Rosemary L Farmer,Neuroscience and social work: The missing link

Reviewed by: Keryn Bernstein and Deborah Gioia, University of Maryland, USA

Keryn and I met when she was a student in my social work class on practice with individuals. During this first semester of classes, Keryn was feeling that her choice for a profession might not be the best fit with the interests that she had. We had a couple of very enjoyable discussions where I began to learn that Keryn was hungry for more health-connected course work but specifically she had a fascination for neuroscience, and pondered why social work did not include this in the curriculum. I have also held this interest in neurocognition and have published two articles exploring neurocognition and community functioning in individuals with schizophrenia (Brekke et al., 2007; Gioia, 2009; Gioia and Brekke, 2009), and welcomed the chance to begin a conversation. Below are some of Keryn’s thoughts on her journey to explore this topic:

“As a first year social work student, I sat in class trying to listen while my mind wandered to neuropsychological phenomena and the organization of the brain. Having majored in psychology, and brain and cognitive sciences while in undergrad, I learned everything from the developmental stages of the brain to the theoretical underpinnings of consciousness. I vividly recall learning about a neurological defect called simultagnosia-a visuospatial processing disorder characterized by an inability to comprehend more than one element of a scene at the same time or integrate the parts into a whole. Once I began learning about these types of endless possibilities regarding the ‘black box’, I was hooked.

I had intended to combine my interest in the brain with a master’s in social work, but my google searches only brought me to the same few research articles, and this one book, titled, Social Work and Neuroscience by Dr. Rosemary Farmer at Virginia Commonwealth University. To my surprise, this book was not just about the details of how these two subjects intersect, but it also serves as an argumentative essay for why there should be more overlap across the disciplines than there currently is. The author packs a lot of information into just seven chapters, and makes a very thorough case for how neuroscience is applicable, and necessary for quality social work practice today.

Farmer successfully provides an informative introduction to neuroscience for anyone unfamiliar with its terms and concepts, while still engaging with the subject on a deeper level. The first chapter makes the case that social workers must keep up with “the neuroscientific revolution”. The second chapter provides a tour of the brain and a small index of terminology, while the third chapter explains how to best incorporate neuroscience using the transactional model, which is explained as the social work framework for “understanding the dynamic interrelationships between the biological, the psychological, the social, the spiritual, and the challenge in living”. The final four chapters are where Farmer truly delves into how neuroscience pertains specifically to four common topics in social work-attaching and bonding, trauma, psychotherapy, and medications and drugs.

The lack of opportunity for pursuit of biological sciences within social work feels like a major drawback within the field, as well as a significant shortcoming of a profession that does discuss implementing a transactional model. How can social work students truly be prepared to use the transactional model if we have no biology foundation? That is not to say that all social work students should be experts on human biology, but it does a disservice to the social work profession when this large component of the transactional model is undervalued, and inaccessible for those people that wish to have greater knowledge in that area. Preaching this holistic perspective does a disservice to the profession if newly graduated social work students have no biological background to incorporate into practice.

One of Farmer’s many reasons for why social workers should have a better grasp on neuroscience is because of people’s increasingly complicated problems. Today, practitioners are much more likely to encounter a client with multiple diagnoses and numerous problems, instead of just one diagnosis and a few problems. For Farmer, who has once worked with someone suffering simultaneously from ADHD, depression, anorexia, bipolar disorder, and personality disorder, understanding the brain has aided her in painting “a fuller conceptualization of the challenges being faced by [the] person and how to recognize and use all of the person’s strengths (p. 8)”. The brain certainly has a lot to do with the etiology of psychological diagnoses, and this too would seem to be especially important in understanding the foundation of a person’s diagnosis or thought pattern.

Chapter 7, another standout chapter, explores the necessity for neuroscience knowledge when working with people using psychotropic medications and drugs of abuse. This is yet another reason for why social workers would benefit from learning about the brain. Social workers are educators, advocates, consultants, counselors, and monitors of medication. In order for social workers to successfully fulfill these wide ranging roles, especially within the mental health arena, they must be educated in psychopharmacology to some degree-a topic that once again requires an understanding of the brain. In the same vein, working with populations using “drugs that hurt”, such as cocaine, alcohol, and nicotine, demands the same level of engaging with the brain. In the last 10 years research on addiction has reaffirmed the neurobiological components to the brain disease. Although social workers may tend to focus on the behavioral elements of the problem, understanding the underlying biological system controlling the problem behaviors allows for a more comprehensive view of the person, his or her challenges, and a treatment plan.

Addiction is a good example in which the notion of learning about biological processes applies. Here, it may be seen that the problem behaviors stem from a lack of motivation to break the habit when in reality the person becomes programmed to behave differently. In other words, “the result is an addicted brain in which the reward circuitry malfunctions or becomes dysregulated, and ever larger amounts of the drug are required for the person to feel a reward” (p.142). Although social workers have long been working with these issues, incorporating neuroscience would simply improve practice and raise the level of quality work within the profession.

During my first and only semester in a master’s of social work graduate program, I consulted professor after professor regarding my hopeful pursuit of combining neuroscience and social work. To my disappointment, I discovered that there seemed to be few social work avenues that would lead me to studying the brain in a way that I envisioned. While doing my own research on neuroscience within social work, there were very few graduate programs that offered classes on this topic, and just as few licensed social workers incorporating this material into their everyday work.

Although social workers have never been held to this standard of learning, it’s important to continue raising the bar, and re-evaluating the larger impact of the field. As Farmer puts it, “members of practice-oriented disciplines such as social work, counseling, and nursing typically face the dilemma of how to broaden their perspective beyond what has traditionally seemed to work, beyond the little fiefdoms that make up traditional social work and the other traditional sub-divisions of the human service spectrum. For a discipline such as social work, which is grounded in human behavior, such insights as are available from neuroscience on the intricacies of brain function are significant”.

A year has passed, since Keryn and I first began our conversation about neuroscience and social work. Keryn did take a semester off from her courses in social work and has since made the decision to apply to an occupational therapy program, where she will undoubtedly be exposed to more biology in her coursework. However, she raised some key issues with me which I feel are beginning to be addressed under the current shift to behavioral health in the social work curriculum. Essential benefits for all participants within the Affordable Care Act include treatments for mental health, substance abuse, and consider the health care needs of each individual. Although there is a long way to go and new interventions to be developed, there is no doubt that the social worker of the future will be well versed in all three aspects of care in their work with individuals.

Most of the research published by social work scholars and allied disciplines has been around neurocognition and schizophrenia which has been my main area of research. A sign that neurocognition, biological sciences, and social work are finding their common ground and expanding the reach beyond serious mental illness is with the publication of a new text, Neuroscience for Social Work: Current Research and Practice (2014). The lead editor of this text, Holly Matto, is the author of the other review for this publication of Dan Siegel’s seminal text for social scientists, The developing mind: How Relationships and the brain develop to shape who we are (2012). Dr. Matto, whose practice and research has been in the area of addiction science, has added to the direction begun by Dr. Rosemary Farmer in exploring this intersection of social work and neuroscience. I speak for Keryn and myself in acknowledging the excitement of this step forward in the social work literature, and hope that this work will become a part of generalist social work practice, so that future students seeking the platform for their own interests will find the evidence they need that social work is committed to this direction.