a i r l y consistently i n a majority of the cases despite the fact that precipitating events and socio-economic circumstances may vary xjidely. The marital relationship of these couples, however unstable endures. I t i s chiefly characterized by a partnership between im-mature males with a l l the attendant manifestations of such disturbed personalities; and neurotic, frequently guilt-ridden, dependent women. There i s a pronounced sadistic-masochistie element i n most of these marriages, and the behaviour pattern of each partner shows cer-tain characteristic forms. The following may be noted about the men:-82 1. Sadistic behaviour. A l l the men, with the possible exception of Mr. G, beat their wives harshly and frequently. This i s sometimes followed by brief periods Of harmony as i n the case Of Mr. E. 2. Alcoholism. A i l the men, again with the possible °ex»: ception of Mr. C of whom Very l i t t l e i s recorded, appear to drink heavily. (The records do not indicate whether this i s to tho point of being alcoholics). This i s i n sharp contrast to the women of whom Mrs. A i s the only one known to be a heavy drinker. 3. Money. A l l the men except Mr. E appear unrealistic about money and debts. Three of the men gamble to the extent that i t becomes a cause of marital conflict. (Mr:*. A, Mr. B and Mr. F). Two of the men witheld money from their wives. (Mr* F and Mr. G). U. Attitude to home and children. A l l the men with the possible exception of Mr. E neglect their children at times and re-fuse to accept household responsibilities. $• Employment. None of the men, with the exception of Mr. E and Mr. F show a b i l i t y , or, i n sone cases, willingness, to hold jobs. 6. Other. Other types of immature or neurotic behaviour are exhibited, such as "extreme dependency on their wives (Mr. A, Mr. G)$ hypochondria, (Mr. A, Mr. C)j resentment of children (Hr. A, Mr. C, Mr. F, Hr. G). The women exhibit a wider range of behaviour deviation. 83 Most frequently i t i s characterized by ambivalent feelings about their husbands* VJhile many of them express a strong desire to break away from an unsatisfactory relationship they do not do so because of emotional 9r economic dependency on their husbands* Temporary reconciliations and short periods of harmony are typ-i c a l of many of these marriages* A l l of the women appear to have genuine concern for the welfare of their children although i n the case of Mrs. A this concern i s more apparent than real. In some of the cases this concern appears to be motivated by gui l t feelings, psychogenetic i n origin. Two of the women became pregnant before marriage (Mrs. A and Mrs. F). This may alsb have been the situation i n at least one other case (Mrs. E). Three of the women threatened suicide. (Mrs. A, Mrs. B and Mrs. G). , These same three women were diagnosed as neurotic or psychotic although a l l seven seem to give evidence of neurotically motivated behaviour* Most of these women were generally i n poor physical health. In the case of the children, although there i s no infor-mation for three families, there i s diagnostic evidence of both mental retardation and personality disturbance i n the children of the four other families because of the disturbed home environment* The foregoing facts, (and assumptions), emerge despite some serious shortcomings i n recorded information* These may furnish some of the clues to the cause* effect relationships i n long-term cases this exploratory study i s seeking. Basic Personality Defects: Some Parallels One fact stands out i n a l l t h i s . That i s thdse par-ents a l l have personality defects which stem from their immediate or earlier psychosocial backgrounds. At a certain point i n time these weaknesses are exacerbated by a congruence of socio-economic factors - bad housing, unemployment, low income, etc., and the pre-cipitating c r i s i s arises. Both personality defects (behaviour) and psychosocial factors can be identified and scheduled. Which i s cause and"which effect i s not always clear, but the close interlock-ing of personality and environment i s obvious. Because of the inter-dependence of personal and' social factors the destructive consequences of these defects affect not only the family, but society as well. The marriages appear to be based upon neurotic "balance", whereby each partner meets certain emotional needs Of the other, such as a marriage between a dominant partner and one with extreme depend-ency. To a large extent these marriages seem to provide new avenue's to express neurotic drives' engendered by the basic immaturity Of each partner. Since, as H.A. Overstreet wrote i n The Mature Mind» ego-centricity i s a characteristic Of immaturity and sociocentricity a characteristic of maturity, i t follows that these individuals and families are incapable of accepting f u l l social responsibility. They cannot, or do not, function adequately as members of society. The 85 further defects i n personality such as financial irresponsibility, persecutory attitudes, brutality, etc* arising out of th i s basic imnaturity have already been shown for each family, insofar as the information allows. As has been emphasized, these personality defects are inter-related with environmental influences. This cause-effect interdependence may be indicated in'approximate, not absolutd terms. Nevertheless, for effective diagnosis* even the p a r t i a l connection must be noted. Maladjustment and dependency does not become chronic or long-term merely because of the fact that i t exists* The time d i -mension I t s e l f needs exploration; and this'requires i t s own analysis* I f the socio-economic and emotional influences which give rise to the acute condition cannot be effectively treated, the condition may then become chronic. A p a r a l l e l can be drawn with medicine where a condition which resist s treatment becomes "chronic", i . e . long con-tinued* Within recent years,, however, medical research has found treatment techniques to prevent chronicity i n most diseases which a generation ago or less, usually became chronic,, (e.g. tuberculosis, syphilis). In the same way social research may find the techniques whereby maladjustment and dependency may be "cured" i n the acute stage — or more hopefully, as i n the case of many onee common dis-eases, prevented from ever developing. 86 This study i s a beginning attempt to identify the etio-: logy of maladjustment'and dependency, just as extensive research into the causes of disease led to the advances made i n preventive medicine during the l a s t decade. Community Implications Given the tentative findings of this reconnaissance study what are the next steps for investigation and exploration? This study proceeded from the postulate that i n every com-munity a small "hard core" of multiproblem families absorbs a dis-. proportionate amount of the coraminity*s health and welfare resources. An attempt was then made, despite serious gaps i n information, to identify and isolate the influences operating within a.group of seven.multi* problem families. These psychosocial influences were scheduled under certain headings socio-economic, health, and background social history,. A significant number of common elements were shown, to be oper-ating within each family. The emerging behaviour patterns of each family were then studied, and .a farther correlation between these influences and behaviour patterns became apparent. These cases exhibit similar emerging patterns of disturbed emotional and social behaviour, and these pi tterns arise i n response to a complex inter-relationship of personality and environmental, factors. Nevertheless i t i s possible to advance the view that these "hard core" eases axe susceptible of relatively, early identification. I f this i s 87 possible, then a major step has been taken towards more effective diagnosis and treatmoht planning for these long-term multiproblem families* What i s effective treatment planning for these families? What about prevention? What are the community and agency resources? There are the further steps envisaged by surveys which have approached these problems more extensively, such as the St. Paul, Minnesota project, 1 9 U 8 to 1 9 5 2 ^ described i n de t a i l by Bradley Buell i n his book Community Planning for fluman Services* This was an intensive study of the nature and extent of what Buell c a l l s "disordered behaviour"* I t was probably the f i r s t systematic attempt to compare the t o t a l community services available f o r diagnosis and treatment with those available for situational treatment. In a sense i t was a p i l o t study for the surveys now being conducted by Commun-i t y Research Associates* A demonstration project i n San Mateo County, California i s the meet extensive and important of the three projects currently 1 underway by t h i s organization. In the book, The Prevention and Control of Disordered Be- haviour i n San Mateo County* California, Buell cites three basic 1 The three projects are being conducted i n Winona County, Minne-sota; Washington County, Maryland; and San Mateo County, California, 88 weaknesses with respect to existing agency functions. " 1. Diagnosis at different times by practitioners with different degrees of diagnostic competence. 2. Only at a few points does a thorough diagnosis of the total family situation illuminate the be-haviour of i t s members. 3. Treatment itends to be varied and sporadic, l i m i -ted to immediate behaviour problems.*1 -' Buell goes on to say: "There i s , i n short, no f u l l y equiped,, ad-equately staffed community resource to which the agencies can turn to for continuous diagnostic guidance and treatment direction." the Community Research Associates therefore propose the establishment of a new agency — The Family Mental Health Centre, This i s not to be a direct service agency. I t i s to receive no di r -ect applications and have no intake procedure. As the-author says i n the same text " I t i s rather a comrnon-purpose tool, designed to give qualitative help and systematic direction to present service efforts, to assure f u l l diagnosis,..treatment continuity, evaluation of results." In an article appearing .in. Family; Service Highlights for February 1<?£6, entitled. ?Focus of Infection", Marion 0. Robinson, Editorial Consultant f orCoimaunity Research Associates, reviews this project and writes: "When this "mental close-up i s expanded to a community-tri.de picture, one sees why C.S.A. has concluded, at least 89 tentatively, that this concentrated spot (the Multiproblem families) i s the'counterpart of public health's "focus of infection"." This demonstration project has made a noteworthy contri-bution towards the solution of some major problems of welf are i n our society; and has raised questions challenging to a l l public and. p r i -vate agencies within the f i e l d of social welfare. I t i s questionable, however, i f i t i s the sole answer, or would be workable without i a * portant supplements. As well, there are aspects of the G-.R.A. pro-posal ihich may be queried. In the f i r s t place, the view expressed by Miss Robinson that these multiproblem families are the "focus of infection" appears based on the narrow assumption that somehow, within them-selves, these families carry the germ of what Buell calls "dis-ordered behaviour". The suggestion i s that i f these "infected" families can be isolated and then made the objects Of community concentration, then what Miss Robinson c a l l s "the prevention t r i c k " can be arrived at. Objection may be made to this point of view on several • Counts, For one thing the expression i t s e l f militates against tak- • ing a broadly objective approach to the problem. I t seems to imply that these families are themselves wholly responsible for the result-ing maladjustment and dependency. The term "focus of infection" while perhaps not consciously so, .is f a i n t l y censorious and narrows down the cause of disordered behaviour to the family which breeds 90 this pathological behaviour. But a family i s not l i k e a stagnant pool i n which the malaria bearing anopheles mosquito breeds. I t i s . . . " v. • part Of society* and as this study has suggested, i t s disordered and anti-social behaviour emerges from a variety of influences* ^ h i l e a great deal of disordered behaviour i s due to pathological condi-tions within the family there are also many influences conducive to disordered behaviour which originate' outside the family. Unempioy-a b i l i t y and il l n e s s are two illu s t r a t i o n s of thie* The thinking be-hind inc me maintenance and other services (Unemployment Insurance, YJorkmen's Compensation, the proposed National Health Insurance Act, etc*), i s that some family breakdowns are entirely beyond the control of the family or the social agency, that the causes l i e within the social and government order, rather than x&thia the individual or family* There are other forces at work - economic, industrial* socio-logical and p o l i t i c a l , among others, (e*g« seasonality of employment*, discriminatory legislation or^titudes with respect to minority groups, restricted educational opportunities, etc*), which tend to influence the rate of "disordered behaviour". Such forces are quite beyond the a b i l i t y of social agencies even a Family Mental Health Centre - to control* I t i s of interest, i n this connection, to note an ongoing research project i n Sweden under government sponsorship on the problem of dependency among Stockholm's public assistance recipients. This 91 stud? i s as yet uncompleted, out i n a preliminary statement published i n the Stoekholmes Morgantidniregen of September H i , 19$k, Br. Gunnar 1 TigUe,.tfae psychiatrist i n charge of the project stated that unless families requiring public assistance were given.help at an early date "psychical withering" ensues, making rehabilitation d i f f i c u l t and.often impossible to achieve. This reinforces the view taken i n this study that early diagnosis i s essential for the purpose of adequate treat-'stent planning. 2. Care would have to be taken to ensure that the multi-problem families designated for the services of the Family Mental Health Centre do not regard this service as a form of social control and a stigma* i n i&leh event they might reject or resist agency help. I t could be disastrous to the program of such an agency to be identi-f i e d i n the community as one concerned pi^o a r i l y or exclusively with problems of severe social pathology. 3* A plan such as this necessarily places considerable emphasis on individual and family personality disturbances i The i n * tegrating s k i l l s of psychiatrist, psychologist, and 4}asworker are em-phasized as the key to preventive planning.. However, this approach 1 I t i s of interest to note that i n Sweden psychiatrists are known as "social doctors"* 92 may conceivably not supply a l l the answers to the problem of pre-vention for as already stated, there are forces at work $iich are not within the control of the family,, such as physical handicap* sickness, the death of the breadwinner, lack of educational and vocational training, etc. Buell himself foresaw this. In his text Gomannity glannjhg for Human Services, he said that there was to l i t t l e known about the effect of 11 economically handicapping dis- " a b i l i t i e s " such as unemployment, Buell f a i l s to amplify this ob* servation although i t i s obviously iu^portant i n any evaluation of the ccOTminity function with respect to human services. I f the community i s led to expect marked is^roveme&t through the-.establishment of a body such as that of the Family Mental HealtJi Centre, there may be disappointment i f the plan f a i l s to meet the expressed hopes of those identified with i t . Such dis-appointment may militate against further efforts at investigation of this problem* ii. The fact that this demonstration project i s being carried, on i n one of the wealthiest counties i n the United States cannot be overlooked. While the sponsors o£ the project shew a genuine concern with a. nation-wide problem and. commendable generosity i n the financing of this project, the fact remains that San Mateo County may not be trul y representative. Theso criticisms are not to ddtract from the overall value 93 of the San Mateo and other demonstration projects. Buell himself has repeatedly emphasized the "experimental" nature of these pro-jects. • , ' Certainly any attack on the, problem posed by these "hard core" families and individuals must give, f u l l weightr.to the importance of the integrated psychiatric, psychological and casework approach* But no appx^ach can ignore those forces, outside the direct control of the family. These are the forces which are being given key consider-ation i n the approach of countries 13ke Great B r i t a i n and the Scan-dinavian bloc where considerable stress i s placed upon income mainten-ance, health, old. age insurance, and other environmental services f o r a l l citizens. I t may be that In these countries insufficient emphasis i s placed upon tho "mental health" approach of the United States* Like* wise i n tho free enterprise economy of the United States the emphasis may be too typically upon the emotional health of the individual or the family. Perhaps this indicates the need for a new approach to the problem based on a balance between the Eruopoan and North American concepts* Agency and Community Resources Lous-term cases such as tho seven reviewed, are, aidmittedly, the mce t d i f f i c u l t of the many different kinds thatcome to a Family Agency, But because of i t s family focus, an organization such as the 9k Family Service Agency of Greater Vancouver i s bound to receive some. I f other resources are not available, the family agency may become* i n effect, a catch-all. In one sense at least, i t may be at the mercy of the community. This i s not because the purpose and functions of the 1 Agency are not clearly stated. Although these functions are not re-s t r i c t i v e , the Family Service Agency does have limitations imposed by such r e a l i t i e s as a limited budget, insufficient personnel, and re* stricted physical f a c i l i t i e s , Nevertheless, i t also has i t ' s conscience. I f there i s nowhere else a ease can be referred to, the Family Service Agency gets i t and, i f humanly possible, accepts i t . However, a family agency, l i k e any other, i s only part of the broader community apparatus for coping with the personal and socio-economic problems of the individual, the family* and of society i t s e l f . The fulfil3jnent of i t s functions depends upon the sound* carefully integrated organisation 1 In a report prepared i n November, 19$k these were stated ass-"Basic purpose 8- (a) Strengthening family l i f e In the coamminity. Functionst- (a) To provide casework services. (b) To further community planning and action i n iaporving conditions and services, (c) To contribute to Social Work education. (d) To participate i n education act i v i t i e s aimed to strengthen family l i f e . (e) To develop research." 95 of the entire range of community assistance, care, and treatment f a c i l i t i e s . The forty persons i n those seven cases must then be seen, not only as members of their families, but also as members of the larger crararaunity. This study has not been an attempt at an analysis of casework, or of Family Agency service as such. (This could be an important area for further research). I t i s a reconnaissance study of some families showing long-term maladjustment and dependency} an attempt to describe the main features j and at least i n f i r s t approx* iination fashion* to determine and evaluate the constituent psycho-social factors which appear to be unsolved. The isolation and Identification of these components i s not only of general social importance]; i t may provide one of the keys to more effective diag-nosis and treatment planning; and, as already indicated, i t has community implications beyond the scope of a single agency. These seven cases are not the worst examples of chronic maladjustment and dependency. They are not Jukes and Kallikaks. while they show a pattern of emotional i n s t a b i l i t y , they are neb the Congenitally degenerate for whom treatment can only be ameliorative and supportive rather than preventive. I t would have been possible to select numerous other Cases at the Family Service Agency which showed more severe pathology of maladjustment and dependency. How-ever* these cases were selected on the basis of certain c r i t e r i a des-cribed i n Chapter 1} chiefly that they originated ten or eleven years ago, remained active continuously or intermittently into 1955* i.e. throughout a period of relative economic stability? and represented family groups which remained intact throughout that time. The social worker's responsibility i s not only to the individuals and families with whom he uorks to eliminate or amel-iorate the effect of disabling problems} i t i s also to the aamraun*-i t y which must be protected against the deteriorating consequences of such problems by preventing, as far as possible, their occurr-ence or re-occurrence. In. a program aimed at implementing the p o s s i b i l i t y of more effective diagnosis and treatment planning and better preven-tive techniques for these multiproblem.families, the resources within the community must be carefully examined. I t i s significant that while health resources are being made available In Vancouver at an over-increasing rate, that they are not being paralleled by improved resources for diagnosis, treat-ment, and prevention of long-term maladjustment and dependency,, Bradley Buell has commented On t h i s i n the following words; "So far, i n spite of s c i e n t i f i c progress, there has been l i t t l e systematic effort to develop and assemble data which have, or 97 should have* strategic significance to a commun-ity-wide attack upon pathological behaviour* The various parts of the community's correctional and casework systems have been organized mainly around the particular symptoms of maladjustment <* a crime, an act of delinquency, a neglected or dependent child, a broken family, a r e l i e f family, or a strand-ed transient family. Psychiatry, up to the present, has concerned i t s e l f largely with perfecting i t s capacity to diagnose the individual case, rather then i n dealing with the manifestations of mental disorder on. a community-vri.de basis." 1 Today, i n this community, casework services are increas-ingly administered through an organizational Structure which may block the most effective diagnosis and treatment of their client*s problems. The growth of agency specialization poses the problem of service relationships. These "segmented" services make the objective of treatment focussed on the family constellation i n -creasingly d i f f i c u l t of achievement. The Family Mental Health Centre as proposed by Bradley Buell i s an important step towards the more purposeful integration of a l l the specialized services; and one whieh must be taken very soon i n this community. This fact has im-portant implications for the Family Service Agency, which, because of i t s strategic position, i s uniquely qualified to bring this matter to the attention of the community. Along with integration of agency services, there must be a constant awareness Of the resources offered by the income maintenance and other services, particularly their train-ing and rehabilitation programs which must be part of the frontal 1 Buell, Bradley and Associates, Community Planning for Human Services. Columbia University Press, Hew York, 1952, p.252. 98 attack upon the problem of long-term maladjustment and dependency. Significance of Recording Shortcomings YJhatever else may be true, i t i s clear that diagnosis and treatment w i l l only be improved when adequate information, which i s essential to clear diagnostic thinking, i s obtainable; just as i n medicine, the f i n a l attack on cancer and tuberculosis s t i l l awaits the results of current research, Ono of the findings of this study i s that there i s a lack of comprehensive information about the many interrelated influences operative within these seven family constellations. 1. Numerous gaps i n face^sheot information appeared i n the majority of these long-term case records* This Information pro-vides a minimum of social hisotry. Yet f o r the 35 eases originating i n 19U5 and 19it6, diagnostically important information such as the date of the marriage was missing for 36% of the married couples* The fact that the marriage date i s shown i n a l l . of the 7 cases selected for intensive analysis does not mean this date appeared on a l l the face-sheets. I t was not recorded for 3 of the 7 cases and was arrived at only by deducing the date from information available i n the case records.. I t may be noted, however*, that during recent years, face-sheet information has been completed to a far greater extent than i n the earlier years when these long-term cases originated. 99 2. There i s a pronounced lack of comprehensive i n -formation about the psychosocial and health faotors influencing the behaviour of these seven families. (As already emphasized i n Chapter H I ) . There are particularly obvious gaps with respect to physical health, education and training, background social history, and cultural factors* (Chapter HI). Likewise, there are few cases i n tfcich psychosocial and other influences affecting family behaviour are scheduled for diagnostic purposes. In con-sequence, the lack of recorded, diagnoses during the course of these cases i n most noticeable. 3. Information about the wives i s far more complete than for the husbands. This follows i n part* from the fact that since i n most cases i t i s the wife who seeks help, casework and other services are therefore directed to her. This i s confirmed by the records which show that the great majority of Interviews are with the wife. However, this also reflects the fact that i n some eases the role of the husband i n the family situation i s given too l i t t l e con-sideration. Also, i n a majority of these oases, the social worker appears to nave made l i t t l e effort to get psychosocial and health i n -formation about the husband - even i f only indirectly. k* A long-term case requires spe c i a l consideration for the purpose of effective diagnosis and treatment planning. But because of 100 heavy case-loads, wishful thinking, or procrastination; the workers sometimes simply "carry" them along with their regular load. This does not appear to be the result of failure to recognize these cases as long-term. Any ease whioh has been continuously or intermittently active In the agency for ten years or more, as i s the situation with 10.133 of them, obviously requires special attention. ( I t i s also the view of this study that comprehensive, scientifically-oriented diagnosis can result i n earlier assessment of potential chronicity). •h >. Because of their multiplicity of problems and their r e l -ative hopelessness, these cases sometimes receive only secondary consideration. They may be "closed" prematurely only to f i n d that they have to be reopened repeatedly. That this i s the situation to an appreciable degree has been established by direct interview with social workers. Such a situation, whether within the control Of the worker or not,, i s oncompatible with sound social work practice. Im-p l i c i t i n a l l this i s the need for comprehensive and sustained high quality of Casework, I t i s not the purpose of this study to elaborate upon this subject as i t may more properly come within the purview of continuing research into casework techniques, However, the importance of accurate complete and s c i e n t i f i c a l l y oriented recording procedures cannot be over-stressed i f meaningful research into problems such as that of long term maladjustment and dependency i s to be made possible. 101 Areas For Further Research and Exploration There i s urgent need.of further research into a l l aspects of the problem of long-term maladjustment and dependency i n thi s community* . The present study has been based on long-terra cases i n one agency * the Family Service Agency of Greater Vancouver. Further re-search should be based upon a community wide approach* There are other agencies i n which such eases are frequently encountered; older agencies such as the Children's Aid Society, public assistance agencies such as the City of Vancouver Social Service Department; where dependency and maladjustment of second and even third gener-ations challenge the profession to fi n d new and better ways of meet-ing this problem* Such further research must be focussed on the family * both as an entity and as a member of the wider community. Other re-search must be directed towards, the assessment of community resources - and more importantly, community responsibilities. A . J . Altmeyer* President of the National Conference of Social ¥ork, J J I a paper entitled The Dynamics of Social tJork. deliver* ed at the 1955 National Conference of Social Work, said this of re-search actions-"at the very least i t should be possible for social &>2 workers to stimulate their own agency to undertake more systematic and continuing studies of the social results of existing agency policies to determine whether they are i n heed of change.. I t should be possible to go further and stimulate the agency to co-operate with other social agencies i n focussing on particular soeial and economic problems of con-cern not only to individual clients but to the en-t i r e community," 1 Social work> and casework s k i l l s i n particular, have been effective In dealing with the presenting problems of the individual or the family, dependent or maladjusted for whatever reason. But research i n the social sciences generally, and i n social work irorfcicularly, i s only now, coming to grips with the v i t a l problem of causal faotors * with the challenge to devise effective preventive techniques. Within the professions and inside the com-munity i t i s often true.there.may already exist more s c i e n t i f i c knowledge than i s being constructively u t i l i s e d . I t may be that tradition and inherited ideas axe interfering with the p o s s i b i l i t y of using such knowledge,. Perhaps s c i e n t i f i c methods with x&ich to prevent maladjustment and dependency from becoming chronic have yet to be wrested from experience, this i s a challenge whieh society cannot afford to ignore* It The Social Work Forum, proceedings? Columbia University Press, Sew York, 1955. APPENDICES Page Appendix A. Some Statistics of Long-Term Oases Table k - Number of Long-Term Gases (Family Service Agency) Originating 19k9 or earlier*........ lOU Table 5 ** Some Social Characteristics of Long-Term Cases Originating l$h$ and 19U6,.....,...;*,. 106 Table 6 - Some Characteristics of Long-Term Family Cases. (Illustrating also "split-halveS" ; method of assessing consistency of samples • »•••***•«••*•»••,.•«• »••» »• • •»*..».»•*.*«*••«•*• 111 Table 7 - Pathology i n Hultiproblem Families -St.. Paul Project*.....»*..*•• • «*..• •••««••*•*•* 111? Appendix S. Abbreviated Case Records of Seven Intensively Considered Cases........•*• . . . . . .«. . . . .* .• .• .• 133 Appendix 0* Bibliography ................................. 160 A F P E M D C A Table U. Number of Long-Term Gases (Family Service Agency)  Originating 19i*9 or Earlier Year i n which No. of Year i n wbich No. of case originated Cases Case originated Cases 1931 1 I9l i l 5 1932 2 zskz .. * 1933 3 3-91*3 11 193U 3 191& 11 1935 3 191*5 9 1936 5 191*6 26 193? 2 19U7 26 1938 h 191*8 31 1939 k 191*9 19U0 5 Total 185 105 Of these 185 long-term oases, 1*1 were on the open caseload of the family Service Agency i n November 1955. the remaining lltU were act* ive some time during 1955 (prior to Novefltoer). Because of the pattern ef intermittent closing and re*opening characteristic of long-term cases, these are l i k e l y to be re-opened again, the November 1955 ease-load at the Family Service Agency consisted of 569 Oases, I t would therefore be appropriate to add to this number the thh long.* term cases closed before November since they are susceptible of re-opening. This must be done i n order to establish the proportion of long-term cases to a l l "current** eases. This procedure gives a total Of 713 cases (569 plus lite). L0&G-.TBRH OASES AS PERCENTAGE OF TOTAL CASE-LOAD • • 1 »*•>•*. ' - . - M i . .• i > i \. i ••••» .mi ...II "i ...i • i II. ' u - . . . i ' i i • 11 • . • i.- ft As. at Noveim^er 1955 Period Of Aotiyity No. Of Cases As P.C. of^T^tat 6 to 9 years 112 15.7 io to 12* " i t i 5.7 15 to 19 " 20 | 2,8 i 20 to 21* " 12, j 1,6 Total 185 25.8 I t can then be said that 25«8j» Of the t o t a l current caseload at the Family Service Agency has been active 6 years or more* *jhile 10.155 has been active 10 years or more. 106 Table 5 ( s a r i 1) Seme Social Characteristics of Long-Term  Cases Originating 191*5 & 19U6 1 Item. 2 Number EQletraht Proportions and other Comments 1. Marital Status, a) Married couple not? with chilclren b) Married couple xjith-out children c) Common law couple d) Divorced e) Separated f) Widower 2. Current Number of Children a) For a l l 35 cases b) For 22 married couples 3. Occupation r Household  Head" (i^iere listed) a) s k i l l e d b) Semi-skilled o) Unskilled U* Birth Places (where  listed), a) Canada (Cauos b) Canada (Native Indian) c) Br i t i s h Isles d) United States 5* B i r t h Bates (where  listed) a) 1890*1899 b) 1900*1909 e) 1910-1919 d) 1920-192? a i I 3 h 5 Hi 95 71 7 6 A 19 25 2 7 1 60$ of a l l oases 3% « « «• 9Jg <» 13$ " 3% " Icy II It f t t l n t t i t At time of ptudy the average no* of children per married couple 3*2 37$ of household heads 31-1/2$ of household heads 31~l/2g » "•• *' 71$> of adults 20$ " » « i t 1 2% of adults 9 17g " H 31 60$ " •» 11 21$ *» » "152" iooT I I t J selected. 2 As per Family Service Agency face-sheet schedule. Table g (concluded)  Item 107 Number ilelevant Proportions and other comments 6. Marriage Bate (where  Listed) 1930 1938.1{0 191*1-1*2 191*3 191*6 7. Religion - couples only (Aere l i s ted) a) Same b) Different 8. Source of Application  frwhere l i s t e d ^ a) Personal b) Other 9* 'Soeial Service Index a) No previous l i s t i n g b) Previous l i s t i n g s ) 1 30. Presenting problem(s) a) Marital b) Economic c) Personality d) Phys,illness/handicap e) Parent-child relations f ) Subst. care children g) Alcoholism h) Legal i ) Unmarried parenthood j ) Mental illness-suspected k) Employment 1) Housing 1 3 I 1 1 6 17 12 12 10 7 6 U I* 2 1 1 1 For I i i of the 22 married couples for whom this i n -formation was l i s t e d , the average time married at the time Of referral to the F.S.A. was' 6 years/ Too l i t t l e information l i s t e d for significant findings. 70$ of cases Jip$ of cases ±00% kl% Of eases of cases 100& The number ef presenting problems ranged from one to f i v e per ease. The average number of pre-senting problems per case was 2.2 1 As discussed i n the text these presenting problem(s) are chiefly as seen by the client and thus may be both incomplete and inexact. 108 As noted i n the text, 35 or 18*92 of these long-term cases at the Family Service Agency originated i n 19U5 or 19U6. I t i s from this group that the seven eases for more intensive analysis have been selected. Since, i n many instances, face-sheet information has not been f u l l y l i s t e d , there are, xdLth respect to some of the items i n the preceding table* inconclusive s t a t i s t i c a l findings* To the extent that information was l i s t e d ; the following findings emerges-1. Marital Status* I t i s significant that of the 35 cases origin-ating i n the Family Service Agency i n these two years, that a sub-stantial majority, 63%, were legally married couples* Xf we include common law couples of which there were 3, the percentage of couples i s 72%. Of the legally married couples only one was childless at the date of referral and remained so throughout the period* The rest had two or more children at the time of the survey* 2. Number of Children. At the time of the survey the 22 married Couples had an average of 3*2 children per family. This i s two and one-half times the number of children i n the average B r i t i s h Columbia family which at the date of thj§ last Decennial Census of Canada i n 1 1950, was 1,3 children per family* 3* Occupation* Occupation was l i s t e d for only 19 of the heads of families i n these 35 cases. Of this group a l i t t l e over one th i r d 1 Source: Canada Year Book 1953. Department of Trade and Commerce* Queen's Printer, Ottawa, Ontario* 109 qualified as s k i l l e d workers. The remainder were evenly divided between semi-skilled and unskilled classifications. Birth pieces. Birth place was l i s t e d for only ef the 60 adults i n these 35 cases. Results, showed that of these 100$ are ef Canadian or B r i t i s h origin. Two of the Canadians are native Indians. 5; Birth datesa These st a t i s t i c s indicate as far as these 35 cases are concerned that the cases originated i n the agency while the clients are s t i l l relatively young, i n summary, a) 21$ of the adults were from 18 to Z6 years of age at the time they f i r s t became clients of the agency. b) 81$ of the adults were under 36 years of age at the time they became,clients of the agency, e) 98S> of the adults were under U6 years of age at the time they became clients of the agency. 6* Ifcrriage, date. The marriage date was l i s t e d for only 61$ of the married couples* . Of these only one had been married for more than 11 years at the time they f i r s t came to the Family Service Agency. The median length of time married at the date the case originated with the agency was five years. 7. Religion. This information i s l i s t e d for only half of the 22 couples concerned. I t shows that $h$ were of the same religion. Where the religions differed, one partner was usually a non-pract* icing Roman Catholic. 110 8. Source of Application, Information available on s l i g h t l y over half the adults concerned shows that the majority, 70$ were self-referred* The rest were referred by other social agencies chiefly, or by schools, doctors or ministers* 9* Social Service Index* Heariy half (U?$) of the cases show no previous l i s t i n g s with the social service index prior to 19&> or 19U6. Where there are previous l i s t i n g s the number of such l i s t i n g s ranges from one to eleven. 10. Presenting Problems, The face-sheets l i s t e d an average Of 2.2 presenting problems per case. However i t should be noted that t h i s i s an understatement as presenting problems are frequently l i s t e d on the sole basis of intake information which,, to a considerable extent, i s the Client's own assessment of his problem or problems. This i s considered further i n the analysis of the seven cases for intensive study* Presenting problems are about evenly divided between those which, can be described as emotional or personality d i f f i c u l t i e s , and environmental problems. Usually such problems are present i n combination* This i s discussed f u l l y i n the body of the study* J L 3 J L . , Table 6. ^ g | j 3 H j y ^ (Family Service Agency, vaae o u v e r j l ^ l ^ ^ S ) ( i l l u s t r a t i n g also wsplit-halves n method of assessing consistency of samples) 1. Age of Husband (Pate of Intake) 1 Age Sample A . Sample B Total Under 21 0 1 1 6 21 * 2U 3 3 25 * 29 5 ? In 30 * 3tt 15 9 2k , 3 5 - 3 9 8 8 16 UO - U9 7 9 16 6 50 or older U 2 Hot known , 50 52 102 Totals 92 . .. :. 93 . • 185 ... Family Size (1955) 2 Size of Family Sample A Sample B Total (Children 1955) No children 2 •* 2 1 m 20 3U 2 21 28 U9 3 17 20 37 it 16 lh 30 5 or more 15 9 2U ..not known 7 2 ... ,9. .... Totals 92 93 185 How SiOng Married (Bate of Intake' 1... 3... . No. of Years. Sample A .. Sample B Total Up to 1 year 2 1 3 1 • 2 3 0 3 3 - U k 8 12 5 * 9 6 7 13 10 or more k U 8 Those i n which) marriage post-) dates date of) 1 3 10 origin. 66 Not recorded 70 136 Totals 92 . 93 . 185 1 This table shows good comparability 2 There may be some question as to whether family size i s a representative factor i n such eases, 3 This table i s of l i t t l e significance except to show gaps. 112 Table 7. Pathology i n HulttorgblemFaMIies 1. - •  • • •. ' - - '• -. ffaal. Project..'..,. ,~..... Pathological Element Present Kumbar • Bepeadent-. -• . 5000 Seriously maladjusted $000 Serious i l l - h e a l t h $000 Chronic i l l n e s s . . . 2200 ...... . Chronic handicap ., 1700 Antisocial behaviour 2100 Mental defectiveness . 1300 Failure to meet soeial responsibilities...2600 Total families (6,1$ of a l l families i n the. . r.., .. . .... ,.. community) 1 Source! Buell, Bradley and Associates, Community Planning For Human Services: Columbia University Press, New York, 1952 P. U12. 2 One family may exhibit more than one defect* APPEMDIX B 113 FAMILY A A. FACE-SHEET INF0BMAT10II AT TIMS CASE FIRST QFMSg AT FAMILY SERVICE AGMGY Sate Case jetted Man Woman Sate of Marriage. Children at thie Sate January*: Born i n Alberta* 1902 (U3 years of age at this time) Born i n Manitoba, 191U (31 years of age at this time 1930 (Wife age 16, man 1, Diane 2, Wilbur 3, Lorraine 1*. Louise 5* Nadine 6. Gordon Protestant Personal Regina Welfare Bureau, August, 1938 APAC July* 19U3 b. 1930 ( 3 months after marriage) b. 1933 b* 1935 b* 19li0 b. fe.- X9hk Religion Source of Application Sooial Service Mstings  At This Time Presenting Problems Marital, c h i l d care, personality, illness* B. ADDITIONAL FACE-SHEET IHFQKMTION AS OP lft55 Children born since 19U5 Social Service Listings Since 19U5 7* 8. G i r l C.G.C. G.X.S. P* Pay, S F. D.G. P* Gt* M.H.C. G. A.S. V.G.H. P. Psy. S. J.C* G.A.S* July, 19U5 jNcember, 19U5 July* 19I46 . August, 19U6 July, 19U7 June, I9I1S June, 19li8 December, 19U8 October, 19lt8 October, 191J8 March, 1952 1 Certain items of Face»sheei information not diagnostically or s t a t i s t i c a l l y significant (including a l l names), have been disguised i n this and the following s i x abbreviated records* Hit In January X9h$ Mr, A came to office requesting aid on a marital problem. He complained that another man (Hr. I»), who wee separated from b i s own wife but not divorced was "stealing his wife's affections". He said that his wife i s having relations with this man end that She had recently taken Mr. It's two small children i n to home to board them. This was greatly resented by Mr. A.* and he wants them removed, Mr, A. said the family had come to Vancouver i n 191*3. Prior to that he said they had been on r e l i e f i n Eegina "for several years". ( I t was later established at approximately 12 years * i.e . * throughout the depression). Mr, .A. Said his wifV i s . working as a waitress. He i n d i -cated resentment of this,- saying she can't do housework, properly, l e t alone work, Mr. A. said his wife has varicose veins. Mr. A. said he s t i l l loves his wife and wants agency help i n keeping her away from the other man. The caseworker recorded that Mr. A, i s "not physically prepossessing". On February 6, %9h$9 Mrs. A. came into the office. She i s described as "nervous and tense". Hrs, A, said she loves Mr, 2*., and has never been nappy with her hsuband. Mrs. A, said her husband drinks, gambles, works only intermittently, (he i s a painter by trade)* neglects her and children. She said she married Hr. A. three 22$ months before -the b i r t h of Diane at his request. Mrs. A. said she was oldest of six, unhappy at home, and told to leave home by her father when she was fifteen. She went as far as Grade 9 i n school; her husband completed Grade U* Mrs. A. expressed concern about what w i l l happen to her children i f she enters into common-law relationship with Mr, L* On March lU> 19U5, the worker visit e d the home of the A. family and reported i t as a two story frame house i n poor condition » dark, dirty, and i n need of paint. Mr. A. expressed concern about Mane going out with an "older crowd". (Diane has JU.Q. of 115). On the next day Mr. A. came into office very upset about one of the children finding Mrs, A. i n bed with Mr, L. In A p r i l 19U5> following the discovery that Wilbur, who i s age 12, and doing poorly i n school (Grade U), has an I.Q. of 70, there was a case conference about him, attended by Children's Aid Society, Alexandra House, Health C l i n i c , and Family Welfare Bureau representatives. Later that month Mrs. A. bought a cafe i n partnership with another woman. (The subsequent records indicate that Mrs. A. remained i n restaurant business, to which she devoted considerable time and energy. The financial returns seem small). In May 19U5 the L. children were removed from the A. family 116 by Mr. L, Mr. A. plans to sue Mr. L. for "alienation of affections". Mr. A never does, but the records show that throughout the next two years he repeatedly refers to the p o s s i b i l i t y ) . Later i n the month Mr. A. reported that "things are patched up" with his wife. He goes into hospital for prostate operation, . In June 19k5 the A's expressed concern over Diane's "tear-ing around". Later that month a new worker Visited the A home and re-ported emotional immaturity of Mr. A, who told the xrorker that he S t i l l loves Mrs. A, but she i s s t i l l seeing Mr. L., and must be stopped, Mrs. A.' expressed c r i t i c a l attitude to Diane( at same time she has apparently abandoned any effort at trying to control her hours, tru-ancy, etc.) Worker,reported children neglected, "dirty, unkempt". In July, 1°U5, C.A.S. held a case conference on A. family. Later i n the month Diane again stayed away from home overnight. Psy-chiatrie consultation was held at Child Guidance Clinic re Diane, and the psychiatrist reported "a poorly adjusted personality" and recom-mended a foster home. During July, 19h$, Mr. A. went back to the hospital be-cause of his prostate, Mrs, A, complained of financial d i f f i c u l t i e s , and the fact that Diane was staying out a l l night and associating with prostitutes. At the end of the month Diane came to the Agency office. She was extravagantly made-up and dressed. Worker described her as "attractive and self-possessed". During the interview Diane said she 117 would prefer a foster home (rather than boarding school). She ex-pressed a strong d i s l i k e for father - admiration for mother. ( I t may be noted here that Diane subsequently did not go to either a foster home or boarding school). . Early i n August, 19h$9 Diane t-ras picked up by police i n a cafe at 3 A.M. Charged with promiscuity, but released* Later i n same month Diane came into the agency office. . Told worker she i s not promiscuous .•*> but was raped by a boy one night i n a park on way home from dancing when she bent down to t i e shoe lace. Diane appeared i n juvenile court later i n the month on a charge of i n c o r r i g i b i l i t y . Judge urged a foster home. During the next three months the pattern continued the same. Mrs. A. became i l l with pleurisy, Mr. A. worked intermittently. Mr.L. l e f t Vancouver, presumably to f i n a l i z e his divorce i n Winnipeg* Diane was seen drunk on the street. In December, 19U5* Diane again l e f t home. Told worker that her father threw a knife at her. The same month she got a job but as on an earlier occasion quit after a few days. Towards the end of the month she was picked up by the police.in company with some juveniles i n possession of stolen goods. She was sentenced to an indefinite period at G i r l s ' Industrial School. In January 19U6 Mr. L. returned to Vancouver and moved i n with a young woman who he was reported as wanting to marry. In Feb-ruary 19U6 Mr. A. gave his wife a severe beating. During the month 118 another C.G.C. conference was held x-jith respect to the A. family. I t found "a pattern of emotional immaturity" and recommended that Mrs. A. be brought i n for further work. During the early summer of 19U6, Mr. A. was largely un-employed. Mrs, A. H a s depressed, started drinking heavily, and. threatened suicide, ta June 19U6 the psychiatrist at C.G.C. interviewed Mrs, A. and reported "he could not offer much hope regarding the F.W.B. con-tact with Mrs, A. as she appeared to get no satisfaction from her marriage or her children." i n August 19U6 Mrs. A. told the new worker at F.W.B. that she i s "sexually repelled" by her hsuband* and can't bear to have him touch her. At the same time she expressed further concern over the welfare of the children. In this same month there was another C.G.C. conference re Diane who was reported as making "a good adjustment" at G.I.S, The conference also concluded that "the home marital problems i s not treat-able." In September, 19U6 the case was transferred to. another worker who recorded more fighting at home, continued neglect of the children, and more drinking by Mrs. A. I t i s also learned about this time that Mrs. A's parents were divorced when she was young, and that during her teens she had sfltacks resembling "epilepsy", 119 In October, 19U6 Diane> was released from G.I.S. She , started again at High School, but almost immediately resumed her old ways. For the rest of the year we get a pattern of truancy, staying away nights, iritermittent jobs, drinking and general delinquency from Diane* The parents were fighting steadily, and Mr. A. -was again hospitalized for his chronic eczema* In December, 19U6 C*A>S. held another, case conference re Diane and reported that "the outlook was not hopeful". In January, I9u7 Diane tol d the worker that her father h i t her with a poker and tried to get "fresh" with her. (This i s not sub-stantiated)', . . •. ' During the summer of 19U7 the family situation appeared to deteriorate further. Mrs* A. continued to drink excessively, and was hospitalized because of "trouble with tubes", and gallstones* The children a l l suffered from acute skin infections'. . Diane had started stealing, from her mother and i n the f a l l married a young man with, a poor social history who went to Oakalla for one year on a charge of theft shortly after the marriage. School authorities reported trouble with the younger A. children. , In February, I9U8 a conference was held with a private psychiatrist* who reported that Nadine, age !>, x*as "retarded1?, and needed a foster home, and that neither Mr* or Mrs. A. were l i k e l y to respond to service from any health or social agency. He said that Mr. A 120 would not leave Mrs. A. - "his source of support". In March 19U8 the C.A.S. held a conference re foster home placement for Nadine. (Ho placement subsequently made). In Ap r i l , 1948 there was reported the fact that Lorraine age 13. was also staying out a l l night. The family had been given an eviction notice with the landlord offering cancellation of two months rent due and $50 to boot. In August, 19U8 Diane was sent to Oakalla on a theft charge and the following month Lorraine was i n Juvenile Court on a charge of drinking. In December, 19U9 Mrs. A again applied for Social Assist-ance but was refused by C.S.S.D* as in e l i g i b l e . I t was about this time that the case was closed at F.W.B., as i t was being carried by C.A.S,, and i t was not f e l t that anything further could be done. However, between that date and the present the case was reopened and closed several times. In June, 1950 Diane was again i n j a i l ; throughout this period the children remained problems both i n and out of school. In 1953 Mrs. A. had her seventh child, and again, i n early 1955 an eighth child, at which time F.W.B. placed a super-vised homemaker i n the home for a,short period. At that time Mrs. A. reported to the agency that family relations were good. 121 FAMILY B A. FACE-SHEET INFORMATION AT TIME CASE FIRST OPENED AT F.S.A. Date Case Opened Man Wife Date of Marriage Children at. t h i s date  R e l i g i o n Source of Application S o c i a l Service L i s t i n g s  At t h i s time Presenting Problems December, 19U5 Born i n Manitoba, 1921 (2U years of age at t h i s time) Bom i n England, 192U (21 years of age a t t h i s time) 19ii3 (Wife age 19, husband age 22) 1. Owen b. 19U5 Protestant Personal F.S.B. Gait, Ontario, %9hS> Economic, alcoholism, personality, m a r i t a l , employment. B. ADDITIONAL FACE-SHEET INFORMATION AS OF 1955 Children born since 19U5 S o c i a l Service L i s t i n g s  Since 19h5 ' ' 2. Donald 3. Twins C.A.S. P.psy 6. T.B.S.S. M.H.C. V.G.H, C.G.C. F. Ct. C.S.S.D. b. 19U6 V i o l e t b. 1950 Leo b. 1950 July, 1950 June, 1951 June, 1951 June, 1951 , 1950 April ,1953 ,1953 ,1953 122 CASE HISTORY In December, 19U5> the Family Welfare Bureau, Vancouver received a letter from the Family Service Bureau i n Gait, Ontario, stating -that Mrs, B's parents t f e r e concerned about her mental health and requesting that the F.W.B. make inquiries. In January, 19U6 -the F.W.B. worker vi s i t e d the. B home. They were then staying at Mr. B's parents' home. The worker reported that the husband was s t i l l unemployed following his discharge from the A i r Force the previous October. The worker also recorded that Mrs* B. had an "odd, furtive look and mumbling voice"* Later i n that month the couple came into the office for a joint interview. The couple quarrelled openly there and Mrs. B. appeared unwell. She expressed some concern about the baby who had been born with two thumbs on one hand* They stated that their f i n -ances were very low* I t was also revealed that Mr. B* had a poor job record before joining the R.C.A.F, He expressed a desire to learn a trade - preferably carpentry. There was f r i c t i o n between Mrs. B* and her mother-in-law. Mrs, B. also said her husband was not interested i n her and insinuated a wish to commit suicide. She had an uncle and aunt who had committed suicide, and another uncle i n a mental hospital; The case was closed at the end of the month when the B's moved back to Gait* In February 19U8 the case was re-opened on the basis of a referral from another agency saying that the B's were back i n town and 123 without resources. They were invited to come i n to the F.W.B* but when they f a i l e d to appear the case was closed. In January, 1950 the case was re-opened when Hr* B." Phoned the agency demanding their help i n getting a coal Company to speed delivery of a coal order. I t was also ascertained that Mrs. B. was just back from the hospital with twins and that Mr. B. was now working i n the Post Office at &1U0 a month. In July of 1 9 5 0 a neighbour of the B. family complained te> , the Public Health nurse that the four B. children "were being neg-lected", and that their U year Old boy "stripping" l i t t l e g i r l s and assaulting them as well as "exposing himself". This was brought to the attention of the F.W.B. The case was closed by a referral to the C.A.S. In November, 1950, the case was re-opened when the parents trere referred to the F.W.B. Mrs. B. came into the office and was re-ported as "immobile1", "confused", and very depressed* She cried dur-ing discussion of her worries about' money and their heavy debts. She also indicated a fondness and concern for the children. She t o l d the agency she was being treated for anaemia at the out-patients 1 depart-ment of the V.G.H. During the month the agency gave her 021 . 5 0 to ' supplement the food and fue l budget. The following month, December, 1950, Mr. B. came to the office. The xjorker described Mr. B. as "tense", "nervous", "immature", "unrealistic". Mr. B. said he Owed about §3000 (actually about $1000). 12k He said that his tiife had been i n the mental hospital i n Gait, Ontario, for three months u n t i l he signed her out (later established as schizophrenia). Mr. B. complained about their poor marital re-lations. He said, that he only knew her three months before marriage, that he had never intended to marry her, that she was jealous and hysterical. He also said that after marriage he nearly l e f t her be-cause of her insatiable sexual demands. He blamed his wife for her l a s t pregnancy saying she did i t to keep him* The B. heme was again v i s i t e d this month and Mrs* B. was found to be very worried, partly because she thought she was pregnant, and again Contemplating suicide. Mrs. B. was again given financial assistance, and a budget drawn up. In early January of 1951 Mr. B's brother who was just out Of Oakalla moved i n with them. Further financial aid was given them by F. i n B, Later that month Mr. B. was. arrested for non-payment of a b i l l , but was bailed out the following day by an uncle* Mrs. B. was very upset by this, Mrs. B, was found to be not pregnant, but did not t e l l her husband of the fact. She was now attending O.P.D. at V,G.H. for her defective Vision* On February 1951 Mrs, B. developed a bad rash on her hands. The C.A.S. also received an anonymous let t e r complaining that the children were being neglected* During March, 1951, the family continued to have serious 125 financial problems and Mr. B, complained that his wife refused to use the pessary supplied by V.G.H. O.P.D* During March, 1951, the family continued to have serious financial problems. Mrs. B. continued unwell, and the O.P.D. planned a psychiatric consultation about Mrs. B. Mrs.3. was reported as con-tinually f a i l i n g to keep V.G.H. appointments. During the following three months three different workers had this care. A l l of them continued to work with Mrs. B. on budget-ing, and the F.W.B. supplied intermittent financial aid. In August,, 1951a Mrs. B. became i l l with asthma. During an interview i n October 1951, Mrs. B. mentioned the pos s i b i l i t y of an operation on her "i-jomb". She also said her mother was now i n a mental hospital, (This later proved to be untrue) and expressed worry over how hard her husband was working. Mr. B. was i n the office during the next month at which time he complained of his wife's neglect of the house and children and said that i f i t wasn't for the children that he would have already l e f t her. In these and succeeding months the family continued to receive intermittent financial aid from the agency* In mid-January, 1952, Mrs. B, came into the agency and ex-pressed concern over her husband's health. She said he worked very hard. At the end of the month a cade conference on the B family 126 was held with'Miss Wolfe, the agency* s consultant. Mrs. B. continued i n poor health and seemed to become increasingly dependent on her husband* In February, Mr. B. phoned the agency to enquire about . . committing his wife to F.M.H* He also complained about his wife's . i •• constant lying. * A budget survey was made by the worker i n March and i n d i -cated debts of $575. s t i l l outstanding. The worker f e l t Mr* B was unrealistic about money and debts* In A p r i l 1952 V.G.H. Q.P.D. diagnosed Mrs. B. as< schizo-phrenic. Discussions were held about 'Mrs* B. going to Grease* Mrs. B. indicated Strong opposition to the idea, expressing strong fear of "those shock treatments". As.a result such plans were not furthered. In May a second consultation was held with Miss Wolfe, who said Mrs. B. was "pre-psychotie" and recommended placement for the children* A net? worker took over the case that month* She was a young, attractive woman, and for several months Mrs. B* resisted every effort the worker made to see her husband. In June Mr. B. quit his post office job. He claimed he did this because they had refused him a lighter job which he had requested beoause of his rupture* ( I t was later learned that he quit because he was to be discharged for drinking). 127 Mr;* B« then got a job as bus driver for the B*C* Electric. During his six weeks of training his rate of pay was to be 65 cents per hour. That same month tbeB* family was threatened with eviction but this was averted. In September Mr. B, was f i r e d from his job for drinking and announced that he was going to Eitimat. During the next three months he sent his family irregular small amounts of money. ( I t was later learned that he never l e f t Vancouver, Instead he got a job driving a ta x i and was reported to have drunk and gambled heavily * during this period,) . In December, 1952 Mr. B. was again unemployed and for a time the family was a social assistance. From January,, 1953 to March 195U numerous v i s i t s were paid the Bjs <* almost one per week*. During this time a C.G.C. re-f e r r a l was made and the psychiatrist advised that the family be kept together. On one occasion the police had to be called when Mr, B. beat up his wife. Mrs. B. continued to be i l l but resisted treat-ment. Mr. B. showed considerable h o s t i l i t y towards the agency, He was.operated on for hernia.during this period. During 1953 Mr* B. joined the Foursquare Gospel Church and reported that he had "re-formed", , A p a r t i a l survey by the Agency showed that between Nov-ember 1950 and December 1953. the family had received #13u9 i n direct assistance. 128 In June 19$U the Agency received a phone call' from Pearson T.B, hospital saying Mrs. B. had just been admitted with advanced T.B. Six weeks later Mrs. B, l e f t Pearson of her own accord and was subsequently put into Ward R, v",G.H, for investigation. Shortly after she returned home. The case was closed about this time as i t was i n the hands of other agencies. In May, 19$$ the case was re-opened with a phone call, from Mrs, B. She sounded cheerful and said that things were much better and that her husband was now working for Shell. However, she said she required more money. Mrs. B. was referred to the Poppy Fund and the case again dosed, . 129 FAMILY C A. FACE-SHEET INFtSMSTJOJI AT THE TIME .CASE FIRST OPENED AT P.S.A. Date Case opened  Man Wife Date of Marriage  Children at this date Religion Source of Application Sooial Service Listings  At •this date Presenting Problems May 19U6 born i n Manitoba* 1915 (31 years of age at this time) born Ontario 1917 (29 years of age at this time) 19U1 (wife age 2h, husband age 26) 1. John b. 19U6) 2. Joseph b. 19U6) Twins Protestant V.O.N. VON 3/U8 Economic, personality, physical i l l n e s s , marital. B. ADDITIONAL FACE-SHEET INFORMATION AS OF 1955  Children born since 19h$ . 3. Marion b. 191*7 Social Service Idstin^s Since 19U6 ' D.V.A. (psych) 3/hS 130 In May, 1$U6 the V.O.H* enquired whether the F«tf«B, could provide any financial assistance to this family with heavy medical expenses, Mr. C. i s a discharged R.C.A.F, now working i n the shipyards for §1E>0 a month. Mrs. C, had twins i n March, 19U6-Both have been i l l since, one i s now i n hospital. Mrs. 0* extremely upset and overworked. An attempt was made to get aid through the Airforce Benevolent Fund who did give assistance. In July, 19U6 the psychiatric department, D.V.A., re-ferred Mr. G. to F.VJ.B. Mr. C was reported as being resentful of the children, annoyed with Mrs. C s incompetence. Mr.C. had been examined i n this department i n October, 19k$, for headaches and general de-pression. His father apparently suffered from the. same problem. Mr. C* was to have a further examination through the psychiatric department. At this time the V,0*N* also reported that the C*s were l i v i n g i n a not too adequate three room basement suite. They also reported that Mr. C. has seemed tired and distraught and indicated to the V.O.N, nurse that he hoped the smaller twin would die. He seemed to have gui l t feelings about t h i s . Mrs. C. was reported to have spent an unreasonable amount of money on furniture against Mr. t C»e wishes* A l i t t l e l ater i n this month Mr. C. was seen by the D.V.A. psychiatrist who recommended supportive help from F.VJ.B, Mr. C. found over-anxious, needed to be mothered. 331 On July.19, Mr. C. came into the office. He was des-cribed .by thr worker as a " f a i r l y nice looking, well b u i l t young man. His complexion i s dark and he wore f a i r l y thick glasses", . Mr.C. confessed impatience with bis wifels handling of the children* One of the twins was again i l l , and might have to. be hospitalized. On July 22 the x-jorker v i s i t e d the C home. Mrs. C. i s des-cribed as "a rather plump young woman, medium height* dark uswept hair, glasses". Their suite was Clean and eomfortable., ,-On.e twin was i n the hospital with diarrhoea - the other looked thin and pale. Mrs. C seemed proud and fond of the baby. She Said .the doctor had said something about the twin's poor condition being due to an EH. factor i n her blood* She also talked about her d i f f i c u l t y handling the twins, and her fear of doing the wrong thing. Mrs. 0. also ex-pressed concern over her husband's continual xwrrying. In August the psychiatric report on Mr* C. was received. I t revealed that there was considerable discord between his parents * mainly over money, Mr. 0, said his wife had "talked him into marriage". In 19U3 they separated for an IS month period. Mr. C, was diagnosed as "psycho-neurosis,, anxiety state* hypochondriases. Prognosis guarded". I t was f e l t that F.W.B. could help Mr. 0. Mr, and Mrs*0 were seen by the worker on August 16. Mr. C had been l a i d off work the week, before and had found i t impossible to find another job. . Mrs, 0 was going into the hospital that night to have a l l her teeth re-moved. One twin waS s t i l l i n the hospital. Arrangements were made to 132 have the xrell twin examined at O.P.D. Mr. C. told the worker he was feeling better and more settled. On August 2Uth the worker drove Mrs. G. and -the baby to the Clinic. Mrs. C* expressed concern for her husband because he tri e d too hard to help. She said that she feared she was again preg-nant and said she would seek an abortion i f she was. The other twin was to be released from the hospital next day. On September 1U Mr. C. phoned requesting help for Mrs.C. The worker called two days later. Mrs. C. had been ex-tremely nauseated and unable to cope with the twins. A supervised homemaker was discussed, Mrs, C. said that her husband was again working but dissatisfied with the job. Also their expenses were heavy and burdensome, A supervised homemaker went into the C. home on the 23rd and remained for about s i x weeks. In October Mrs. C. was found to be pregnant. The doctor said there was no reason why the child should not be healthy. Mrs. C. was, however, apprehensive. Mr. C. complained that his employment was not steady and that the house was inadequate. The worker suggested he apply to the Wartime Housing Committee for a house. In December, 19U6 Mr. C. changed his job. Although Mrs. C. said, he was depressed at times, things seemed more satisfactory. In March, 19U7, arrangements were made for a supervised 133 homemaker. Some planning was done on the budget and the C. family were advised that they would be ablo to move into a Wartime House at the end of the month. At this time Hr. C's earnings were $lU5. a month. On March 26 a g i r l was born. I t was premature about a month but i n good condition. A supervised homemaker was placed. During the following months family affairs seemed to go f a i r l y well except for debts which were relieved by Mr. C. going fishing. In August 19U7 Mrs. C. said she and her husband were most happy i n their relationship and therefore f e l t no further need for further services. Accordingly the. case was closed. In February I9U8 the case was re-opened when D.V.A. re-ferred Mr. G. to F.W.3. for casework services. In March Mr. C. came into the agency. He appeared dis-traught and was worried about his expense. The agency agreed to accept Mr* G. for casework services i f a psychiatric report would be given from D.7.A. to the effect that such would help him. As no report was received the case was closed at the end of this month. There was no contact with the family for the following 6 years. In February, 1955 Mr. G. appeared at the agency. He said he wanted help with budgetting as his wife was running up b i l l s . 13U Mr. C. said he was now in. the Navy. He said he sent h i s wife §1U0. every two weeks and wondered where the money went. Some discussion followed and i t was suggested that Mr. C. contact the North Vancouver office for further help. Mr. C. did not contact the North Vancouver office and the case was closed i n March 19$$. 135 FAMILY D A. FACE-SHEET INFORMATICS AT TIME CASE FIRST OPENED AT F*S.A. Date Case Opened Man Wife Date of Marriage  Children at this Date  Religion Source of Application Social Service Listings  At this time Presenting Problems August 19n5 Bora i n Sask. 1923 (22 yrs old at this time) Born i n Eng. 1920 (25 yrs old at this, time) 19U0 (man age 17, wife age 20) 1. Jane b. 19^3 Man - Protestant Wife - Hebrew Citizens' Rehabilitation Council N i l Economic, marital, personality B. ADDITIONAL FACE-SHEET IWQBMATIOHAS: OF 1955 . Children bom since 19U5 • 2, Joseph b.. 19U8 336 On August 1, 19U5, the Citizens Rehabilitation Council referred Hr. D. to the F.W*B. He was requesting a loan to help establish his family i n Vancouver. Mr. D. had married a Jewish g i r l i n England i n 19i*0. She had preceded him back to Canada with their 2-1/2 year old c h i l d and had; stayed i n Regina u n t i l her husband joined her there. They had then moved to Vancouver where' they had arrived a few days ago without funds; Mr. D, wanted to get permanently settled at once and requested a loan i n order to purchase furniture. He was opposed to the idea of moving into a furnished Suite temporarily. Mr. D. was vague about his future plans other than to say he wanted to take a D.V.A. course i n building. The agency told Mr. D. that they could not give him the requested loan but said that after he found suitable place they might give him some assistance i n order to help him re-establish himself. -The following month the agency received a telephone c a l l from the Overseas War Wives Committee saying that Mrs. D. had been Into their office. She had been very upset and told them that her husband was non-Jewish and that she did not f e e l accepted by h i s people. Her one idea was to return to England with the baby. The case was referred to the Seaforth Auxiliary for them to determine whether i t should be referred to a casework agency » either the Family Welfare Bureau (now Family Service Agency (or the Jewish Family Welfare Bureau. 137 In January, 19U6 the C.R.C. called again. They said Mrs. D. had been i n to their off ice c»B^laining.that her husband was constantly drunk and neglecting his family. I t was agreed that C.R.C. would try to have Mrs. D. come i n to the F.W.B* However, Mrs. P. did not appear and i t was not u n t i l March 1?5>5» that she was heard from again when she appeared i n the Agency office. . Mrs. D talked of her unbappihess i n Canada, of her husband's physical abuse of her, and their heavy debts. She said he had had frequent periods of unemployment and that .they were heavily i n debt. They had an outstanding, bank loan of $2000. Mrs. P* said that she married i n England when she was 18 and that immediately after that her husband had gone to Italy to fight. Her baby was born shortly after and i t was about that time she ex* perienced the terrors of bombing. Some shrapnel had entered her shoulder and pierced her lung. Because of her extreme nervousness as a result of this experience she and her baby were evacuated to ^ Canada. The worker described Mrs. 0. at this time as a f a i r l y t a l l and slim woman, but with an "extremely diffident" manner, perhaps due to the fact that she was trying to hide the fact that many of her lower teeth were missing* For 18 months, up u n t i l a few months ago, Mrs. D. had been working i n a laundry, but she quit because of the disadvantages to the children. Mrs. D. described her husband as quiet and studious. He 2 3 8 disliked going out although she would have wished i t . Hrs. D. said she could understand her husband's attitude as he was not a very outgoing man. She said that he had been un-happy as a child and that his mother died when he was only a few months Old, ., Hrs, D, f e l t that i t might help her feeling of depression to talk things over with the worker who could also help her find some recreational outlets. Another appointment was made for Mrs, D. She did not.keep i t , phoning to say that she had returned to work -this time i n an office. She was phoned again i n Hay (1955) and another appoint-ment made. Hrs. D. did not keep this appointment* The case was therefore closed. 339 FAMILY E A." FACE-SHEET INFORMATICS AT TIME CASE FIRST OPENED AT FAMILY SERVICE AGENCY Date Case Opened Man Woman Date of Marriage  Children at this date Religion Source of Application Social Service Listing  At this Time Presenting Problems May 19l|6 Born Saski 1918 (28 yrs Old at this time) Bom Eng, 1919 (27 yrs old at this time) 191*2 (Man age 2k, wife age 23) 1. Gloria b. 19U3 2. Peter b. 19U5 Man - Roman Catholic Woman - Protestant Personal N i l Marital B. ADDITIONAL FACE-SHEET INFORMATION AS OF J.9% Social Service Listings since 19U6 P.Psy S, Red Gross In May* 19U6 Mr3. E. telephoned the Agency requesting immediate help saying she was having d i f f i c u l t y with her in-laws, that her husband was bullying her, that she had no friends and that she wished .to return to England* In her f i r s t interview that month Mrs. E. explained that she was married to Mr. E. who was then a p i l o t officer i n England, knowing him five months. In 1?U3 they came back to Canada. He went to the. station at Lethbridge and she moved i n witli his relatives, where, however, she said, she was not made welcome so she joined her husband. However, through the intervention of a clergyman they were reconciled. They then decided to have another child. Mrs. E. thought i t would improve their relationship. But fighting started again, and Mrs. E. said that even during her pregnancy Mr. E. beat her* She described him as cold, conceited, dishonest and without feeling or affection. On his discharge they moved to Vancouver where they stayed with friends at f i r s t i n over-crowded quarters. Mr. E. joined the police force. Mrs. E. said she cries a great deal and has pleaded with him to change but he only considers her hysterical. She said her hus-band likes his job principally because he looks well i n uniform. She said he i s a heavy drinker and i s nice to her only when he wants money or intercourse. She said that while she came from a happy and affec-tionate family, her husband came from a broken family. She stated that Mr. E's mother died when he was two and his father remarried an i i a alcoholic and that the family lived i n hotels. When. Mr. £. was 1 5 his father committed suicide. At a later date a brother also comm-itt e d suicide, and another brother was imprisoned for manslaughter at the age of nineteen. The worker described Mrs. £. as "very emo-tional and upset". At the end of the month the worker telephoned Mrs. E. and suggested an interview with her husband. Mrs. E. said that things were going better and that she feared i f the worker saw Mr. E. i t might up-set things. She said that she would l i k e to see the worker again, and also mentioned the po s s i b i l i t y of she and her husband seeing a psych-i a t r i s t . Mrs. E. mentioned that she thought her husband to be queer and peculiar. She also asked the worker i-jhat she thought of the idea of her going to England fon6 months to help make Mr. E. realise whether he really loved her. The worker replied that she f e l t so long a separ-ation would erect barriers. In June, 19U6 this case discussed at the Psychiatric Clinic but the psychiatrist said Mr. E. would also have to be seen before any plan could be made. Later that month the worker called on Mrs. E. Mrs. E. told her that the week before her husband had come home drunk, thrown her on the bed and spanked her t i l l she was black and blue. Then he had cried. However, since then, she said, things had seemed better. She also told the worker that she obtained no pleasure i n the sex relationship and since her husband became annoyed when she fa i l e d to reach a climax she feigned one. The worker suggested she see a doctor about this. Mrs. E. i i i2 s t i l l wanted to take a t r i p to England^ but the worker again advised against i t . As well Mrs. E, s t i l l opposed the idea of the worker -seeing her husband* At the end of the month Mrs. E. phoned the agency saving that her husband had found out about a $50 b i l l she was supposed, to have paid. He was very annoyed and beat her severely, she claimed* The worker again suggested she see Mr. E. but Mrs, E. demurred saying •' i f she suggested this to her husband he would k i l l her. She later changed her mind and suggested the worker c a l l the next day at l.F.M. When the worker called the next day Mr. E. was s t i l l i n bed. He at f i r s t refused to see her, saying his wife could go back to Eng-land i f she wished. A few minutes later he invited the worker and his wife to come into the bedroom to see him. The worker described him as "very good-looking, clean, and well-groomed". Mr. E. told the worker • that he was sick of his wife's hysteria - that she was a poor cook and housekeeper and that he did not beat her but merely slapped her to stop her hysteria. Mr* E* said he wrote to his wife's father about her and he replied that she had always been that way. Mr. E. also said that his wife's parents did not get along and Mrs, E. agreed. ( This contradicted an earlier statement of hers. - May* 19U6). Later, on this occasion, Mrs. E. commented that she did not want to repeat the misery of her own mother who was constantly bull i e d by her husband. Mr. E* told the worker that he had not wanted to get married u n t i l they arrived i n Canada, but that she had thrown such a tantrum that he had agreed to XU3 marry her i n England. He also complained of ..sex relations being unsatisfactory since the b i r t h of the children. On the following day Mrs. E. telephoned the worker to say she f e l t everything was going to be fine as her husband had promised not to his her again* She said that. Mr* E* had been greatly impressed by the xforker when she said her husband did not beat her* In July 1?U6 Mrs. E* was given help with her budget and loaned a couple of books on Sex and Marriage. In August Mrs. E. told the worker that she was going to England i n September for a year, during which time she and Mr. E. would decide Aether to divorce or l i v e together again. The case was subsequently closed. In March 19U? the City Police Department telephoned regard-ing a let t e r from Mrs. E. i n England saying Mr. E. had promised to Supp-ort her but was not doing so. The letter also described i n some det a i l Mrs. E's complaints about her husband's general behaviour. The police were informed that Agency information was confidential and Mr. E's per-mission would have to be obtained before further information could be released. The case was re-opened i n D ecember 1°U8 when the Red Cross telephoned to refer Mrs. E, who had l e f t home with her children follow-ing an assault by her husband. Mrs. E. came into the office of the P.W.B. that same day with her two children. She launched into a spirited attack about her husband's brutality and his changeable moods since her return from England* She said he had beseeched her to return - telephoned long lUU distance several tames, etc. She said she wanted F.W*B.,- or other help i n staying away from home a few more days "just to show him". She expressed great ambivalence about her feelings about divorce. She also requested that theAgency arrange a psychiatric examination for her husband. Although arrangements were made with Mrs. E, to see the d i s t r i c t worker, she telephoned to say that she did not think she would come i n as she had returned to her husband and things seemed to be better; Accordingly the case was closed again. There was no further activity on this case u n t i l November, i?5U, when Mrs. E. telephoned the Agency asking fOr an appointment. She sounded extremely upset, ciy :ng and near-hysterical. She said she had gone to . I her she could either accept f was under a doctor's care for her nerves. A few days later Mrs, E. came into the office. She i?as "agitated" and gave the impression "of being under great tension". The worker also commented about "an impression of dullness". Her chief complaint was about her husband's i r r i t a b i l i t y - particularly about her housekeeping habits. Her description of her husband suggested he was a perfectionist. She talked about his brutality but how she could not leave him because of losing security. The worker explained the p o s s i b i l i t y of using the Family Court as a resource i n such cases. The worker also proposed that Mr. E, be brought i n on interviews. Mrs. E, agreed to this and said she would 2k$ telephone the worker. * At the end of November, Mrs. E. telephoned. She said -Mr. E. had refused to see the Agency but had agreed to see a psy-chiatrist. Mrs, E. seemed hopeful about this plan and saw no fur-ther need of Agency services. The case, therefore, was closed again, -3li6 FAMILY F A. FACE-SHEET INFORMATION AT TIME CAStf FIRST OPENED AT F.S'.A. Date Case Opened Man Wife Date of Marriage Children at this date Religion Source of Application Social Service Index  Listing at this date Presenting Problem June l$k6 Born i n Ontario 1918 (28 yrs of age at this time) Born i n Alberta 1920 ( 26 yrs of age at this time 19U2 (Wife age 22, husband age 2U) 1. Steven 2, John b. 19U2 b, 19UU Man - Protestant Wife - Greek Catholic (N.P.) Personal N i l Marital, personality, substitute care of children. B. ADDITIONAL FACE-SHEET INFORMATION AS OF 1955  Children born since 19U6 3. Gail - I9!i7 Social Service Listings Since June 19U6 F. Ct. 11/U6 M.H.C. 31/gl F* Ct. 10/55 lit? In June, 19h$ Mrs. F. phoned the Agency saying she wished to discuss the placement of her two children because of marital con-f l i c t . Mrs. F. came to the office and was described as a "tiny, neat, attractive woman with a pleasant manner. She appeared "self-contained" and showed l i t t l e emotion. Mrs. F. complained that her husband had a violent temper and would sometimes strike her or the children. She f e l t the quarrelling was bad for the children, and thought they should be placed while she t r i e d to establish a home away from Hr.F* During this interview Mrs. F. said she came from a large family, that her parents were not happy be-cause the father was shiftless. She had completed Grade 10 i n school and looked after herself since, working as a domestic. She said she did not wish her children to experience the same unhappiness and i n -security she did. Mrs. F. described her husband as unhappy and insecure. He had had l i t t l e affection at home and was frustrated because after completing Grade 11 he had been unable to achieve his ambition to become a lawyer. She also said that both families had found depression times hard. Mrs. F. went on to talk about Mr. F's "bitterness", saying he had a very poor relationship with his religious, autocratic mother. He had enlisted i n the Navy during the war but was discharged after five months because Of a minor heart condition which does not incapacitate him i n his present job of electrician at $U8 a week* Mr. F feels this i s not enough money. At this time they were l i v i n g i n cramped unfinished quarters i n the basement of Mr. F's parents with whom<. relations appeared ULi.8 f a i r l y good. Mrs. F. said Mr. F. had been most insistent about marry-ing her. On one occasion about two years previously Mr* F. had beaten her up when she was pregnant and the police had been called. Mrs* F. moved away for three days but returned xohen her husband expressed con-triteness. Mrs. F. said that i n between quarrels Mr. F* i s quite con-siderate and i s a good provider. Mrs. F, appeared indecisive about her idea of leaving home and was unwilling to lay an assault charge i n the Family Court. Mrs. F. said that she thought her husband s t i l l loved her and claimed she was s t i l l very much i n love with him. The worker discussed the desirability of also interviewing Mr. F. with respect to this problem. Mrs, F. thought this a good idea. Later that month Mrs. F. telephoned to say she had had a long discussion with her husband who had, she said, admitted his responsibility for the problem and promised to change. Mrs, F. was defensive about her husband being "a l i t t l e b i t on edge" because of hard work but now f e l t that things would remain improved. The case was then closed. In December, 1°U6 this case was re^opened after a referral from the Family Court, Mrs. F. had l e f t home and moved i n with her sis ter, taking Steven with her. Mr, F, had gone and taken the child away, and his mother was now looking after the two children, Mr. F, was phoned and given an appointment, which, however, he cancelled l a t e r , advising the worker that everything was now a l l l i g h t . The case was again closed* On October, 19U7, the case was re-opened then Mrs. F. asked, for an appointment to discuss her marital problems. She later appeared 1 U 9 at the agency looking drawn and tired*. Also she. was advanced i n pregnancy. She revealed that there had been further quarrelling and some consultation with a lawyer about a. separation* She also complained of her mother-in-latr's meddling. The family was now l i v i n g i n a temp-orary two room shack without plumbing behind some stores Mr. P. was building, Mrs, F. complained of her husband's unpleasantness and j e a l -ousy. She said that althoug he now made over $200 as an electrical i n -spector he only gave her $50.a month while he spent money freely on drinking and gambling. Mr* F. has told her he: would divorce her except for the children. Mrs. F. spoke b i t t e r l y about her pregnancy saying she did not want another c h i l d because,of her husband's lack of respon-s i b i l i t y . Mrs. F. said that she considered Mr. P. unnecessarily brutal with respect to sex, and that she considered many, of his demands (un-stated) as abnormal and indencent* She f e l t he viewed her as a pros-titu t e , Mrs. P, complained Of Mr. F.'s mistreatment of the children. She went on to talk of the financial strain. She said she was again con-* templating leaving Mr. P. but wanted assurance that satisfactory plans could be worked out* The worker suggested that i n view of this i t would be desirable i f M$. F. could also come into the agency. The worker then asked her how she f e l t about the expected child and Mrs* P. answered that she had decided to hive i t adopted because her husband seemed Inadequate as a father although she herself wished i t could be otherwise. The following week Mrs, F. telephoned the agency. She said 150 that her husband would not accept agency help, that he had been drunk again. She then expressed her "disgust" and suggested that the Agency-take over a l l the children. The intake worker to whom she spoke sugg-ested that she delay her plans u n t i l she spoke to the new d i s t r i c t worker. Mrs. F.ageed to t h i s . The next day the worker visited the F. home. She described ' their unsightly small tar-papered shack, the inside of which was over-crowded but clean. There was no t o i l e t or bath. The worker said the children were clean and well-dressed, and that the mother's manner to-wards them "was at a l l times gentle and patient". She described the mother, as neat and tidy who spoke i n a monotonous manner but with some humour and at least average intelligence* Mrs. F. talked about her hus-band's unreliability and cruelty and opposed these qualities to her own courage, high standards, loyalty and patience. She Said that her hus-band's family was quarrelsome, that the mother was a s t r i c t religious person who thought a l l pleasure was si n f u l . Mrs, F. Spoke of her hus-band's now earning §200 a month and their plans to buy a house. She talked of her coming confinement but did not mention adoption, Mrs. F. mentioned her d i f f i c u l t y using contraceptives. She said that her hus-band was h i g i l y sexed and demanding. She had f e l t his sex interests were not normal but after reading a book by Tyrer she discovered that his de-mands were not abnormal but she remained unhappy about the situation. VJhile she talked of her husband's cruelty to the children She contra-dicted herself by mentioning the pleasure with which the children greet their father when he comes home from work. 151 Mrs. P. talked of her father 1 s cruelty to his wife but said that despite that the children were happy. After completing Grade 10 at school she moved i n with a married sister and went to work. At the end Of the interview she told the worker she f e l t hopeless about her i n -a b i l i t y to make a decision. The worker interpreted this as a positive factor and arranged to see her again the following week. At this next interview Mrs, P, told the worker a l i t t l e more about her background. She was the second youngest of s i x children. Her parents were Ukranian but the children did not participate i n the Ukran-ian community's activities* She had not liked l i v i n g with her sister who was lazy but she liked her brother-in-law who was quiet and kind* She commented that she always got along better with men than women, When die was 19 she moved to Vancouver where she lived i n a l i g h t housekeeping room and did housework by the day* She enjoyed this experience - had men friends but siad she never became sexually involved and was determined only to marry a man with money. At the interview On Oct, 31, 191*7* Mrs. P. said that things seemed to be going more smoothly at home. I t was at this time that she revealed for the f i r s t time that she was pregnant before marriace. She said she considered this a strike against her marriage from the beginning* At the next meeting i n Hovember Mrs, P, told the worker that she and her husband had made up their minds that they did not wish any more children. She had already spoken to her doctory and f e l t he was agree-able to the idea* Mrs. P, again talked about her childhood, and discussed the 152 d i f f i c u l t times the family had had during the. depression xahen they were on r e l i e f for a time; She also discussed the. constant brutality and quarrelling of her father and how her mother had frequent "breakdowns" which would necessitate her removal to a "rest-home" for a tiiae. Mrs. F, said that, these breakdowns were not mental but physical. At an interview later this month Mrs, F, talked more about her pre-marital, pregnancy and what an unhappy time i t had been. She said that Mr. F, had suggested the. child was not his and suggested an abortion* On Dec, 3rd a g i r l was born to. Mrs, F.. During this period the worker v i s i t e d Mrs.. F. i n hospital and also the.other children at the home where they were being, looked after temporarily. Mrs, F. had been s t e r i l i s e d as she wished and appeared happy with the situation. She also spoke of Mrs. F's greater interest i n the children. Since Mrs, F. appeared happier and better adjusted the Case was closed i n January 19it8. The case was re-opened i n November 1951 on the basis of a * 1 request for information about Mrs, F's eldest boy from.the M.H.C.. A psychiatric' conference was being planned for him because of school work below his a b i l i t y , thumb^sucking, nail-biting and day-dreaming. This conference was held later i n the month with, an agency representative attedding. I t was planned after psychiatric examination to give hi$ a special course i n remedial reading and to have him return to the Clinic for some sessions of therapy. Since M.H.C. was assuming responsibility for this case i t was again closed. 153 There was no further activity on this case for four years u n t i l October 1955 when the case was re-opened after a c a l l from the Family Court which wished to discuss referral of Mr. F. Mrs. F. had been to see them on a complaint of assault. Mr. F, had admitted being rough with her and the children and seemed to want help because of drinking and financial problems (although he was now earning §360 a . month), A le t t e r was sent to Mr, F, offering the agency's services* However, he did not reply to this l e t t e r so the case was closed, (December 1955)* 15U FAMILY G A. FACE-SHEET IHFORMATION AT THIS CASE FIRST OPENED AT FAMILY SERVICE AGENCY Date Cage Opened Man Wife Date of Marriage  Children at this Date Religion Source of Application Social Service Listings  At this time Presenting Problems May 19li6 Born i n Alberta 1915 (31 yrs at this time) Born i n Sask, 1917 (29 yrs. at this time) I9I4I (Man age 26, wife age 21*) 1. Jack b. 191*3 2. Harry b, 191*1* Protestant City Social Service C.S.S.D. 191*6 Marital, i l l n e s s , parent-child relationship, substitute care of children. B, ADDITIONAL FACE-SHEET INFORMATION AS OF 195$ Children born since 191*6 3, William b. 191*8 I*. Marion b. 191*9 Social Service JOndex Listings since 19U6 C.G.C. 19U7 V.G.H. 1952 F. Ct. 1953 155 CASE HISTORY This case was opened on May, 19U6 on a referred request for .a supervised homemaker. Mrs. G. was i l l . Her husband had just been discharged from the R*C*A*F. and was on an allowance of §9U a month "awaiting returns from Business Benefits". The two bosy at the . time were.aged.two and three. Since no homemaker was available at . the time.the.ease was closed. In September,. 19U7 the C.G.C. asked the agency for. a report as the G's were applying to them for service for Jack. The agency lacked sufficient information to supply the report. In September 191*8 another request for a homemaker was .. received... Mrs*. G>. was i n hospital with herthird child and the doctor was refusing to release her u n t i l there was help i n the home. . . No homemaker was available at the time* ' There «as no further record of. the family u n t i l February, 1952 wh&i i t was reported that the Social Service Department at V.G.H. was working with the second, oldest boy, Harry, aged 8. In March, 1952 the agency received a referral from S*S. at V.G.H, who had found nothing organically wrong with Harry but f e l t that his enuresis. Crying, cheating, etc. was due to marital and personality problems i n the home. At this time V.G.H. reported that they had seen the family and held four interviews with Mrs. G. Mrs. G. Claimed f r i c t i o n exists between herself and her raonther-in-law who lives with them. She said her mother-in-law i s jealous of her and sides with Mr* G. against her. She also said herhusband stays out a 1% l o t * beats her up and i s "not a Christian 1*. She. said that her hue* band*, who Is an o i l burner serviceman en his own makes very poor money but refuses to t e l l her what his earadngs are. The V.G.H. social worker also stated that Mrs. 0, seemed . to have g u i l t feelings. The F.W.B, worker phoned Mrs, G and gave her an appoint-ment* Mrs. G. broke two successive appointments pleading i l l n e s s of herself and her daughter on these occasions. On May 27> Mrs, 6, f i n a l l y came into the agency. She ex-pressed concern over William tiho was almost 5>. She said he was "sick emotionally and insecure" and refused to go to kindergarten. She blamed the home situation on th i s . She said that Mr. G, who claims she i s a bad mother drinks a l o t # i s seldom home, i s constantly los* ing jobs and that they owe $1700, because of Mr* G's. failure i n his f i r s t business. Mrs. G, claimed Mr, G. was very punitive with the children and constantly deprives them. She said that Mr. G, had a poor background (not explained). She did not want to l i v e without him, however,, so long as he kept sober althougi he was now interested i n other women* She said this didn't bother her any more aS she i s not interested i n men. Mrs, G. went on to t e l l the worker that she had "a gynae-cological condition" - that i t was glandular and was manifest i n haemmorhaging, Mrs. G,. talked about the "unlimited f a i t h " she had through her religion (Foursquare Gospel) and said "Everyone i s so 157 helpful". She said her mother-in-law was no longer with them. She reported also that she was anc.oftLy, not happy, and that her father had been a drunkard and her mother had been "insane" for twelve years but that i t had cleared up when she l e f t home. The worker recorded Mrs. G. as constantly b e l i t t l i n g herself. At the end of the interview Mrs. G. said she would l i k e to come back for further help and said she thought Mr. G. would co-operate as well. In a second interview early the next month Mrs. G. told the worker about her husband's outburst of temper when she took away a gun he had been hiding. She again complained about his drinking and told the worker how his mother had warned her not to marry him because he was "too moody". She said that her husband had l e f t her once for 6 weeks to. l i v e with a young g i r l although during that time he returned home periodically for'meals. She said that Mr. G. had never asked for a divorce but i f he had she would have given him one. During this interview Mrs. G. complained that her children never seem willing•to discuss sexual matters with her. She also reiterated how much comfort the church was to her. In another interview later that month (June 1952) Mrs. G, expressed considerable worry over the behaviour of the children -blaming herself, for their behaviour and bursting into tears at one point. She also discussed an argument x-Jith her husband over budget problems. During this interview, i n answer to a question from the worker, Mrs. G. said she belonged to several women's group - P.T.A., 158 Y.W.C*A*, and church. At an interview i n July, Mrs. G. said sic was getting along better vath her husband. She also reported that the 3S.G.C. had told her the eldest child was "mentally retarded", (not confirmed) although, his school had previously told her he had a high I.Q, During {his i n * terview Mrs, G. told the worker that she would l i k e a c h i l d for foster day-caro. Later that month a person describing herself as "a friend"' of Mrs, @. phoned both the Family Court and the F.W.B. claiming that Mr, @. was not supporting his family adequately, that he had threatened them with a gun and that he was an "atheist" and a "playboy"). About this time the f i r s t diagnosis was made i n anticipation of a consultation with the agency casework consultant, Miss Wolfe. Between January 1953 and A p r i l 195U there were seven more, inter*views with Mrs. G. and numerous telephone c a l l s . The same pattern persisted with Mrs, G, getting some help with Xmas toys and clothing. In Oct. 1953, Mr. and Mrs. G appeared i n the Family Court because Mr. G. was not providing adequately for the family. He had a succession of low wage jobs during this time. In May 195U Mrs, G, said her husband was talking divorce. She said that i f she lost the children she would commit suicide, and said that she had previously intended to k i l l herself. In June 195U Mr. G. went to Kitimat. Mrs, G. became i l l . Between June and September the family received very l i t t l e money from Mr. G. and wore helped financially by the Agency, Mrs. G continued to worry a great deal about the children. 159 From that date u n t i l the present, sporadic contact has been kept with Mrs. G. During that time, she was twice hospitalized once for a hysterectomy, the second time for a bladder condition, A supervised homemaker was provided during the hysterectomy and she reported the children as very badly behaved - rude, disobedient, etc. During that time the oldest boy was caught shoplifting. Mr. G. continued his drinking habits, was providing only minimally for the family, and had a new woman friend. Mrs. G. was greatly discouraged, and expressed herself as trapped. By December, l 9 5 5 a Mr, G, had a new job paying $62 a week, but refused to buy anything for the family at Xmas. There has been no a c t i v i t y on the case during 1955* (to Fob. 10), APPENDIX G 160 BIBLIOGRAPHY (a) Spscifie References Buell, Bradley, Community Planning For Human Servieeea Goluraela University Press; New York, 1952. Buell, Bradley, "Preventing and Controlling Disordered Behaviour, A OoaBBonity Expe:rmelttt,,; Mental Hygiene *New York, Vol* 39 No. 3, July, 1955, Ckfflmittnity Research Associates; the Prevention a Dis-ordered Behaviour i n 3an Mateo County, California; New York 195u, French, David G, An ^ pyoaeh ^Measuring Results i n goeial Work Columbia University Press; NewYork, 1952. Robinson, Marion 0. "Focus on Infection" ; Family Service Biffin  l i g h t s ; Family Service Association of America j New ^ ork, Feb-ruary 1956. (b) General References Hamilton, Gordon, theory end Practies„of Spcial Case Work} New York School of Social Work; Columbia Universiiy Press j New York, Second Edition revised 1951, Lamson, Warren C, "Integrating Mental Health Services into the CoBsaunity Health and Welfare Program; Journal of Psychiatric  Social Work, New York, September 1955, Marsh, Leonard C* Rebuilding a Nei^bourhoody University Of Br i t i s h Columbia} Varttouver, Ijpjft,. Overstreet, H.A, the Mature Mihdi Norton and Co*, Hew York 19U9. Richmond, Nary, Social Masposis; Russel Sage Foundation, New York* 1st Edition I9i?> lUth' Edition 1936, the Social Work Forum; Proceedings; Columbia University Pressj New York, 1955. towle, Charllotte, Common Human Needs, American Association of Social Workers; New York, 1953* 

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