Category: Psychology

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?

Doctor’s Dilemma

In 1909, George Bernard Shaw wrote a nonfiction companion piece to his play The Doctor’s Dilemma.  It should be kept in mind that the state of organized medicine had reached a nadir at this time in its history.  Europe and America abounded in headlines regarding infamous cures and infamous practice.  At the same time, public health initiatives were making real inroads into communicable diseases.  Medicine had reached a fork in the road of professional development.  Either it would degrade further into playing upon the fears and credulity of the populace, or it would lock step with the march of scientific inquiry and practice.  Mr. Shaw stepped into this discussion with several points he felt were necessary in order for medicine to follow the latter road and abandon the former.  Please consider these concepts in light of the era it was created, as well as the work that remains to be accomplished.

1)  Nothing is as dangerous as a poor doctor: not even a poor employer or a poor landlord.

2)  Of all the anti-social vested interests the worst is the vested interest in ill-health. Mr. Shaw was very much against the profit motive in medicine, and conceptualized it as the greatest impediment to achieving truly scientific medicine.  In an early phase of this treatise, he goes on to write…private medical practice is governed not by science, but by supply and demand; and however scientific a treatment may be, it cannot hold its place in the market if there is no demand for it; nor can the grossest quackery be kept off the market if there is a demand for it.

3)  Remember that an illness is a misdemeanor; and treat the doctor as an accessory unless he notifies every case to the Public Health Authority. Mr. Shaw was for greater transparency in medicine.  He believed that much of the confidentiality advanced by organized medicine assisted the doctor’s practice more than the patient’s health.

4)  Treat every death as a possible and under our present system a probable murder, by making it the subject of a reasonably conducted inquest; and execute the doctor, if necessary, as a doctor, by striking him off the register. This may be considered an extreme form of increasing accountability.

5)  Make up your mind how many doctors the community needs to keep it well.  Do not register more or less than this number; and let registration constitute the doctor a civil servant with a dignified living wage paid out of public funds. This harks back to Mr. Shaw’s belief that the greater the number of physicians practicing in a given area, the greater the pressure on the doctor to secure an income by any means available.

6)  Municipalize Harley Street. This is a famous street where very expensive medical specialists practice.

7)  Treat the private operator (doctor in private practice) exactly as you would treat a private executioner. A bit harsh.

Also several other antibiotics, pain relief, muscle strain relaxers, birth control pills etc cialis prescription are available eon an online store. Here enjoy the ordering on buy cialis this site a cost preventing method. bulk buy cialis In some cases surgery is also done, that helps in clearing the vascular blockages. Aging comes about when cells can no longer replicate cell DNA and cialis cheap uk thus begins the gradual decline of the body. 8)  Treat persons who profess to be able to cure disease as you treat fortune tellers. Mr. Shaw perceived that most medical treatments are advanced because of habit, rather than usefulness.  It was the duty of the doctor to be above treatment based soley upon habit and tradition.  He wrote a bit earlier in this work…A respectable man will lie daily, in speech and in print, about the articles he is selling, because it is customary to do so.  He will flog his boy for telling a lie, because it is customary to do so…He will give the same boy a present on his birthday, and buy him a spade and bucket at the seaside, because it is customary to do so, being all the time neither particularly mendacious, nor particularly cruel, nor particularly generous, but simply incapable of ethical judgment or independent action.

9)  Keep the public carefully informed, by special statistics and announcements of individual cases, of all illnesses of doctors or in their families.

10) Make it compulsory for a doctor using a brass plate to have inscribed on it, in addition to the letters indicating his qualifications, the words “Remember that I too am mortal.” Mr. Shaw believed that much of the doctor’s difficulties in providing scientific treatment were the superstitions of the public.  He understood that frustrating the demands of the patient will quickly bankrupt the doctor.  Despite this understanding, he did not excuse the profession for gratifying the public need for a medical messiah.

11)  In legislation and social organization, proceed on the principle that invalids, meaning persons who cannot keep themselves alive by their own activities, cannot, beyond reason, expect to be kept alive by the activity of others. Mr. Shaw is alluding to the fact that society cannot afford to provide total care for all the needy, and that rationing care should be based upon the usefulness of the person.  A very dark proposition indeed.

12)  Do not try to live forever.  You will not succeed.

13)  Use your health, even to the point of wearing it out.  That is what it is for.  Spend all you have before you die; and do not outlive yourself. This may not be as roughly untrue as it sounds.  The evidence is piling up that antioxidants may actually reduce lifespan, since intermittent stress on the organism appears to increase length of life.  For example, exercise increases free radicals and stresses the organism, but it is indispensable to a healthy lifestyle.

14)  Take the utmost care to get well born and well brought up…Be particularly careful to have all this done at the expense of the nation, as otherwise it will not be done at all, the chances being about forty to one against your being able to pay for it directly yourself, even if you know how to set about it.

As a comedic writer, Mr. Shaw pushes concepts to absurdity in order to find humor in the mundane, such that a number of his statement shouldn’t be taken literally.  The core of his argument appears to be threefold.  First, that medicine was too reliant on ritual and tradition; all too often at the expense of the patient’s health.  Second, that organized medicine was too reliant on pushing more drugs and procedures, at the expense of the patient’s health and finances.  Third, that organized medicine was too isolated and insular, at the expense of the patient’s possible comprehension of their condition.  Regarding the present state of affairs, the gentle reader will have to judge for themselves whether the “was” in the last three sentences should be replaced with an “is.”  All in all, it is fortunate that the study of psychology was strictly an academic discipline at the time of Mr. Shaw’s excoriation of medicine.    It is likely that the Psychologist’s Dilemma would be equally unflattering.