Category: Grief

Emotional Support

Business Logo for Psychological and Neuropsychological IssuesBuildings are supported, bridges are supported, governments are supported, and even people are supported.  It is relatively easy to spot sufficient support of the first three.  If the physical structure of the first two bear your weight and resist the urge to fall down, then the building or bridge is considered well supported.  Governments that receive sufficient financial support shoulder the desires of the populace and stand tall in adversity.  Similarly, people who receive adequate emotional support bear the weight of their world and remain standing throughout.  Perhaps physical support is not far removed from its emotional cousin.  Perhaps that is why the word “support” lends itself to both interpretations.

It may be less than flattering to compare oneself with a government, much less a building or bridge.  Americans do not readily accept support, and view the need for support as a sign of weakness.  Americans are great at providing support, especially physical support; perceiving the lending of support as virtuous and powerful.  Americans are much happier giving support than receiving the same.  Perhaps it is the vestiges of the pioneer spirit.  Perhaps it is a fear of appearing needy and weak.  It can’t be denied that the receiving of support automatically assumes a one down position.  How one chooses to perceive this one down position is the critical factor in the equation.

No matter the degree of intelligence and self-sufficiency, all people require support at some time in their lives.  Some people may never require further physical support after childhood, but they will require emotional support to thrive.  We are social animals, and the fact that ninety percent of us live in cities is sufficient proof of this allegation.  A particular subset of people called schizoid do not appear to need contact with other people; at least not much.  For the rest of us, depression ensues when there is a lack of emotional support in our social environment.  The experience of grief is largely the result of a sudden break in social support.  The recent surge in mass shootings almost always comes from those who, for one reason or another, lack emotional support.

The schizoid person, mentioned above, does not perceive a problem with little emotional support.  This is their preference, and they may be quite successful in other areas of their life.  Such people are rather rare, accounting for far less than one percent of the population.  People that experience grief over a sudden loss are typically bathed in attention from other people, as this is the standard response of most cultures.  A progressive loss of support from illness or job loss does not curry the sympathy engendered by the death of an intimate attachment.  It may be difficult for this subset of people to develop supportive relationships, at least until they feel better or obtain a new job.  Those who take up a gun are exacting revenge upon a society that they perceive as purposefully withholding support.  They experience the lack of emotional support as a personal affront.

Perhaps the alienation many Americans experience is really a loss of emotional support.  We Americans are loath to ask for physical or emotional support, such that the subsequent alienation may be more prevalent in this country than others.  Furthermore, the recent economic downtown has disrupted work relationships and created greater familial stress over finances.    It is a general rule that increased stress engenders decreased emotional availability.  It is difficult to think of others when preoccupied with ourselves.  Many are injured and yet they do not ask for help.  Perhaps it is time for the pioneer philosophy to end.  It would be great to retain its spirit of optimism and enterprise, but this philosophy appears to come at the cost of our emotional well-being.  Increasingly, it is placing our physical well-being at risk from an alienated few.  If only Adam Lanza had decided to pick up the telephone, before deciding to pick up the gun.

Support Subtypes

Business Logo for Psychological and Neuropsychological IssuesTo support someone is to render assistance.  The person in need of assistance may be overwhelmed with physical tasks, cognitive demands or emotional reaction(s).  The act of supporting another person may be divided along these lines.  To assist others with physical labor speaks for itself.  It is the most observable of the support subtypes, and the outcome lends itself to measurement.  To offer cognitive/thinking assistance is typically less obvious than direct physical support.  It is still observable and the outcome is measurable.  The offer of emotional support is the least observable and its effect is typically difficult to measure.  This begs the question whether the subtype of emotional support is of less worth than physical and cognitive support.

The difficulty in observing and measuring emotional support may account for its discounted importance.  If you help a neighbor erect a barn, that barn will stand as a monument to your physical support for many years.  If you assist an aged relative with their finances, their continued independence is a monument to your provision of cognitive support.  If you spend hours wiping away the tears of a recently widowed neighbor, rendering them emotional support, how will you know if it was helpful?  Perhaps it did not help them work through the grieving process, whatsoever.  Perhaps the emotional support merely encouraged them to wallow in self-pity.

This is a similar issue as those who suffer with chronic pain.  Unless others are able to physically visualize the damaged body part, they will tend to progressively discount the suffering of the afflicted over time.  Even if someone spends a thousand percent more time lending emotional over physical support, most people will only be aware of and reward the results seen with their own eyes.  This is to be expected and has good face validity.  There is a greater level of confidence if something is seen rather than inferred or communicated symbolically.  It is as if the world states,”It’s nice you held their hand, but what did you really do for them?”

Perhaps it is less the global worth of each support subtype, than what type of support would be most helpful at a given moment in time.  After a bout of incontinence, it is better to clean the person’s undergarments than hold their hand.  It may be helpful to hold their hand after the garments are cleaned, but the primary need for physical support is quite clear.  On the other hand, if a relative is already placed in a nursing facility, the act of giving physical support may be discouraged by the facility.  The relative worth of a nursing center is realized in its ability to provide physical support.  Most nursing centers encourage significant others to provide cognitive and emotional support.  The provision of cognitive support is typically managed by a relative acting as a power of attorney.  This type of support is cannot be provided by an institution, since it would be a conflict of interest.  The role of social work is to offer both cognitive and emotional support, but all to often, nursing facilities lack a sufficient number of social workers to offer emotional support.  Their hands are full with admission and discharge paper work, which is of critical importance, but limits the time they may employ in what is regarded as support of a secondary nature.

Modern nursing facilities often look to activities therapy staff to provide emotional support, or at least distraction from emotional issues.  This is not the task most of these staff were trained to perform, and it may distract them from the primary mission of providing cognitive stimulation.  It is as if emotional support were a bastard child that is placed with increasingly distant relatives.  Because of these complications, the role of emotional support tends to fall squarely on the shoulders of friends and family.  The most common mistake of the family is to offer physical support in lieu of emotional.  Many family members are critical of the physical support received by their loved one, and often jump in to change or clean the resident of a nursing facility.  This is commonly the result of a guilty conscious.  The caretaker is unable to provide effective care for their loved one in their own home.  In this situation, the relation is providing physical support in an effort to achieve personal emotional support for their own guilt.  Offering physical support to an institutionalized person is rarely appreciated by the person, and is actively discouraged by the nursing center.  It is not the type of support needed from friends and family of an institutionalized person.

The act of providing emotional support is largely measured in the negative.  For example, the resident is not depressed or the resident is not acting-out aggressively.  If the resident is compliant and seemingly happy, it is presumed they are receiving adequate emotional support.  Conversely, if an institutionalized person is depressed or hostile, a lack of familial support is often assumed by the staff.  Emotional support is typically measured by the absence of emotional problems.  This is an inaccurate and sometimes dangerous inference.  All too often smiling friendly people fall to tears after a five minutes of unstructured conversation.  A person’s facial expression and behavior are important clues into their emotional life, but are not by any means a road map.

Unlike physical and cognitive support, do not expect others to acknowledge or appreciate the provision of emotional support.  It typically lacks the emergent and observable nature of physical and cognitive support.  The importance of emotional support assumes a back seat to physical and cognitive support when a person lives in the community.  It moves to the front seat when they reside in an institution.  The individual needs of a person will define the subtype and possible worth of a supportive intervention.   The nature and magnitude of their needs are highly dependent on the environment.  Regardless of the particular environment, though, it is rarely wrong to offer emotional support.  Managing the finances of a independent clear thinking person is usually wrong.  Changing your mother’s bandage in the hospital is always wrong, and may result in the prohibition of further visits.  Offering sympathy is rarely rewarded, and it may not be critically necessary, but it is almost always correct.  How can something be considered of little worth if it always has some value?

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