While nursing my disappointment that I’d missed the talk that inspired last week’s blog, “People Who Heal Us: the role of peer support in mental healthcare treatment”, I found myself dwelling on the question posed by Jenelle Clarke. Was it “the principles of CBT or the peer support that had been the most helpful in overcoming social anxiety”? I was reminded of an article I read recently, entitled: ‘Water clubs in residential care: Is it the water or the club that enhances health and well-being?’ (Gleibs et al., 2011). This study explored whether the reported benefits of water club membership led to enhanced perceptions of wellbeing due to a reduction in the negative effects of dehydration or the increased social engagement. Interestingly, the beneficial effects of water were only found when delivered in the context of a club, as opposed to in an individual intervention. Social support had a positive effect on quality of life and, intriguingly, it was identification with other club members that mediated this effect.
Warnings against the spiralling consequences of our individualistic society are all too familiar and it is now well established that lack of social contact can have detrimental effects on both physical and mental health. The additional contribution made by the water club study was to propose identity processes as an underlying mechanism. There has been a burgeoning interest in the social identity approach to health in recent years, but, returning to Jenelle’s question, what are the implications for the realm of mental health research and practice?
Perhaps the additional factor in the context of mental health is that of stigma, topically discussed in Amanda Keeling’s IMH blog earlier this month, “Fear and Loathing: Combating the Stigma Against ‘Scary’ Disorders”. If identification with fellow group members indeed underlies the benefits of peer support, what happens when those identities are stigmatised? Much has been done to raise awareness of the barriers to social integration created by stigma and considerable research now documents prejudices against those living with mental health difficulties. Apparently less attention has delved in any detail into the ways identification with stigmatised groups influence recovery.
A notable exception is research by Crabtree and colleagues (Crabtree et al., 2010). This explored self-perceptions of stigma and the implications of identification with a stigmatised group. According to social identity theory, group membership plays a key role in determining self-esteem (Tajfel & Turner, 1979). Since intergroup comparisons are relative, membership of a stigmatised group has the potential to adversely impact self-esteem.Clearly this has implications for engagement with both clinician-led and peer support groups. However, the researchers found that the shared identity of stigmatised group members provided the support needed to resist stigma, challenge prejudice and provide a buffer against the negative effect of discrimination. There was a darker side to this finding, though; the protective mechanisms positively affected self-esteem, but simultaneously supressed a negative relationship between self-esteem and social identification. Underneath the protection afforded, the more individuals identified with their mental health support group, the worse they felt about themselves (Crabtree et al., 2010).
I’m the first to advocate the importance of community and social support and to lament the rise of an individualistic culture. We exist in relationship with one another. Nevertheless, such research does point to the complexities of group dynamics and the need for caution when presenting the mere existence of support groups as a route to improved wellbeing. How such groups are viewed by participants and the impact of belonging to them needs to be considered, particularly if membership does not alsoprovide increased social support. Perhaps part of the problem is where our primary identity lies and the tendency to see diagnostic labels as part of an individual’s essential identity. As Amanda pointed out in her blog, “people with mental health problems are people first and foremost”. This makes the fight against stigma all the more urgent. If their fundamental identity and value is secure, more people may avail themselves of the potential benefits of therapeutic groups rather than avoiding the opportunity due to the connotations being part of such a group may confer.
Crabtree, J., Haslam, S. A., Postmes, T., & Haslam, C. (2010) Mental health support groups, stigma, and self-esteem: positive and negative implications of group identification. Journal of social issues. 66 (3), pp. 553-569
Gleibs, I.H., Haslam, C., Haslam, S.A., & Jones, J. (2011). Water clubs in residential care: Is it the water or the club that enhances health and well-being? Psychology and Health, 26, 1361-1378.
Tajfel, H., & Turner, J. C. (1979). An integrative theory of intergroup conflict. In W. G. Austin &
S. Worchel (Eds.), The social psychology of intergroup relations (pp. 33 – 47). Monterey, CA:
Kathryn Smale, ESRC PhD student, School of Medicine