Support Subtypes

To 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.
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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?

Remember?

There is a century old debate in psychology regarding the method the brain employs to store memories.  A recent article in the Scientific American (February, 2013) contained an article that spoke to this very debate.  It attempts to revive the theory that the human brain stores memories in specific neurons.  Put another way, any memory encoded is programmed into a discrete cluster of neurons within the brain.  For example, the authors reported they discovered the exact brain cells that encoded the image of Jennifer Aniston (actress) in someone’s brain.  Quite impressive.  The competing theory is that the features of any memory are distributed across the brain.  Rather than being stored with Ms. Aniston in a particular area of the temporal lobe, this same area is conjectured to be the site where the location of each sense memory is stored.  For example, the name of Jennifer Aniston would be stored in the area of the brain that retains words, her face would be stored in a different area that stores faces, and her body type would be stored in an area that retains spatial details.  This retrieval strategy has similarities to the library card catalogue system.  The actual books (content) are not stored in the library cards, but rather the cards store the location where the content may be found.

This article is perhaps most notable for its contradictions than it is for presenting new ideas.  It is very seductive to believe there is an exact area of the brain that serves as a storage sight of each memory.  It corresponds to the way we store objects in our everyday life.  Nothing is easier or more attractive than to relate complicated processes to our everyday experience.  Contrary to this end, the authors (to their credit) admit that brain cells that fired to a picture of Jennifer Aniston also fired to a picture of another blond actress.  This tends to disprove their contention of discrete cellular representations of each memory.  Another objection advanced by the authors is that there is not enough brain cells to encode every new experience in the human brain.  Essentially, our brain would fill with memories until the bucket could hold no more.  The authors believe the solution to this contradiction is that a “typical person remembers no more than 10,000 concepts.”  Their notion of “concept” is problematic, even beyond their vague definition as to what defines a “concept.”  The notion that all information regarding objects and their relations should hover around 10,000 bits is difficult to accept.

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Even without a detailed knowledge of neuroscience, a critical reading of this article would alert the reader to fundamental problems.  In psychology it is called “internal consistency.”  This refers to a story having a logical progression that avoids contradictions.  The authors brought up the contradictions in order to dispel these arguments; long advanced by psychologists.  They tended to reframe the contradictions in an effort to prove their theory; rather breath new life into an old theory.  This is a perfectly normal error that bedevils all human thought.  Once humans formulate a goal, we will tend to gloss over the contradictions to obtain that goal.  It may be termed “messaging the data” to ensure that data proves the desired outcome.  Science is the bulwark protecting us from ourselves.  Always maintain a critical eye.  These authors have a bit of wool over theirs!