REVIEW ESSAY Clarifying Social Support David Jacobson
Brandeis University Community Support Systems and Mental Health: Practice, Policy, and Research. David E. Biegel and Arthur J. Naparstek {eds3. New York: Springer
Publishing Company, 1982. This is a collection of nineteen papers, orignally prepared for two conferences in 1980. The major premise underlying these studies is that since our country's mental health needs cannot be met by professionals alone {there are not enough of them), and since government agencies and programs are limited and inadequate for meeting those needs, people will have to help themselves, primarily through "community support systems." This raises, for the editors, several questions: what is a community support system?~ what is its proper role in a mental health system?, what are the similarities and the differences between the roles of community support systems and those of professionals in mental health?, and what should be the relationship between community support systems and mental health professionals? These questions inform the organization of the book and the distribution of its papers over four parts: theory and research about community support systems, examples of programmatic interventions which utilize community support systems, analyses of the relationships between professionals and community support systems, and the policy implications of community support systems. Since the seven chapters on theory and research with which the book begins provide a foundation for the other papers, analyzing and evaluating them is an appropriate focus for this review. The theoretical papers reflect the conceptual confusion which generally troubles the study of community support systems. First, there is the issue of what constitutes a community. The editors argue in their introductory chapter that a " c a t c h m e n t " area is not a community and that the neighborhood is the proper focus for studying community support systems. Many of the papers follow that lead, describing different kinds of neighborhoods and the support systems found within them. Correspondingly, they do not consider sources of support external to the neighborhood nor do they ask about the relationships between local and non-local supporters, especially the important questions of their differential mobilization. Other papers circumvent the issue by focusing on self-help and mutual support groups, as kinds of communities, without exploring the relationships between individuals who share specific common interest and others who are related to them, regardless of their physical or social propinquity. That is, the community aspect of community support systems is not taken as problematic, although it is clear that. difQualitative Sociology,7(4),Winter 1984
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ferent definitions of community lead to quite different conclusions about the formation and function of such support systems. A more serious limitation in these studies is their failure to consider social support theoretically. Warren ("Using Helping Networks: A Key Social Bond of Urbanites"}, for example, describes different kinds of helping behaviors, including "passive social support" and "more active behaviors", and concludes that the passive type is not much better than the individual coping alone. This observation ignores the fact that different kinds of support are appropriate to different situations. Examining and evaluating support without reference to the stress which precipitates it renders it a meaningless concept. Such atheoretical definitions of support, of course, have made it a difficult concept to measure, as many researchers have noted. One way of defining support theoretically is to describe it in relation to the types of stress with which it is associated. This presupposes a definition of stress, which in itself is not a simple matter. Indeed, there are several different concepts of stress, each implying a different concept of social support. One approach, for example, defines stress as a reaction to the individual's unmet needs. Weiss' work (1974) on the provisions of social relationships exemplifies this viewpoint. Weiss posits that individuals have needs or requirements for well-being which are met through social relationships, and, furthermore, that relationships are specialized for what they provide. Weiss hypothesizes that the absence of a required relationship and its provision leads to stress and that the form of stress will be specific to the relational deficit. Another concept of stress is found in research on loss and change. Parkes (1971), for example, outlines a theory which links psychosocial transitions and stress. A psychosocial transition is a relatively abrupt change in a person or in his or her environment which affects the individual's assumptions about the world and his or her place in it. Central to this view is the idea that these assumptions shape behavior and that events which undermine, challenge, or change them are stressful. It is important to note that it is not only the event which is stressful but rather the readjustment in the individual's assumptive world which it requires. The change entails not only one's external circumstances, but, most importantly, the ways in which one perceives the world, one's mental representation of it. The existential change may be sudden, but the cognitive change is slower. Still another concept of stress is that of the 'transactional' psychologists, illustrated in the work of Lazarus and his associates 11978). They conceive of stress as an imbalance between perceived demand and perceived resources which has negative consequences for the individual. Each of these concepts of stress implies a concept of support. Thus, if one sees stress as the absence of a provision or of a relationship through which it may be provided, then one may also see support as providing that which is missing. Correspondingly, if one defines stress as an imbalance between demands and resources which has negative consequences for a person's wellbeing, then support would be anything which serves to decrease demands, increases resources, and/or alter the consequences of failing to meet demands.
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Finally, the concept of stress implied in the study of psychosocial transitions suggests another aspect of support, that of its timing. In Parkes' view, griefwork is the process through which an individual gives up an old "assumptive" world and adopts a new one. This process occurs in stages over time. Therefore, support is necessarily a matter of timing. A new object or assumption offered to someone before he or she has relinquished the old one will not be accepted and will not be seen as support. Weiss also deals with matters of timing and the dynamics of support systems. In another collection of papers dealing with support systems (1976}, he defines three forms of stressful situations, those in which almost everyone exposed to them experiences distress. These are crisis, transition, and deficit states. Crisis is a situation which is severely upsetting but of limited duration. A transition state is a period of relational and personal change, usually following a crisis, which is more enduring than a crisis and which involves a shift in a person's assumptive world. A deficit is a situation, typically, but not necessarily, following a transition in which the person's life is characterized by excessive demands. That is, in a deficit state, there is a chronic imbalance between demands and resources and therefore it is characterized by stress. Each of these stressful situations calls for a different sort of support. In a crisis, the only useful form of help is emotional support, which is communication from a trusted ally that he or she and his or her training, experience, and understanding are at the service of the distressed individual, tn transitions, the forms of help are emotional support, orientation, guidance, and access to a helping community. This help is primarily of a cognitive sort and is especially important here because it is the time of the construction of a new assumptive world. In deficit situations, the assumptive world has changed and there is a new network of contacts. Here, however, material aid and direct action are needed to remedy an imbalance between needs and resources of a tangible kind. Thus, social support is complex and requires careful conceptualization. Most of the studies contained in Community Support Systems and Mental Health do not consider this issue and consequently their findings are unclear and of limited interest. Yet several of the papers begin to address these problems. For example, Warren's chapter, mentioned above, introduces the concept of a "problem-anchored helping network". This furthers understanding of support systems because it recognizes that networks are mobilized in relation to a stressful situation, implying a relationship between type of stress and type of support {although it is an implication which remains undeveloped). Indeed, Warren recognizes a connection between concepts of stress and support on the one hand and, on the other, a concept of community: "Without a problem there is no helping and even the very social meaning of community may not be expressed." Warren's emphasis on processual issues makes other static and descriptiv e accounts of community support systems seem especiall~ obsolete. In a different way, Gottlieb's paper {"Social Support in the Workplace") contributes to the study of support systems by linking support to the process of coping with stress, a process which takes place over time and through different stages and which involves feedback between the
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evaluation of an event as t h r e a t e n i n g , the perception of additional resources with which to m a s t e r it, and the re-evaluation of such an event as nonstressful. A l t h o u g h Gottlieb does n o t explicitly use the theoretical framework of the t r a n s a c t i o n a l psychologists, his work is closely tied to and illuminated by it. I n short, although a few papers in this collection c o n t r i b u t e to the theoretical analysis of c o m m u n i t y support systems, the others are primarily descriptive, i n c o r p o r a t i n g u n e x a m i n e d concepts, and do not significantly advance our u n d e r s t a n d i n g of them.
References R.S. Lazarus and R. Launier 1978 "Stress-related transactions between person and environment." Pp. 287-327 in L.A. Pervin and M. Lewis (eds.t Perspectives in Interactional Psychology. New York: Plenum. C.M. Parkes 1971 "Psycho-social transitions: a field for study." Social Science and Medicine 5:101-115. Robert S. Weiss 1974 "The Provisions of social relationships." Pp. 17-26 in Zick Rubin ted.) Doing Unto Others. Englewood Cliffs, N.J.: Prentice-Hall. Robert S. Weiss 1976 "Transition states and other stressful situations: their nature and programs for their management." G. Caplan and M. Killilee teds.) In Support Systems and Mutual Help: Multidisciplinary Explorations. New York: Grune and Stratton.
