Theories of Perceived Social Support
Supportive actions and Medication compliance
The stress- support matching hypothesis (Cohn & McKay,1984;Cutrona&Russell, 1990) is perhaps the most explicit statement of how supportive actions should promote coping. The hypothesis is that social support will be effective in promoting coping and reducing the effect of a stressor, in so far as the form of assistance matches the demands of the stressor. According to this view, each stressful circumstance places specific demands on the affected individual. For example, having someone lend you money may be useful in the face of a temporary job loss but useless in the face of the death of a friend. Similarly, having companions and confidants might be extremely useful when addressing the loss of a friend but less helpful when faced with a sudden economic demand.
Appraisal Theory and Medication Compliance
Alternatively, social support might protect persons against the adverse effects of stressors by Leading them to interpret stressful situations less negatively (Cohen &Hoberman, 1983; Cohen & mckay, 1984). According to Lazarus and colleagues’ influential theory of stress and coping, how people interpret situations (I.e., appraisals) is very important in determining event’s stressfulness (Lazarus, 1966; lazarus & folkman, 1984). There are two types of appraisals: primary and secondary. Primary appraisals involve judgments of whether the event is a threat.These judgements involve questions such as “Am i in trouble?” on dimensions such as harm-loss,threat,or challenge.Secondary appraisals involve evaluations of personal and social resources available to cope with the event. Such evaluations involve questions such as “What can I do about it?”More negative appraisals are hypothesized to lead to greater emotional distress (Lazarus & FoIkman, 1984; Cohen &Hoberman,1983; wethingten & Kessler ,1986), hypothesized that the belief that support is available reduces the effects of stress by contributing to less negative appraisals. Consider the recent death of the husband of a frail elderly woman. A threatening primary appraisal might be “Now I am truly alone in the world”. A negative secondary appraisal might be “I won’t be able to take care of myself”. However , if the bereaved believed that she was surrounded by a group of loving, helpful, and committed people, these appraisals might be modified to “I have lost my husband, but there are many dear people I am close to” and the secondary appraisal might be changed to “I can count on others to help me with shopping and home maintenance”. According to Lazarus’ theory, these revised appraisals should lead to less severe emotional reactions to the event. As with received support, perceptions of support availability should be most effective in altering appraisals if they counter the specific needs elicited by the stressful event (Cohen & Hoberman, 1983; Cohen & Mckay, 1984).
Social Cognitive Theory and Medication Compliance
One modern manifestation of social constructions is a social cognitive (Barnes & Sternberg,1997), and several authors have applied social cognitive thought to understanding social support (Lakey & Cassady,1990; Lakey & Drew, 1997; Mankowski wyer, 1997; pierce, Baldwin, &Lydon, 1997; Sarason, pierce, & Sarason, 1990).
This approach to social support draws heavily from social- cognitive theories of personality and psychopathology (Beck, Rush, Shaw,& Emery, 1979, Markus ,1977). Social cognitive views of Social support are concerned primarily with the perception of support. A major premise is that it develops stable beliefs about the supportiveness of others, day-to-day thoughts about social support are shaded to fit those preexisting beliefs. In comparison to those with low levels of perceived support, those with high levels should interpret the same behaviours as more supportive, have better memory for supportive behaviors, display great attention to supportive behaviors, be able to think about support with greater ease and speed (Baldwin, 1992;Lakey & Cassady, 1990; Lakey & Drew, 1997; Makowski & wyer, 1997; Pierce, Baldwin & lydon, 1997). Although “objective” Characteristics of the social world have an influence on perceived support,perceived suport is influenced more strongly by support recipients’ impressionistic understanding of supporter’ personality Characteristic than by the actual support that is provided (Lakey, Ross, Butler, & Bently, 1996).
In explaining the mechanism by which social support is related to health, social-cognitive views of social support draw from cognitive models of emotional disorders (Beck et al., 1979). Negative thoughts about social relations are thought to overlap with and stimulate negative thoughts about the self, which, in turn, overlap with and stimulate emotional distress (Baldwin & Holmes, 1987; Lakey & Cassady, 1990; Sarason, Pierce,& Sarason, 1990). For example there is evidence that perceived support is associated strongly with self-evaluation (Barrera &Li, 1996; Lakey &Cassady, 1990;Maton, 1990; Rowlinson & Felner, 1988) and that priming cognitive representations of different social relative influences self evaluation and emotion (Baldwin, Carrell, &Lopez 1990; Baldwin & Holmes, 1987;Baldwin & Sinclair, 1996).
Theory of Expressed Emotion
Social Interaction Theory
This theory provides a valuable framework with which to understand the reciprocal process associated with relationship between people with severe mental illness and their families and providers. One can attribute high levels of expressed emotion to failed social interactions, arising from both parties not adhering to social conventions.
These interactions are essentially dynamic, creating themselves from second to second Katz (1999). The micro sociological approach provide a theoretical framework for understanding the constant interplay between individual subjectivity, context, and social communication, which shapes how people perceive themselves and others during social interaction. underlying this complex process are emotion states which both motivate and are influenced by social behavior.
Goffman (1967) characterized social interactions as everyday rituals with specific rules and norms dictating their forms. The sacred aspect of this ritual is “face,” the image of oneself that becomes created and communicated through one’s interactions with others. The rules that determine “impression management” or “facework” are, according to Goffman, the central organizing forces in everyday interaction. Constant negotiation is required between individuals to ensure that each manages to save face and, if these negotiations break down the interaction ritual fails. Goffman specifically connects the process of saving or losing face with feelings of pride and shame. Drawing on Cooley’s (1964) concept of looking glass self, he argues that one’s sense of self is both created and reinforced by other’s view of oneself. Social interaction is a service of sequential acts that ensure the protection of face for those participating. often both participants will avoid any more that may embarrass the other, but if some if threat does transpire, corrective process can be put in places, which involve offering, accepting, acknowledging a repair to the threat. This suggests that there is an innate equilibrium in interaction rituals, which participants strive to maintain the majority of time. Interaction sequences can have many variations, but their success or failure is contingent on that extent to which both parties’ positive sense of self is maintained. Failed rituals are often signified by the parties’ embarrassment and a breakdown in communication. Clearly, emotion is intimately involved in these processes, in reflecting what is being done to one’s face, but also, in motivating interactional responses. The extent to which people follow the rules of interaction and maintain face indicates how important this activity is to social order. The key behaviors of expressed emotion-hostility,criticsm and over-involvement-all transgress the rules of Goffmanian interaction ritual by undermining face and violating individual boundaries. Consistent transgression of these rules, as seen in high expressed emotion relationship leads to an accuse sense of social isolation and low self-esteem using the diathesis-stress perspective, the feelings associated with social isolation and low-esteem can be severe psychosocial stressors with the potential to cause medication non-compliance and precipitate relapse among people with severe mental illness.
Social interaction rituals between providers and consumers are largely defined by the treatment context. Consumer – provider relationships are marked by an essential asymmetry that differentiates them from interactions within families or among people of equal status. In describing the role of deference in interaction ritual, Goffman (1967) refers to the fact that in psychiatrist-patient relationship the ability to inquire about aspects of one’s private life is not reciprocal, the privilege lies only with the psychiatrist. He demonstrates how psychiatrist-patient relationships do not adhere to the patterns of ritual deference. Goffman (1961) chose to focus his studies on mental hospital because he could observe many violations of the rules pertaining to interaction, Specifically, privacy and separateness. Even among unequal, Goffman argues that displays of deference can be mutually affirming as with a subject paying homage to his leader. However, the stripping away of any ability to maintain face results in alienation for the patient. For Goffman it is the actions of the professional staff that is the source of the failure in staff-patient encounters. Their clinical rules prohibit face saving activities by patients.
In contrast, the studies on expressed emotion and providers have tended to focus on the actions of the consumers as being the source of high expressed emotion relationships. Providers, who are unable to accommodate these behaviours, violate the social rules which results in alienating interaction pattern for the consumer. In clinical settings there are potentially two focuses at work, created and reinforced by one another which serve to undermine interaction rituals.
Clinical rules that have the power to demean a consumer behavioiur that violates the rules of social interaction.
Managing emotional process is an integral part of social interaction and, therefore, plays a primary and secondary role in the sequence of actions. Societal reaction, how people perceive and respond to emotion, also shapes the way one expresses emotion (Katz, 1999). Symbolic interaction theorist argue that pride and shame are uniquely social in nature and are the primary emotional forces driving interpersonal interaction (Cooley, 1964; Scheff, 1990). The maintenance of pride and avoidance of shame drive the constant self-monitoring that goes on among human beings within a societal context. Both pride and shame , reflecting positive and negative self-esteem, rely heavily on how people believe they are being viewed by other people.
However, due in part to their social nature, the outward indicators of pride and shame are far more complicated to understand than emotions such as happiness, anger or fear.
These emotions accompany complex social interactions where people are vying to both protect and project themselves in a way that will maintain their sense of self-worth.
Scheff(1990) argues that experiencing shame in a social encounter can follow a variety of sequences and is often recursive , in that feeling shame promotes additional feelings of shame.
Also, feelings of anger can trigger feelings of shame , which in turn provoke more angers giving another variation of the ‘’shame spiral”. shame appears to be one of the more difficult emotions to express in society.
Consequently, feeling ashamed of feeling shame motivates people to hide shame. For Scheff(1990), unacknowledged shame can lead to a chain reaction with no natural limit to its duration or intensity. Within a social interaction , shame can arise from some perceived threat to self, but also can be revealed and dissipated by the other party in the interaction. This closely follows Goffmans idea of repair, that a persistent loss of face can be avoided if there is sufficient repair. However, repair is only possible when shame is visible.
Scheff’s description of unacknowledged shame resonates with high expressed emotion interactions,which have described relatives becoming “locked into chains of iterative negative interactions” ( Wearden, Tarrier & BarrowClough, 2000).
Social interaction theory provides a logical theoretical framework with which to understand expressed emotion. The quality of high expressed emotion interactions reflects many of the facet of failed rituals, with both parties failing to adhere to rules designed to avoid embarrassment and humiliation . Failed interaction, therefore, lead to poor self-esteem and arousal states associated with relapse.On the other hand, strong relationships arise from successful social interactions , which maintain pride and respect for both parties. Providers who manage to negotiate a strong social bond with their consumers even within a mental health setting that has the potential to be disempowering , may significantly decrease the relapse rate among their consumers.
Consumers themselves have identified the quality of their relationship with providers as being a key factor in their recovery (Ware, Tugenberg & Dickey, 2004; Redko, Durbin & Wasylenski, 2004).
Theories of Religiosity
Theory of mind and Medication Compliance
Jordan Grafman, Lead researcher at the united state National Institute of Neurological Disorders and stroke in Bethesda, Maryland was interested to find where in the brain belief system were represented, particularly those that appear uniquely human. The researchers found that such beliefs “Light up” the areas of our brain which have evolved most recently, such as those involved in imagination, memory and “theory of mind – the recognition that other people and living things can have their own thoughts and intentions.
In the study, the researchers gave 40 religious volunteers functional magnetic resonance imaging (FMRI) brain scans as they responded of statements reflecting three core elements of belief. For each statement, they had to say on a scale how much they agreed or disagreed. The volunteers were believers in monotheist religions such as Christianity, Islam and Judaism.
First, volunteers responded to statement about whether “God intervenes in the world or not” Here, brain activity was focused mainly in the lateral frontal lobe regions of the brain where theory of mind takes shape, enabling us to interpret other people’s intentions. The regions links to mirror neurons which enable us to empathize with other people.
Second, the volunteers mulled statements on God’s emotional state, such as “God is wrathful.” Again, and as the researchers predicted, the activated areas were those where theory of mind enables us to judge emotion in others such as the medial temporal and frontal gyri.
Finally, the volunteers heard statement reflecting the abstract language and imagery of religion, such as “Jesus is the son of God” or “God dictates celebrating the Sabbath” or “a resurrection will occur.” Here, volunteers tapped into areas of the brain such as the right inferior temporal gyrus, which decodes metaphorical meaning and abstractedness. The researchers beliefs their result are unique in demonstrating that specific components of religions belief are mediated by well-known brain networks, and support contemporary psychological theories that ground religious belief within evolutionary adaptive cognitive functions.
James Fowler Stage Theory Religion Development and Medication Compliance
Fowler (1981, 1991) offers a development model of faith consciousness. He conceives faith as “a dynamic and generic human experience” but does not imply that it is identical with religion. Fowler describes faith as developing in stages .The first four stages of his theory parallel Piaget’s four stages of cognitive development.
There is a stage O or pre-stage, inaccessible to empirical research of the kind he pursues. It is the stage of primal faith, the earliest faith which is found before there is language, in relationship of oneself with parents and others.
In Stage 1 children manifest intuitive projective Faith, which is characterized by productive imaginative process filled with fantasies, and by the awakening of moral emotions. This stage is most typical of children ages three to seven years.
Stage 2 is the stage of mythic-Literal Faith, approximately coincident with the elementary school years. At this stage, faith takes the form of story, drama or myth. As the concrete-operational thinking is developing, children’s logic begins to separate the real and actual from fantasy and beliefs.
Stage 3 begins to take form in early adolescence and it is the synthetic-Conventional Faith, when a person’s experience of the world starts to extend beyond the family. At this stage, faith has to synthesize values and data. There are personal new relations with significant others which “Correlate with a hunger for a personal relationship to God in which we feel ourselves to be known and loved in deep and comprehensive ways”. Fowler (1991) pointed out that this stage is typical of the adolescent period and becomes a fixed placed equilibrium for many adult.
Stage 4 forms mostly during late adolescent and young adulthood. To reach this stage, it is necessary explicitly to recognize one’s identity and differentiate one’s own worldview from those of others. Commitments have to be consciously chosen and critically examined. For this reason, it is a “demythologizing” stage according to Fowler, where symbols, rituals, myths and beliefs are critically evaluated. Their meanings are interrogated and reconstituted.
The stage of conjunctive faith, stage 5 often appears at midlife or beyond and involves the reintegration of elements of strength from the childhood faith. In the religions instance, symbols must be reunited with conceptual meanings.
Stage 6 is very uncommon. The persons best represented by it have generated faith composition in which they feel a sense of ultimate environment which is inclusively of a being. “Persons in this stage are grounded in a oneness with the power of being or God.” Universalization have completed the process of decentralization. According to Fowler, they begin to see and value through God rather than from self.
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