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  3. Social Support and Psychiatric Disorder
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  • Publisher:
    Cambridge University Press
    Publication date:
    31 October 2009
    24 August 1995
    ISBN:
    9780511526749
    9780521442381
    9780521038058
    DOI:
    https://doi.org/10.1017/CBO9780511526749
    Dimensions:
    (228 x 152 mm)
    Weight & Pages:
    0.632kg, 364 Pages
    Dimensions:
    (228 x 152 mm)
    Weight & Pages:
    0.543kg, 364 Pages
    • Subjects:
    Social Psychology, Psychiatry and Clinical Psychology, Medicine, Psychology, Psychiatry
    Series:
    Studies in Social and Community Psychiatry
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    • Selected: Digital
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    Subjects:
    Social Psychology, Psychiatry and Clinical Psychology, Medicine, Psychology, Psychiatry
    Series:
    Studies in Social and Community Psychiatry
    Information

    Book description

    This second volume, in a series looking at the social dimensions of mental illness, collates and critically examines the information currently available on social support as it impacts on mental health. The international team of contributors, each actively involved in both clinical and research work in this field, collectively covers the whole range of perspectives from biological mechanisms through to psychological and social theory. An overview of the latest published evidence and a description of the nature and origins of social support are followed by evidence from observational studies and specific interventions and trials. The text concludes with a summary which will act as a valuable resource for practitioners in their evaluation of social and psychological treatments, and should also serve to stimulate further research and intervention trials. Practitioners and researchers in psychiatry, psychology and social work are certain to welcome this timely guide.

    Reviews

    "This book succeeds in describing the interactional complexity of social support systems, and presenting the challenge of empirically evaluating the contributions of social networks to human well-being. The presentation and evaluation of preventative and therapeutic interventions challenge the clinician to find new ways to incorporate social systems theory into treatment strategies." Patricia M. Meaden, Doody's Health Sciences Book Review Journal

    "...a great deal of timely, relevant information in an accessible, intriguing manner and is well worth reading." Mary Ellen McNaughton-Cassill, Ph.D., The Journal of Nervous and Mental Disease

    "This valuable and well-designed book focuses on an issue of central importance for clinicians-the impact of social support on mental disorder....This is a book that makes accessible to clinicians and mental health administrators some of the advances in social psychiatry..." Richard Warner, M.B., D.P.M., Psychiatric Services

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    Contents

    Contents
    • 1 - Social support and psychiatric disorder: overview of evidence
      pp 1-38
    • View abstract

      Summary

      This chapter traces the origins of the idea of social support within medicine and public health or social medicine. The public health concept of support was centred upon a network of community-based sources of medical, social and welfare assistance, which were to be organised around community mental health centres (CMHCs). The President's Commission on Mental Health in the United States promoted a policy to foster natural support systems in the wider community. The chapter then briefly discusses the nature of psychiatric disorder. Psychosocial theories include cognitive aspects, interpersonal aspects, social skills including assertion, attachment theory, social comparison, exchange and rank theory, social learning theory, coping and self-esteem and social development. In addition to mental health, general life course development, physical health and survival, have been considered to be outcomes that may be predicted by levels of social support. The chapter further focuses on issues relevant to clinical practice.
    • 2 - Understanding social support within the context of theory and research on the relationship of life stress and mental health
      pp 41-60
    • View abstract

      Summary

      This chapter discusses the several parallel themes which have occurred within the subdomains of stress, social support, personality and coping. The stress and the social support domains are the proper conceptualisation and measurement of the concepts. Cobb defined social support as information that one belongs to a socially coherent community and that one is loved and esteemed. One early measure of life stress included in its domain questions about changes in sleeping and eating habits; however, changes in these functions often occur in depressive disorders and hence are enquired about in measures of psychological distress. Self-esteem has also recently received some attention as a personality trait that might play an important mediating role in the stress-distress relationship. The more physiological roots of stress theory would seem to lead to various possibilities regarding biological mechanisms of effect, but these would seem to have more relevance for physical than for psychological disorder.
    • 3 - A developmental perspective on social support networks
      pp 61-95
    • View abstract

      Summary

      This chapter considers how supportive relationships develop from birth through to the adult years, and focuses on how experiences in each preceding life stage influence what happens next. It takes a life-span developmental perspective on the study of social support in all its aspects. Due to the importance of both individual predisposition and the external environment for the study of social support, its study presents a special challenge to the mental health researcher and practitioner. This challenge demands that the broad social influences on the development of social life are considered; these include sex, race, culture and class. Attachment theory is the idea that the earliest attachment formed to the mother is the basis of all later intimate relationships. The interest in patterns of attachment and the development of internal working models has led to an interest in the intergenerational transmission of relationship difficulties.
    • 4 - Cognitive aspects of social support processes
      pp 96-116
    • View abstract

      Summary

      This chapter describes how a cognitive perspective is of value in understanding some of the mechanisms that underlie these interrelated processes. A study by East investigated the theory that family experiences lead to enduring perceptions of interpersonal risks and benefits in early adolescents. In contrast, the majority of studies have investigated the importance of recalled childhood experiences in influencing the likelihood that a person will receive social support as an adult. Shyness, loneliness and social anxiety are extremely common, and in some cases social anxiety is so intense that the mere presence of other people leads to social withdrawal. Shy and lonely people tend to attribute interpersonal failures to internal, stable, and uncontrollable factors such as lack of social ability. Research on the family antecedents of perceived social support strongly suggests that, for some people, there will be deep-rooted barriers to the utilisation of existing resources.
    • 5 - Attachment, cooperation and rank: the evolution of the need for status and social support
      pp 117-142
    • View abstract

      Summary

      This chapter explores an evolutionary view of social support. The models and theories of Sullivan, Leary and other interpersonal theorists suggest that there are two salient dimensions of relating. The first is concerned with rank/status. The second is concerned with affiliation/attachment. An evolutionary approach starts with the premise that most basic social dispositions, like those of rank and attachment, are core potentials for relating and have a long-evolved history. For humans, self-presentation is a central concern and is clearly linked with status in the eyes of others and the avoidance of shame. The evolutionary perspective suggests that helping and support-giving are influenced by the relatedness of the participants. Psychobiological research on the disruption of social bonds would seem the next logical step, and would give more data on the value of social support whilst offering new psychobiological insights.
    • 6 - Social support as a high-risk condition for depression in women
      pp 145-162
    • View abstract

      Summary

      The literature on social support and its influence on mental and physical health have grown over the last two decades, very few studies have compared the effects of support on mental health across basic sociodemographic categories defined by gender or marital status. This chapter addresses the different role of social support in depression for men and women, and the issue of detrimental influences of support on recovery and relapse. Patients were first approached by the psychiatrist in charge of their treatment and asked for their consent to be included in the study. They were then contacted by a psychologist or psychiatrist member of the research team, who conducted a brief screening interview and administered a depression questionnaire. General exclusion criteria were indications of organic brain syndromes, illiteracy, mental retardation, bipolar disorder, obsessive-compulsive disorder, or schizophrenic or paranoid syndrome at any time during the study.
    • 7 - The importance of context: who needs and who does not need social support among college students?
      pp 163-173
    • View abstract

      Summary

      This chapter explores whether social support and personality would affect symptomatology. The extent to which people need or indeed are able to use personal relationships is found in literature. The tradition started by Murray and continued by McClelland and others describing peoples' needs and motives has led to work on the need for power and intimacy. The main conclusion to be drawn from the literature seems to be that there is little evidence of the existence of a truly hardy personality-a person who remains asymptomatic under stress, does not need the help and support of other people and genuinely does as well or better without it. There are indeed people who find personal relationships difficult and may only add to their stress levels when they seek support, but they are not asymptomatic when under stress and the impression is that they could still benefit from the right kind of support.
    • 8 - Teenage peer networks in the community as sources of social problems: a sociological perspective
      pp 174-194
    • View abstract

      Summary

      This chapter discusses how teenagers' peer networks which develop within their community are the source of their drug use. The social support of their teenage peers plays an important part in the normal psychosocial development of teenagers. Drug abuse has been recognised as a major social problem in many European countries and in the United States of America since 1970. In particular, the availability of social network analytic techniques highlights the inadequacy of using individual-level data to explore the concept of peer influence when peer relationship data are more appropriate. This chapter discusses the peer relationship data collected in a survey of the total population of teenagers. The survey demonstrated that peers influence the drug use of other teenagers. Ideally longitudinal data are needed to demonstrate the process of peer tie formation and change and its connection with the diffusion of drug use through peer ties.
    • 9 - Social network and mental health: an intervention study
      pp 197-212
    • View abstract

      Summary

      This chapter discusses a preventive programme aimed at improving mental health by improving social networks. The programme was carried out in a working-class/middle-class neighbourhood with mainly high-rise houses on the outskirts of Oslo, Norway. It describes an intervention project designed on the basis of the epidemiological study. The project prevents the development of mental disorder by influencing the social network in a positive way, i.e. by social network stimulation. In order to demonstrate the preventive effect of social network stimulation on mental health, one had to select a population group in which the high risk of mental disorder was associated with poor social networks, and expose this group to the programme. Poor quality of life was also included among the criteria because this variable is closely related to mental disorder, especially anxiety and depression, and probably acts as an intervening factor between life problems and mental health.
    • 10 - A test of the social support hypothesis
      pp 213-238
    • View abstract

      Summary

      The social network of any individual may be held to comprise those with whom the person has regular face-to-face interaction and some degree of commitment. Social support may be seen simply as the provision of help and advice by other people. Henderson has listed three separate hypotheses about the effects of social support. First, that social support has a direct and independent effect in its own right on mental and/or physical health, whether or not adversity is also present; second, that it provides a buffer or cushioning effect against stress; third, that in persons who have already developed affective or neurotic symptoms, it has a therapeutic effect shortening the episode and reducing symptoms. Clinical work with patients in both child and adult psychiatry is a constant reminder of how the interactions between parents and children influence, for better and for worse, psychosocial development in the children.
    • 11 - Case management and network enhancement of the long-term mentally ill
      pp 239-256
    • View abstract

      Summary

      This chapter outlines the policy background for the care of the seriously mentally ill in the United States, and examines the definitions and practices of case management and its variants. For individual patients, case management has been defined as the coordination of care for patients who require a multiplicity of services. The many variations in the practice of case management share a common set of underlying principles. Their starting point is that vulnerable patients with long-term psychiatric disorders need therapeutic interventions which optimise their social adjustment and minimise their functional disabilities. Community Support Treatment and Rehabilitation (COSTAR) is a community mobile treatment team, closely modelled on Program for Assertive Community Treatment (PACT), which combines case management and psychiatric treatment for a group of long-term mentally ill patients who are unable to utilise effectively the traditional outpatient mental health service system.
    • 12 - Expressed Emotion: measurement, intervention and training issues
      pp 257-276
    • View abstract

      Summary

      This chapter focuses on the measurement of Expressed Emotion (EE) and the range of social interventions it has generated. EE has been found not only in families with schizophrenia, but also in a wide variety of both physical and psychiatric conditions, ranging from weight loss and diabetes to manic depression. The training of staff to deliver social interventions to families and possibly to modify their own behaviour in working with the long-term mentally ill is just developing, and the results remain to be quantified. Both these areas raise issues about evaluating therapeutic processes, although doing so systematically is still in its infancy. It may be that gaining experience in the evaluation of clinical process, and in EE-related intervention, will be of benefit to those wishing to develop interventions based on other aspects of social support.
    • 13 - Social support processes and cognitive therapy
      pp 279-294
    • View abstract

      Summary

      This chapter focuses on cognitive behaviour therapy techniques. It explores ways in which cognitive therapists are able to help their patients improve the amount and quality of social support available to them by tackling problematic sequences of situational appraisal, schema-activation, cognition, emotion and behaviour which result in potential support being unmobilised, rejected, devalued or abused. Assessment prior to support-enhancing cognitive therapy is essential. The assessment includes mapping the patient's network and its structural features, assessing the frequency and types of helping behaviours that the patient has experienced from others in the network, identifying areas of relative strength and deficiency, and pointing up discrepancies between the support available and the patient's perceived social support. The social network map is then examined in conjunction with the helping behaviour tally to analyse how much of the network has been mobilised and in which areas, and to pinpoint specific support deficits.
    • 14 - Social support and psychiatric disorder: recommendations for clinical practice and research
      pp 295-334
    • View abstract

      Summary

      Clinical practice and epidemiologically based scientific research are absorbing and demanding areas of activity; it is hardly surprising that few people are able to find the time to master the problems that need to be understood and worked on in the two areas. Several authors have suggested that a fundamental component of psychotherapy is the provision of social relationship or social support resources. Winefield has discussed parallels and differences in the helping process linking psychotherapy and social support specifically. Both provide esteem enhancement and informational support. Marziali developed a social support measure for use with psychiatric patients entering and completing psychotherapy. An attempt to appraise the effectiveness of case-level and community-level social care has been provided in a review of the social work literature by Goldberg. The future use and development of the concept of social support will depend on an equitable balance between observational studies and experimental research.

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