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Lecture 7

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SOCI 3645

Sociology of Health and Illness Lecture 7 Tahreem Mahmndd October 22 , 2013 Social Psychological Explanations for Illness  Stress and outcomes, social support and coping, Type-A behvaiour and heart disease, sense of coherence, mental illness – sociological explanations, social cohesion and social inclusion vs. the “culture of inequality” Social-psychological factors related to morbidity and mortality  Stress/distress and resilience  Subjective perception of one’s wellbeing or illness  Sense of control of one’s life/sense of coherence  Sense of justice/injustice  Social support and the subjective perception of support  Can religious prayer heal? Outcomes of the stress process  Although stress does not cause mental illness, exposure to stress does increase the risk of experiencing mental health problems  probabilistic relationship  There are substantial differences in the types of stressors one is exposed to and in the ways stress is experienced by different groups in society;  There are many different mental health outcomes associated with stress, e.g. emotional distress, substance abuse or dependence, traumatic disorders, behavioural disorders, and stress outcomes over time;  A variety of stress mediators explain how stress influences mental health outcomes  they transit the effects of stress in the ways they influence our mental processes and behaviour: Ex., psychological responses to threat, cognitive processes (e.g., threat and situational appraisal) that affect how individuals respond to potentially stressful situations, the degree of fit between individuals and their social environments,  There is a small minority of people whole mental health is seriously damaged by exposure to stress  current research seeks to understand why most people adapt to stress while others do not.  Both personal and social characteristics are important in understanding differential responses to stress (stress reactivity) and the degree to which an individual is vulnerable to stress (stress vulnerability). Also spill-over effects from individual stressful events onto family settings (e.g. how the family copes with cancer or job loss)  The relationship between stress and psychological outcomes is modified by social structural variables, e.g. position in status hierarchies, class, ethnicity, gender, and age which differentiate between individuals in terms of vulnerability to stress and likelihood to experience specific disorders, ex: poverty is more damaging to the mental health of black people than to white people (Kessler and neighbours, 1986). Sociology of Health and Illness Lecture 7 Tahreem Mahndod October 22 , 2013 Mental Health and Outcomes of the Stress Process  Social stress acts as a nonspecific risk factor  its impact is not limited to a single disorder but is manifested across a broad spectrum of impaired functioning.  Outcomes include: o Symptoms of emotional distress (nonspecific psychological distress) e.g. depression and anxiety o Affective disorders, especially depression; o Behavioural disorder/maladaptive behaviours, e.g. substance abuse, addiction. Social Support and Coping  What is social in social support? Definition: Social support always involves either the presence or implication of stable human relationships. Several domains of research about social support: o Social bonds o Social networks o Meaningful social contact o Availability of confidants o Human companionship o Emotional support o Social support o Social integration vs. exclusion  The field becomes very active since the 1980s with research in 3 main areas, sometimes summarized also as mental health: o Stress o Social support o Coping 2 Important aspects of Social Support Demonstrated by early Sociological Research/evidence  Primary group bonds are essential for emotional stability and healthy interaction of individuals with their more extended social environment;  Social support is also seen as a developmental contingency associated with the social and physiological adaption of individuals and their well-being throughout life Concept of Social Support  This is a multi-dimensional and multifactorial construct. The main categories of social support that are consequential for people’s mental health are 3 sub-constructs: o According to Dean and Lin (1977): (1) network resources of support; (2) supportive behaviour; (3) subjective appraisals/perceptions of support; Sociology of Health and Illness Lecture 7 Tahreem Mahmndd October 22 , 2013 o According to Barrera (1986): (1) socially embedded ; (2) intact support; (3) perceived social support o Most influential conceptualization – by Cobb (1976): Social support is seen as “Information belonging to one or more of the following 3 classes: (1) information leading the subject to believe that s/he is cared for and loved; (2) information leading the subject to believe that s/he is respected and valued; (3) information leading the subject to believe that s/he belongs to a network of communication and mutual obligation.  Cobb distinguishes social support from other forms of support, e.g., instrumental support (counselling, assisting), active support (mothering), and material support (providing goods and services). Social Support as a Social-Psychological variable: Why?  Social psychologists hold that events and circumstances in the real world affect the individual only to the extent and in the form that they are perceived  perceptual reality is a psychological reality: it is the actual (mediating) variable that influences behaviour and development.  The great bulk of evidence supports the linkage between social support and health/well- being comes from studies of emotional support (=perceived support.)  Wethington and Kessler (1986)  evidence about the primacy of perceived over received support o Perceptions about the availability of support are more important than support transactions per se; o Real support is likely to be effective only to the extent to which it is perceived/appreciated (House, 1987.) Social Support as a Multidimensional Construct  Refers to the clarity and certainty with which the individual experiences being loved, valued, and able to count on others should the need arise.  Includes the following dimensions: o Emotional perceived support; o The dimensions of structural support  characteristics of the social networks in which the individual or family is/are embedded, e.g. frequency of contacts, reciprocity, strength of bonds, homophile, density of ties, etc. o Received support/supportive behaviours (real help) The Nature of Perceived Social Support  Two general explanations of the protective benefit of perceived social support: Sociology of Health and Illness Lecture 7 Tahreem Mahmndd October 22 , 2013 o A situation-specific model in which perceived support is seen as a coping resource in relation to particular stressful events or circumstances ( short-term consequences of social support of health) o A developmental perspective that sees social support as a crucial factor in social and personality development ( long-term/ over the lifetime consequences of social support for health)  Individuals varying their expectations and perceptiveness of social support. I.e. the capacity to derive meaning and emotional energy from a given amount of evidence of positive regard and affection. Perceptiveness is showing consistency over time and therefore  the importance of personality factors…Self-esteem is one factor contributing to perceptiveness; other factors: social competence and personal control (lakey & Cassady, 1990.)  But there is also a reciprocal effect: the more one is perceptive to social support the more likely this person is to develop social skills for developing and maintaining supportive ties with one’s environment. Pierce at al. (1996): individuals with firm expectations that others will be supportive “create supportive relationships in new social settings thus further confirming their expectations and perceptiveness of social support”  Low levels of social support increase the risk for depressive symptoms. Henderson (1992) assessed (meta-analysis) 35 studies about the relationship between social support and depression and found a robust inverse association. Main vs. Buffering effects of social support  Main effect: social support is relevant in all circumstances, whether or not significant stress is present – relatively weak effect;  Buffering effect (Cobb, 1976; Casel, 1976): social support is specifically effective to buffer or moderate the effects of stressful circumstances/life events by facilitating coping with crises and adaptation to change.  Therefore: it is in moderating the effects of the major transitions in life and of the unexpected crises that the effects of social support are most likely to be found  The above effects are found in cases when social support is relatively high. Perceived social support is of dramatic significance in high stress circumstances.  When social support is at a low level the risk for depression/other mental conditions as an outcome of life stress increases whether or not exposure to unusual stressors had also taken place. o Major life events and cumulative theory  two theories leading to stress and depression Social status and social support  The extent to which the effects of social support vary across population subgroups depends on such social and cultural characteristics at population level as the general level of inequality and Sociology of Health and Illness Lecture 7 Tahreem Mahmndd October 22 , 2013 “the culture of inequality”, collectivism vs. individualism, class structure and possibly also ethnic diversity/inequality  At the individual level low SES is associated with increased risk for psychological distress and depression and with lower level of perceived social support which accounts for 15% of the observed differences in depression;  Other factors associated with such increased risk and low support: o Being unmarried (lower support)—social support differences account for more than 50% of observed marital status differences in depression; o Being female (substantially higher levels of perceived social support among women but when the levels of support are low and there are stressful events, the detrimental negative effects of low support may lead to more dramatic negative outcomes in women as compared to men.) Social support: Conclusions  Increasing evidence that social support is importantly associated with mental health status in general and depression in particular ;  Robust evidence through various research methods, including longitudinal studies, that the relationship between social support and mental health status is causal at least in part  It is one’s perception/belief about the availability of support that is more protective against distress and depression  the love or esteem of others (and the availability of emotional, material, or instrumental assistance) is likely to be of little protective utility if kept a secret;  Perceived levels of social support vary reliably with locations in the social system (as defined by SES, marital status, and gender)  the experience of being supported by others arises substantially out of the ongoing social context within which the individual is located;  The early experience of social support within the family is a crucial development contingency that facilitates the later capacity to develop and maintain supportive relationships and to meaningfully experience the support that others provide  Social support tends to matter for psychological distress and depression independent of stress level. But it tends to matter more where stress exposure is relatively high. Sociological Theories about Mental Health and Illness  Stress theory (discussed above)  Structural strain theory  Labeling theory/societal reaction theory o Social contingencies in the application of psychiatric labels o Integrating the three theories Sociological Approach to Mental Health and Illness Sociology of Health and Illness Lecture 7 Tahreem Mahmndd October 22 , 2013  Locate the primary cause of mental illness outside of the individual body and psyche – in the social environment  Assumption: accumulation of social stressors/strains can precipitate mental health problems;  Focus on the unequal distribution of adversities, chronic strains, and coping resources/mechanisms in the population by class, SES, gender, ethnicity, race, etc.  The origins of distress and mental disorder could be located also in the broader organization of society  structural strain theory (e.g., structural conditions such as economic depression  broad experiences of major stressors, e.g. job loss, etc.):  A third sociological approach to mental illness is labelling or societal reaction theory which stresses that treatment methods may exacerbate further the health condition of mentally ill people through definitions and labelling them as deviants violating social norms. The label itself becomes a factor reinforcing the existing mental health condition. Structural Strain Theory  Structural strain theory -- “umbrella” term covering a number of hypotheses that locate the origins of mental disorders in the broader organization of society, where some social groups are disadvantaged in comparison to others  Examples: 2 theories of anomie – Durkheim’s and Merton’s  Durkheim’s analysis of the social causes of suicide; Why Protestants had higher rates of suicide than Catholics and Jews? Why unmarried people without children? Why military men? And why suicide rates were higher during both times of rapid economic expansion and depression than during stable economic periods?  Durkheim’s answer: social integration (the degree to which people are bound together and regulated by shared norms)  3 types of suicide: o “egotistic suicide:” members of weakly regulated groups suffer from disappointment and misery because their passions, unregulated by norms or relations with others, inevitably go unfulfilled; o “altruistic suicide”: social integration may be too strong leading some members to commit “altruistic suicide” (sacrificing themselves for the community(: o “Anomic suicide”: is induced by rapid changes in social structure and breakdowns in norms. Anomie is a state of normlessness or fuzziness of norms, conflicts of legitimacy between norms, etc. As traditional rules no longer can guide people’s behaviour  sense of confusion  causes passions to go unchecked plunging large groups of people into disappointment and despair. o Thus: structural (system-level) strain in society is the cause of increasing suicide rates. Evidence in support of Durkheim’s Structural Theory of Suicide  During the big depression (1930s) in Chicago Faris and Dunham found that schizophrenia patients often lived alone and were concentrated in poor areas, e.g. the inner city core, in rental apartments and boarding houses and high % of immigrants – anomic neighbourhoods. Was schizophrenia caused by social isolation? Sociology of Health and Illness Lecture 7 Tahreem Mahmndd October 22 , 2013  Schizophrenia patients are disproportionately likely to be unmarried or divorced (Braginsky et al, 1969)  Harvey Brenner (1973): higher rates of mental hospitalization were associated only with economic downturns (between 1910 and 1960 in the US): relationship between employment rates and hospitalizations, especially for men, the young people, the old, and people with less education than high school.  Dooley and Catalano (1984) formulated a “contextual” hypothesis – a high unemployment rate may create a climate of uncertainty and insecurity for everyone, thus exacerbating people’s worries in general and leading to increased mental hospitalization for psychological problems among the most vulnerable. This hypothesis was supported by evidence. Conclusion 3 Underlying assumptions in all structural strain studies: 1. Society’s organization (especially economic organization) puts some groups in disadvantaged positions (e.g., women, the youth, the elderly, immigrants, the unmarried, the unemployed) 2. Socio-economic disadvantage is a strain (could be even chronic strain) leading to higher rates of emotional or psychological breakdown, inability to cope, etc. 3. Empirical research and explanations stay at the aggregate/group level, so these models need stress theory to connect to the individual level explanations Sociology of Health and Illness Lecture 7 Tahreem Mahmndd October 22 , 2013 Structural Strain Theory: Merton  Robert Merton’s anomie theory (1938) continues and develops further the Durkheimian theory of anomie, but differs from it.  American culture emphasizes success and wealth as chief values  individuals are expected to strive from material success though mainly increasing education and employment (as a legitimate means) or entrepreneurship.  However, some social groups feel that their means to success (education) are systematically blocked…  “Anomie” is the gap between cultural goals (material success) and the structural means to achieve these goals (access to adequate education and employment). The goals or the means?  5 adaptations to this dilemma: o Conformity o Ritualism o Innovation o Retreatism o Rebellion  Retreatists are sinking into dysfunctional adaptations, e.g. substance abuse, addictions, mental disorder. Labelling Theory  Based on a key sociological idea: People who are labelled as deviant and treated as deviant become deviant.  Deviance: Rule breaking or violation of norms   Symptoms of mental/psychiatric disorders are also viewed as normative violations (Thomas Scheff, 1966). Primary and Secondary Deviance  Primary deviance: labelling theorists (Becker, 1973; Le
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