At Ellenhorn, we work with individuals who encounter complex and often extreme events of mind and mood, as well as problematic habits. While not every person who experiences such states needs the intensive level of service we offer, many do, and we firmly believe this is due in part to the intense social trauma and suffering that often affects people who have been diagnosed as “mentally ill.” Sadly, stigma, ostracism, loss of social support, loneliness and lack of purpose are but a few of the social events such individuals endure. In fact, as someone trained in both sociology and psychology, I’m convinced that these events often have a more powerful effect on our clients’ ability to recover than the actual psychiatric or behavioral issues they confront, and, as a result, cause two significant problems: loss of motivation and difficulty accepting help.
Something tragic happens when we don’t consider the social state of our clients, and assume instead that their behavior is simply skull-bound, i.e., pathologically rooted in a diseased brain, rather than the result of being stripped of what social psychologists call “psychosocial resources.” In my research on what I call “fear of hope,” I’ve been privileged to work with Dr. Kent Harber, Ph.D., a professor of social psychology at Rutgers University and an expert on psychosocial resources, and have developed a real respect for the concepts emerging from Dr. Harber’s field of study and his own research. Indeed, his research on social resources often offers a better explanation as to why a person lacks motivation or has a difficult relationship with help, than do clinical psychology or psychiatry. I recently sat down with Dr. Harber and asked him to share some of his research with us, as well as other research in his field; here are the intriguing results.
Can you tell us a little about social resources and what they are?
There are a wide range of internal properties and attributes and external circumstances and provisions that help people deal with challenges in life. Self-worth and self-esteem are two very strong internal ones. People who have a strong sense of self-esteem are better able to negotiate anxiety and manage their own emotions when they feel afraid or challenged. Having a sense of purpose is another. For example: Do you feel like you have some goals that matter to you and guide what you do in life? Self-efficacy is your sense that you can be effective at one task or another; it can also be called “self-belief.” Social support is another important resource that is more external in that it has to do with what is going on with you socially.
Can you provide more details about social support for us?
Someone who can drive you to the doctor or help you physically accomplish something are clear examples of instrumental social support. This is certainly valuable. However, what often matters most to people is perceived emotional support. Do you have someone who makes you feel valued, someone who makes you feel that you belong and/or someone you can trust to be on your side—and those people do not need to actually be with you in order to help you cope with stressful situations.
Here’s an example from my own research: We did these studies where people happened to be going by this very steep hill, either alone or with a friend. As they were approaching the hill, we asked them to estimate how steep the hill was. As it turned out, those people who were with a friend saw the hill as less steep—and the longer they knew their friend, the less steep the hill seemed to them.
In a second study that speaks to the point that a person needn’t be physically with you in order for you to benefit from their social support, we had people simply think about either a good friend, a neutral person or a negative person in their life. Once again, we brought them out to a steep hill, and in doing so discovered that the people who focused on someone positive, even if it was only in their mind’s eye, perceived the hill to be less steep. Furthermore, the closer they felt to the person they visualized, the less steep the hill appeared.
There is, in fact, lots of research about social support. The field of health psychology shows that people who have more quality social connections are less likely to get sick—and if they do get sick, they recover sooner. One study focused on physicians who had themselves had a heart attack, and showed that those who lacked social support were vastly more likely to die in the following year, as compared to their colleagues. That’s a potent kind of resource.
In our field we talk a lot about denial or, in other words, a person’s unwillingness to contemplate their suffering in a way that allows them to make changes in their life. How do psychosocial resources play a role in such a process?
I see it as a bit of an internal tug-of-war: If a person accepts help, that means they must also accept a certain script or narrative about their situation. In other words: “If I accept help, I have to also accept that I have a problem, and that my way of judging or perceiving things may be in error.” That’s hard to do if you don’t have enough psychosocial resources.
Why do you think that is?
Well, one way to look at it is in terms of “challenges” and “threats,” as psychophysiologist Jim Blascovich first detailed. When does an experience feel like a challenge and when does it feel like a threat? You experience something as a challenge when you believe that your capacities exceed the demands that you’re facing. For example, if you have to go to court but have a really great lawyer with you, you might feel this is a challenge, and that you can handle it. On the other hand, if you’re faced with a situation that you feel like you do not have the capacity to meet, then it becomes a threat. To share another example: Your car breaks down in remote area, it’s very cold outside, and you’re wearing a light coat, and your cell phone doesn’t work—that is a threat. The demands of the situation exceed your resources. Physiologically, challenges and threats have separate signatures. Your cardiovascular response to a challenge is something that appears to be forward moving, while your threat response is about “flight and retreat.” The key is whether the person contemplating how to change a psychological problem sees said problem as a challenge or a threat. It’s either “I’ve got a problem, but I can handle it,” or “I can’t look at that problem right now” because demands overwhelms their capacity to respond in a good way. Psychosocial resources play out in this, because they are often the main things people need to face psychological problems.
Social support is clearly a really important resource—but what if you just don’t have this kind of support? What can you do?
Psychosocial resources may be interchangeable, actually. There’s a theorist on resources named Stevan Hobfoll who describes resources as “fungible,” which is a term related to economics. Your net wealth, for example, is fungible: You can use it right now as dollars, or you can translate it into real estate or stock investments. The point is, you can move that financial resource into different kinds of domains. Hobfoll thinks the same holds true for psychosocial resources. In other words, if you’re feeling a bit bereft of social connection, your self-esteem can be drawn on to help you deal with an issue. Or if you’re feeling a bit like your self-esteem and sense of self-worth have declined, you can phone people who you feel you can trust to care about you. You literally do that just so they can boost your feelings of self-worth. It’s almost like you have different baskets in which these resource “eggs” exist, and when one is depleted, you can draw from another.
So, let’s say that one of our clients forgot to pay their rent and needs to contact the landlord about the fact that they forgot do so, but keeps putting off that call. Do You believe that this could be because they don’t have enough psychosocial resources in their “bank account” to rely on?
Absolutely. Having a psychiatric diagnosis can be a threat to a person’s sense of self-worth which could deplete their psychosocial resources. Having to deal with the landlord, for example, may awaken their vulnerability to being judged negatively, which is something they carry with them. The hope is that this person has another resource to tap into, such as social support—which relates to what you have discussed about the difficulty of accepting help. A study by New York University researcher Yaacov Trope and colleagues looked at when people are more or less able to accept critical feedback. What they found is that when a person’s sense of self-worth is boosted, they feel better about themselves and are more open to criticism. You might think that someone who has high self-esteem might be kind of narcissistic or belligerent and act like they know it all, but, in fact, when people feel good about themselves they’re more open to having their performance and abilities critiqued and making changes accordingly.
Other research by Peter Harris looked at how willing people were to listen to information about their health that had the potential to be scary. They asked subjects whether they were heavy caffeine drinkers, but, before doing so, did something to either boost or lower their self-esteem. They then gave the subjects some reading material, some of which was about how caffeine increases the risk of cancer. Research subsequently showed that those caffeine drinkers avoided the intimidating literature if their self-esteem was not boosted. If, however, their self-esteem had been boosted, they sought out that literature and spent time reading it. You might think that the reason for this was that boosting their self-esteem gave them a thick skin, but that was not what was going on. The “high esteem” subjects were as anxious as their counterparts whose self-esteem had not been boosted, but they used their anxiety as a cue—“This matters to me. I’m anxious, but I’d better check out what’s going on.” As a result, the high esteem subjects were more open to information that they needed to hear, even when it was not pleasant.
That’s remarkable, and makes me think about the relationship of denial to a lack of self-esteem and social resources. In that study, it’s not that they were saying, “that’s not there.” They were saying, “I don’t want to look at it because I don’t know if I can handle the news.”
What it suggests to me is that there’s functionality to avoiding stuff that feels overwhelming. It goes back to threat versus challenge: “If this feels overwhelming, then that will actually be more damaging to me. Therefore, I need to avert my gaze from scary health information that might diminish my already impoverished sense of self-worth. Or, in the case of critical feedback, a low esteem person might feel “I just can’t take any more deductions from my self-worth account. And so, yes, while this information might be useful, the cost to my already diminished self-worth is more than I can handle.” In other words, if you’re on some desert road and your gas tank is creeping closer to empty, you’re going to be very gentle on the gas pedal. You’re not going to floor it.
Well, that last metaphor certainly fits one way we refer to a client’s resistance here at Ellenhorn. We say, “They’re not in denial; they’re just tapping the breaks.”