In taking the time to observe how sociological and psychological influences may impact on a service user or client group, the social worker can remain mindful of the wider context of a situation and not just take what she sees at face value. This knowledge allows the social worker to remain objective and to make informed decisions in order to maintain professionalism in her work. By applying Sociological and Psychological theory to the ‘Bertram’s’ case study I aim to explore the wider social context, outside influence and psychological implications from the past and present. Through this exploration I will uncover the varying viewpoints and sometimes contradictory nature of these theories. To gain a Sociological perspective on the case study I will be applying Functionalist and Feminist theories. I will be able to scrutinise the Bertram’s current situation and apply the theory in order to gain a wider understanding of the social context. In order to maintain a balanced viewpoint, Psychodynamic theory and Maslow’s hierarchy will enable me to consider the psychological impact with a focus on human and emotional development.

By examining a situation from a Sociological perspective we can take into account how various aspects such as class, social structure, religion, disability can impact people from a wider social context. This is essential in gaining a holistic picture the situation.

Functionalism

By applying a Macro theory to the case scenario it allows us to look at the large scale features of society and how individual actions affect society as a whole and vice versa. Functionalism will enable me to contemplate the structure of society and how the Bertram’s fit within that structure. Functionalist theorists regard society as a system with interlocking parts. It is believed that each part needs to function effectively in order for society, as a system, to work as a whole. It is often rationalised using biological analogy. The social role of individuals is an integral part of the theory. Each person is thought to have their individual role to play within society. From a functionalist perspective it is very clear that Mrs Bertram is not fulfilling her role as a wife. Due to her alzemers she is unable to carry out the duties that would have been expected of her. Durkheim believed that everyone had their place, and a woman’s place was in the home. In the context of the 40’s, 50’s when Functionalism was at its peak, this viewpoint would not have been uncommon, if a little out-dated by today’s standards. None the less, it is not through choice that she has become dysfunctional within society. She has legitimate claim for not being able to carry out her societal role and Functionalism would automatically see her take on the ‘sick role’. This would enable her to function again within the system under a different guise.

It could also be observed that Mr Bertram is a dysfunctional member of society. With his reckless behaviour, his outrageous spending, and the lack of care for his wife’s basic needs he is no longer fulfilling his role of husband. A main proponent of Functionalism was Emile Durkheim (1858-1917). He saw marital vows as obligations. “When I perform my duties as a brother, a husband or a citizen and carry out the commitments I have entered into, I fulfil obligations which are defined in law and custom which are external to myself and my actions” (Durkheim, 1982). He believed that if a member of society was deemed as dysfunctional, then he was considered to be a deviant member of society. Deviance occurs when people are not functioning correctly, according to the ‘norm’. This could be through crime, or anything which affects their ability to carry out their societal role. Deviance needs to be controlled or managed. If it was established that Mr Bertram was in fact deviant then he may need some persuading that by providing the care and attention that his wife needs his wife would not be removed from the situation. Through this resolution, therefore, they would both be able to function appropriately.

It could be observed that Mr Bertram had an alcohol dependency. If this was established then Mr Bertram too may take on the ‘sick role’. In which case a different method for resolving the issues within the house would need to be adopted. Talcott Parsons (1902-1979) believed that sickness was a social concept rather than a biological concept. So being ill meant acting in different, deviant ways to the norm. Being sick was therefore a form of social role (Haralambos and Holborn, 2004). Parsons believed the rights of a sick person to be exemption from normal social obligations, the right to be looked after and blamed for their social deviance as long as they were genuinely sick. Obligations of a person playing the ‘sick role’ would be to understand that they have to ‘get well’ as soon as possible in order to continue their normal function and in order to do this they must receive professional help. Mr Bertram’s condition would need to be treated or managed in order to enable him to function again. In that case Mr and Mrs Bertram would be able to stay at home under treatment and the issues about care could be dealt with accordingly. He would no longer be considered deviant member of society. A criticism of the ‘sick role’ would be that it is very difficult to apply to long term illness like that of Mrs Bertram. It is built on the assumption that the person gain help in order to gain function. This would not be possible for Mrs Bertram.

Feminism

From a Radical Feminist perspective it could be observed that Mrs Bertram has been oppressed by her husband. Through her devotion and his dominance she has succumb to subordination. Radical Feminists use the patriarchal social system as a concept to explain gender inequality. Patriarchy is the dominance of men over women in society. They view men as responsible for the exploitation of women from which they benefit greatly, through free domestic labour, sexual duties and so on. The case study describes how Mrs Bertram was swept off of her feet and totally devoted to Mr Bertram. In their current situation, Mrs Bertram is at home in squalled conditions and desperately in need of help. Mr Bertram is avoiding the situation by using diversionary tactic, selfishly seeking social activity and pleasure through drink. This further increases her oppression as she is fully dependent on her husband to provide the care and attention which she is desperately in need of.

“Shulamith Firestone, an early radical feminist writer argues that men control women’s roles in re-production and child bearing. Because women are biologically able to give birth to children, they become more dependent materially on men for protection and livelihood” (Giddens, 2006). Feminists could argue that for this reason Mrs Bertram has become vulnerable within her setting and just accepts this way of life. Jessie Bernard argued that “Men need marriage more than women” (pg 208 Gender). Perhaps this reliance on the domestic labour, comfort and sexual duties of a wife, which has been lost my Mr Bertram through his wife’s condition is attributing to his behaviour. Mrs Bertram is no longer fulfilling her duties as a wife and this could be disrupting his routine. It would appear that Mr Bertram has never had to control the household, take care of his wife or finances, and may lack the ability or may simply consider it beneath him. It could affect his masculinity to have to carry out such chores and duties believed to be part of a woman’s role. This may also be the reason why he is reluctant to accept help with the situation. He may feel he is being barraged and dictated to by his step daughters which may be resulting in a greater defiance. It is not clear from the case study, the nature of their relationship either. He may feel that family and professionals are undermining his authority as head of the household. Mr Bertram may be compensating for his lack of masculinity at home, by using his social appearance, bravado, drinking and defiance. This time away from the house for him may reaffirm his role as a dominant male within society whilst his dominant role as a man disappears at home. He no longer has command over his wife, no longer gets respect, adoration that he was once used to. Men are considered to have more influence within society; Mr Bertram has no influence over this situation or over his wife.

Part 2: Using the scenario describe two psychological theories that can be used to help your understanding of the service users’ situation

Humanistic theory – Maslow’s hierarchy of needs

Humanistic psychologist Abraham Maslow (1908 – 1970) argued that humans throughout life not only want to have their basic survival needs met they strive for more in terms of personal growth. He believed that once basic needs for survival had been met that human development progressed toward higher psychological needs. He argued that “people are motivated by the conscious desire for personal growth” (Rathus, 2004). Maslow believed what separated us from our so-called lower animals was our capacity for self-actualisation (Rathus,2004). He believed that this self- actualisation was as important as basic needs but could not be met unless other stages of human needs were completed. He organised these stages into the hierarchy of needs, often presented in pyramid format. Each stage must be satisfied in order to progress to the next. At the bottom of the hierarchy are physiological needs. These are the basic human needs we all have in order to survive, like food, water, shelter, oxygen. Once the first basic need has been satisfied, the following stage is safety needs, the need for security. The following stage in the hierarchy is love and belonging; the need to give and receive love, to overcome loneliness and achieve a sense of belonging in life. The fourth stage is ‘Esteem needs’; to feel self-confident, respected and not to feel inferior. Self-actualisation is the final stage in the hierarchy and can only be reached when all foregoing needs are satisfied and the person feels he has achieved everything he wants to in life and is the best that he can be.

In the case of the Bertram’s it is clear that Mrs Bertram is currently not even meeting the bottom of Maslow’s hierarchy of needs. It is noted that their flat is in an appalling state, she is unable to feed herself and left on her own for most of the day. You would expect most of her needs to be met within the context of her marriage to Mr Bertram; however, since he has neglected his role as a husband, he has placed her in a position of significant danger. Since not even her basic physiological needs are being met in the current situation then at present there would not be an opportunity to progress through the hierarchy of needs.

If Mrs Bertram was placed in residential care then her physiological needs would be met. She would have food, water and care of her basic needs. She could then perhaps progress to the following stage of safety. She would no longer be at risk of hurting herself and she would be in a more secure environment. Although it could be argued that for an advance Alzheimer’s sufferer, the unfamiliar setting would disorientate her and she might not actually feel secure there. Because of her diagnosis, Mrs Bertram is unlikely to meet the third stage of ‘love and belongingness’. Her advanced Alzheimer’s may mean that she fails to recognise her husband, family members and have a declining ability to communicate. Mrs Bertram would never reach self-actualisation. The best that could be achieved would be basic survival and safety needs, whether this was achieved at home with the compliance of her husband, or in residential care. Although it could be debated that residential care would not be the best option. As the GP states in the case scenario, “a move to residential care might well kill Mrs Bertram”.

It would appear from the case scenario that Mr Bertram’s basic needs are being fulfilled. However it is uncertain as to whether his s safety and security needs are being met. He certainly would not get a sense of love and belonging from his wife, in the latter stages of sever dementia. I would observe, however, there is some attempt from Mr Bertram to achieve a sense of self-esteem, since he spends the majority of his time with his compatriots at the golf club. It is clear that in this relationship and the current situation faced by the Bertram’s that he too has no way of reaching self-actualisation. Maslow observes that it is mainly social factors that hinder the personal growth of humans. Potentially at least the first two stages of Maslow’s hierarchy could be reached within the context of their marriage, with the right services in place.

Psychodynamic theory

Through the Psychodynamic theory of personality we could speculate about Mr Bertram’s past and how that has influence on his behaviour in the present. It would be difficult to achieve a comprehensive result in regards to Mrs Bertram because of her Alzheimer’s. Since her behaviour is wholly attributed to her condition.

Studying Sigmund Freud’s (1856 – 1939) theories, with a focus on psychosexual development, would be the most relevant to apply to the case scenario. Psychodynamic theory had been developed and evolved over the years. Freud’s idea of Psychodynamic theory depicted humans as largely driven by unconscious motives and desires. He proclaimed that humans come into conflict when their basic instincts come up against social pressure to follow, laws or moral codes. “At first this conflict is external, but as we develop it becomes internalised” (Rathus, 2004). Freud explains the conflict of personality using psychic structures. The id, which Freud believed is present at birth and located in the unconscious mind, and revolves around our basic biological drives and instincts. It operates on what Freud called the ‘pleasure principle’. It demands instant gratification regardless of laws or moral rules. Another feature in the structure of personality is the ego. Formed from the id, developed through learning and experience. This is the part where conscious thought takes place (Beckett and Taylor, 2010). The ego operates on the ‘reality principle’. This takes into consideration what is practical and possible in gratifying needs (Rathus, 2004). When the ego senses improper impulses arsing it can sometimes deploy a number of defence mechanisms. The third psychic structure is the superego. This is formed throughout early childhood and is developed through standards, values, parenting and moral standards. “Psychodynamic theory emphasises the way in which the mind stimulates behavior, and both mind and behavior influence and are influenced by the person’s social environment” (Payne, 2005)

Freud believed there were four stages in psychosexual development. The first stage took place during the first year of a child’s life. This is known as the ‘oral’ stage. Much of the child’s development is explored by putting things into the mouth and sucking, biting chewing. Freud believed it was possible to have arrested development through trauma. And be fixated on one of the stages. From the case study we could surmise that Mr Bertram is fixated on the oral stage of psychosexual development through his ‘drinking’. We could speculate that he may have had a significant trauma at that stage which has left him with a possible alcohol dependency, thus fixated on the oral stage.

It could perhaps be identified that Mr Bertram is using psychological defence mechanisms in order to avoid the situation that he is currently facing.

Part 3: Reflect on your own background describe it and indicate 1 sociological and 1 psychological theory that can be applied to you, giving examples

The relationship I have with my father has often been fraught, difficult and tense. As a sufferer of a severe mental disorder, my father has often displayed irrational, delusional, paranoid and sometimes violent behaviour. Throughout his life he has had frequent hospitalisation. For me this is something I have grown up with and am used to dealing with on a day to day basis. I am acutely aware of how our relationship differs to that of my friends for example. I have as close a relationship as possible with him, and to that end I usually bear the brunt of his paranoia and aggression when he is unwell. I have witnessed first-hand the stigma attached to mental illness. I find it extremely difficult to trust anyone enough to tell them about the situation, and I strongly feel I shouldn’t have to tell everyone that meets him, this only leads to labelling him as mentally ill, thus changing the way in which they treat him; which only compounds his paranoia.

Some Sociological theorists believe that mental illness is a social construction in order to rationalise bizarre or irrational behaviour that cannot be in any other way explained. This is known as labelling theory. Scheff (1966) argued that people are labelled as mentally ill because their behaviour does not make sense to others. “Scheff points out that labelling of a person as mentally ill is facilitated by stereotyped imagery learned in early childhood and continually reaffirmed, inadvertently, in ordinary social interaction and through the mass media. Thus, when a person’s violation of social norms or deviance becomes a public issue, the traditional stereotype of “crazy person” is readily adopted both by those reacting to the deviant person and, often, by the deviant person as well” (Lamb. 2002). Erving Goffman suggests that when someone is labelled as mentally ill then they are treated differently. When an interaction takes place with that person it is with this knowledge of the mental illness, therefore creating what Goffman called a spurious interaction (Haralambos and Holborn, 2004).

From a behaviourist view, Schizophrenia could be viewed as a kind of learned behaviour. “From this perspective, people engage in schizophrenic behaviour when it is more likely to be reinforced than normal behaviour (Rathus, 2004). This could be the result of being raised in an unrewarding or punitive situation. It could also be observed that this kind of behaviour is reinforced within the hospital setting, where the schizophrenic behaviour is reinforced through attention from professionals within that setting. Cognitive theory argues that behavior is affected by perception or interpretation of the environment during the process of learning. “Apparently inappropriate behavior must therefore arise from misinterpretation. Therapy tries to correct the misunderstanding, so that our behavior reacts appropriately to the environment” (Payne, 2006)

I believe the experiences I have had with my father give me the ability to understand mental illness without stigmatising. It also helps me empathise with the sufferer and the family. An empathetic approach to someone who was hearing voices for example, would be to understand that to the person affect, they are very real. I fully understand the importance of having the right services in place in order for that person to thrive. My experience allows me to observe the wider context of a situation and realise that it is not only the primary sufferer of the condition that is affected. The wider family needs to be considered as they have a huge role to play in the well-being of the person concerned.