From the Editor—The Red Pill or the Blue Pill? Transcending Binary Thinking

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Corrigendum

Classification is something that comes naturally to us as humans and is an essential skill in the development of cognitive abilities. However, although essential, classification can also lead to binary thinking, which pits two opposites against each other and also includes the implicit hierarchical assumption that one of the two is inherently more valuable than the other. The concept of binary opposition based on fixed hierarchical arrangements was one of the central ideas introduced in structuralist theory, which led to critiques by later theorists such as Jacques Derrida and Michel Foucault, among others.

For classes of things to be true binary opposites, they must be mutually exclusive. Although this may seem to be true for phenomena in the natural sciences (i.e., north–south, hot–cold, matter–antimatter, electrical polarities of plus–minus), there is an increasing understanding that even with these seemingly polar opposites, there are gradients that lie in between these extremes (Hart, 2005). It is important to note that binary thinking extends beyond the physical sciences and informs our understanding of social reality.

In the social sciences, as well as in social work, acceptance of and reliance on binary opposites not only creates boundaries between groups of people, it also posits that one group is superior to the other. Not surprisingly, this easily can lead to prejudice, discrimination, and oppressive policies and practices toward the less favored group. Us–them, Black–White, gay–straight, male–female, oppressed–oppressor, mentally ill–normal, and able-bodied–disabled provide some concrete examples of binary opposites that have permeated our thinking and research as we attempt to classify individuals and groups of people. This, of course, has not been lost on scholars in social work and other fields who have written about the problematic use of binaries in relation to gender, sex, critical feminisms, feminist research, identity, First Nations people, leadership, and advocacy, and scholarship, among other topics (Ben Anderson-Nathe, Gringeri, & Wahab, 2013; Calliou, 1998; Gonzalez, 2010; Gringeri & Roche, 2010; Kannen, 2008; Linstead & Brewis, 2004; Markman, 2011).

It is important that binary thinking applies not only to how we categorize and perceive groups of people but also to opposing ideas and methods of practice as well. Currently, two of the prevalent binaries in social work education and practice are the oppositions between positivism–social constructionism and micro–macro practice.

The tension between positivism and constructionism is certainly not new, but it has taken on an increased antipathy with the rise of evidence-based practice (EBP) in social work. First introduced in the social work literature by Eileen Gambrill (1999), EBP has become mainstream and is now widely embraced by many social work programs. However, some mistakenly confuse EBP with empirically supported treatments (EST), even though they are not the same. ESTs are treatments or interventions that have been tested with randomized clinical trials, and their effectiveness has been shown to be empirically supported. In contrast, EBP is a process of working with clients that is based on the intersection of the social worker’s expertise and practice experience; the client’s values, expectations, and preferences; and the best available evidence. This process involves formulating a practice question, searching for the best possible evidence, critically appraising that evidence, and choosing and evaluating interventions or services based on the collaborative work of the social worker and the client in their development of an individualized treatment plan (Shlonsky & Gibbs, 2004).

In a recent scholarly debate about the increasing use of EBP, Gitterman and Knight (2013a, 2013b) proposed an alternative approach to integrate the art and science of social work practice. They aptly pointed out that many of the problems for which clients seek help occur in a larger context that are not typically amenable to the types of clinical interventions that are empirically supported. In response to this, Thyer (2013), noted that the EBP model has also successfully been used in social policy to examine more complex interventions that address larger social problems. Although this is true, I would note that it is rare that social policy is based on empirical evidence, as political ideology often steers policy decisions, even when the evidence runs counter to the policies that are enacted. Our current drug policy is a prime example of the ways in which existing evidence is not only ignored, but counter evidence is actually fabricated to support a political agenda (Robinson & Scherlen, 2013).

Despite their stated differences and positions, a careful reading of this debate shows that the actual disagreement among these authors is not that great. In this vein, Gitterman and Knight (2013a) not only support the scientific method but also cite the need for social work education to better prepare students to value and use research in their practice. Likewise, Thyer (2013) clearly agrees that complex problems and interventions are a necessary focus of EBP. And he concurs about the importance of clinical experience and taking the client’s situation, values, expectations, and preferences into account. There are, however, unresolved points of difference, and I would urge those who are interested in the fuller debate to read it in the original.

We find more significant divergence from scholars who not only support a constructionist and postconventional paradigm to guide social work practice but also seek to supplant the Western positivist tradition with one that they believe is better suited to the profession’s mission to strive for social change, social justice, and human rights (Bell, 2012; Witkin, 2011). There are, of course, many diverse ideas in constructionist scholarship, but one of the central tenets is that the Western positivist paradigm supports and reinforces oppression and oppressive structures and therefore impedes the profession’s mission of social justice. However, not all constructionists assume such a strident stance and it is important to recognize both the philosophical and empirical contributions made by constructionist scholars.

To be quite honest, I have never understood the rationale for either-or thinking related to epistemology, as both make valuable and indispensable contributions to our knowledge base in social work. Coming from a strong sociological background, my primary orientation has always been constructionist, based on the theories and writings of classic and contemporary symbolic interactionists and ethnomethodologists. Yet, despite my clearly constructionist stance, I have always seen the value in empirical verification. For example, during the early to mid-1990s, as the now widely discredited recovered memory therapy came into vogue, I relied heavily on the empirical research, rather than a questionable and largely unsupported theoretical stance, to examine that particular phenomenon. However, as events unfolded, it was equally important to look at the phenomenon through a constructionist lens as well, to explain the historical, social, and cultural forces that not only gave rise to but also supported the growing acceptance of a therapy that was clearly harming many clients and families. As Thyer (2013) aptly noted, poorly supported theories can, in fact, be quite injurious to both clients and clinicians, and I certainly concur.

We must, of course, be aware of extremes in both camps, as this can make an otherwise important paradigm look foolish, as was the case with Sokol’s (1996) exposé of postmodernist deconstructionist writing. Likewise, it can also lead to dangerous reductionism and an overreliance on minuscule statistical differences that fail to capture the complexity of people, their contexts, and their cultures. Apart from the extremes, what we fail to recognize is that both paradigms are necessary for a fuller understanding of the human condition, and both can be used to support the missions of social work practice.

Somewhat related is the perplexing distinction that we make between micro (clinical) practice and its macro counterpart. Although I was trained clinically in my master of social work (MSW) program, I am forever indebted to my mentor, the late Dr. Joe Paull, who insisted that I also enroll in macro courses in order to gain skills that would serve me throughout my career. Needless to say, I was dubious at first. However, as I began my first post MSW job working for the Seminole Tribe of Florida, initially doing program planning and grant writing, I was thankful for his sage advice. My work there also made me acutely aware of the way in which structural conditions and policies directly affected people’s lives.

As Reisch (2013), among others, has noted, professionalization (among other forces) has created a division between individual and social change. This has not only led us away from our historical commitment to social justice as a profession, but it has depoliticized the work that we do. As macro practice has become increasingly marginalized (Rothman, 2012), we move further and further away from the unique features of social work that distinguish us from other helping professions. There is no reason, as Shdaimah and McCoyd (2012) have suggested, that social work cannot be viewed concurrently from both perspectives. However, we must truly value the integration of both to achieve this end. That said, such integration must value and support both methods equally, and not allow macro practice to remain at the margins.

In the popular film The Matrix, the protagonist, Neo, is presented with a binary choice between ingesting a blue pill, which will keep him in virtual reality, or a red pill, which will awaken him so that he can experience the real world (Gunkel, 2008). Why only two options? Surely, there are others that can be considered. It is imperative that we, as educators, resist forced binary choices that not only constrict our ability to appreciate the complexity of the human condition and the lives of our clients but also limit our vision of the knowledge, values, and skills that we impart to our students. As Phillips (2011) has observed, binary thinking narrows our ability to determine the scope of a problem and locks us into one perspective. Not surprisingly, it also serves to enforce the status quo. Rather than requiring students to choose between evidence-based practice and constructionism or clinical and macro practice, it is crucial that we transcend these artificial boundaries and appreciate and embrace the contributions of both.

Susan P. Robbins

University of Houston

Editor-in-Chief