Is Graduate Social Work Education Promoting a Critical Approach to Mental Health Practice?

By Lacasse, Jeffrey R.; Gomory, Tomi | Journal of Social Work Education, Fall 2003 | Go to article overview

Is Graduate Social Work Education Promoting a Critical Approach to Mental Health Practice?


Lacasse, Jeffrey R., Gomory, Tomi, Journal of Social Work Education


A sample of 71 psychopathology course syllabi from 58 different graduate schools of social work was analyzed to determine whether different viewpoints and the concomitant empirical evidence were presented regarding 4 significant mental health topics: concepts of mental disorder, reliability and validity of psychiatric diagnoses, biological etiology, and drug treatment. There is little evidence that graduate psychopathology courses cover viewpoints other than the most conventional and institutional--that of biomedical psychiatry. A small handful of secondary (textbooks) rather than primary (research articles) sources provide the majority of the mental health content in these courses. Implications are discussed. The article includes an overview of both the relevant conventional and critical literature.

People make too big a deal out of DSM and spend too much time studying it. DSM is a labeling system that is inherently superficial, and it is a convenient fiction to suppose that patients' problems can be broken down into discrete categories. We don't understand the etiology of mental illness, and lab findings are practically never found that are diagnostically useful. --Michael First, DSM-IV-TR co-chair and editor

No longer do we seek to understand whole persons in their social contexts--rather we are there to realign our patients' neurotransmitters. The problem is that it is very difficult to have a relationship with a neurotransmitter--whatever its configuration.--Loren Mosher, former chief of the Center for Schizophrenia Studies, National Institute of Mental Health

HISTORICALLY, the field of social work has been committed to work toward a "just society" (Reamer, 1993). This means that social work has often rejected mainstream institutional views and has offered or supported alternative viewpoints furthering its goal of a just society. In addition, evidence-based practice suggests that professional decision making should rest on the evaluation of well-tested empirical evidence, not prevailing dogma (Gambrill, 1999). This commitment to exploring nonmainstream positions is exemplified by the range of arguments found in popular social policy texts authored by social work academics. For example, almost every social policy textbook presents the entire range of arguments for and against the paradigm of welfare reform, epitomized by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (e.g., Gilbert & Terrell, 2002; Karger & Stoesz, 2002; DiNitto, 2000; Sherraden, 1991). Some authors present detailed alternatives to the conventional wisdom (i.e., Fox Piven, Acker, Hallock & Morgen, 2002). Typical examples appear in one popular textbook which questions the currently accepted wisdom of for-profit provision of human services: "[d]espite the undesirable attributes of proprietary human service providers, they are likely to continue to play an active role in defining social welfare" (Karger & Stoesz, 2002, p. 197). This textbook also questions the utility of the entire Temporary Assistance to Needy Families (TANF) program driving much of our current government policy on poverty:

   The TANF program is predicated on a
   kind of welfare behaviorism: an attempt
   to reprogram the behaviors of the poor.
   Current welfare reform efforts, however,
   are unlikely to deliver on the promises of
   this approach. (p. 291)

Additionally, social work academics have often critiqued the use of interventions that have failed empirical tests, for instance, the use of psychological debriefing (Lewis, 2003). Social work academics have promoted alternatives to the status quo by critically analyzing current policies. For example, in their widely used chemical dependency text, McNeece and DiNitto (1998) find the government's broadly marketed "War on Drugs" deeply flawed--after carefully analyzing this policy and discussing the pros and cons of drug legalization (pp. …

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