Class 20: Family Systems (continued)

FINAL EXAM TUESDAY, MAY 13 11:45-2:45 Other Important Info: Quiz 2: Thursday, April 17 Diary Study Write-Ups: Tues, April 22 Quiz 1 Answers on Web page

Illness and Family Goals Family Goal: Homeostasis Quiet, No Conflict, Conformity Maintain Order, Follow Rules Tight Controls (emotional, behavioral) Conflict Anxiety, Stress Symptoms Emergency / Crisis Mode Solidarity, Unity

Symptom Maintenance Child's illness/symptoms becomes useful to family, creating a reinforcing positive feedback loop. Family feels: Concerned Manipulated Family responds by: Monitoring more closely Give advice to child Try to control behavior Child feels: Reduced control Child learns: Symptom is most powerful tool he/she has Symptoms --> Control --> Dependence --> symptoms

1. Autonomy is curtailed 2. Mind and body under others’ control 3. Control is under guise of concern 4. Denial of self for others Family Systems That Promote Illness

1. Therapist points out how child uses symptoms to manipulate family. 2. Parent coached to not reward symptoms. 3. Child seeks better ways to assert self. 4. Underlying conflicts allowed to surface. 5. Family system makes correction. 6. Child learns he/she doesn't need to depend on symptom. Family Systems Therapy

Diabetes : Reduced hospital admissions Asthma : Ratings reduced from Level 3 (serious) to Level 1 (routine maintenance). Anorexia: Change from 32% wgt. loss to wgt.gain. 85% recovery rate. Results of Family Systems Therapy

Enmeshment Classic: Mike Nichols and Elaine May

Class 21: Illness and Stigma

Fear Revulsion Concern/pity/sympathy Fascination/curiosity Confusion/uncertainty Mixture of all the above: ambivalence How Do People React to the Stigmatized?

Marked: Those with a characteristic (physical disability, racial identity, past history, etc.) that distinguishes them from others, typically in a negative way. Markers: Those who do not deviate extremely from the norm, and through their strong reactions and because of their in-group status, have the inclination and the power to assign marks to deviant others. Marked and Markers: The Players in Stigmatized Relationships

"...Don, underNembutal, was wheeled on a hand cart up to the cages of nine other adults. Ami, Nira, and Vera showed fear, and Dean and Bokar did also but then followed this by a show of aggression at a distance; Kambi showed generalized excitation in screaming only; Frank, with hair erect, spat at the anesthetized Don, Pam first avoided then attacked through the cage wire; and Lelia, with general excitation but not avoidance, also attacked. The youngsters in the infants' enclosure were afraid, one very much so, and all showed signs of marked excitation." Hebb and Thompson, 1954 in Jones, et al., Chimps' Reaction to Anesthetized Fellow Chimp

A. Verbal Report: Preference for disabled vs. able-bodied B. Non-verbal behavior 1. Terminate interview sooner 2. More motor inhibition (sit rigidly) 3. Express opinions different from own Responses to Disabled: Differences Between Statements and Action Hastorf, et al. 1979

Interactions with the Disabled, C/O Bloom County /Berke Breathed

Feedback to the Physically Disabled Hastorf, Northcraft, and Picciotto (1979) Issue: Does "norm to be kind" affect feedback to the physically disabled? 1. Set up : Subjects work with confederate on hand-coordination task. 2. Task involves guiding metal ball over difficult path. 3. Confederate is able-bodied or on crutches 4. Subjects' job is to provide corrective feedback to confederate.

Feedback to the Physically Disabled Hastorf, Northcraft, and Picciotto (1979) Question: What kind of feedback does confederate get due to handicap vs. no handicap? Result? Handicapped confederate gets less negative feedback. Deprived of info needed to improve. Distrust genuine praise Is this a good or bad thing?

Staring at Strange Strangers Ellen Langer, 1976 Langer Study 1 : Do people want to stare at physically unusual? Ss can stare at a normal, a pregnant woman, a person in leg brace. Who do Ss stare at more? Disabled can be disturbing, upsetting. Do we want to avoid looking or do we want to stare? Why? Spend more time staring at pregnant woman, leg-brace, than normal. Conclusion: People fascinated by the abnormal.

Langer Study 2 : Ss can stare, or not stare, at person wearing a leg brace. Ss then talk with person. Who sits closer, those who stared or those who didn’t stare? Staring at Strange Strangers, cont. Ellen Langer, 1976 Is it ever OK to stare at the disabled? What happens if we try to suppress desire to stare (recall Wegner White Bear studies)? Ss sit closer to person in leg-brace if they first had chance to stare. Why?

* We know who we are based on the way others respond to us. * Others' responses serve as a social mirror. * Let's us know if we're liked/disliked, attractive/unattractive, smart/limited, etc. * Helps us gauge our own emotional reactions to difficult, unusual events. * Provides us feedback about the appropriateness of our own actions. How would stigma affect the social looking glass/mirror? Symbolic Interactionism and the Looking Glass Self

How We See Ourselves Shaped By How Others See Us Snyder, Tanke, & Bersheid, 1977 a. Men and women talk on phone, can’t see each other. b. Men led to believe women attractive/not attractive c. Expectations shape responses -- Positive response to “Attractive” -- Negative response to “Unattractive” d. Women respond according to feedback from men e. Women rated by “blind” observer after phone conversation -- “Attractive” condition rated more attractive -- “Unattractive” condition rates less attractive f. Take-home point -- Others’ view of us shapes our view of ourselves -- Our view of ourselves shapes others’ view of us.

I always felt when I went into some boutique, that all the salesgirls were staring at me.... I always felt that the first thing anyone would notice is that I was fat...and they would know why I was fat. They would know I was neurotic, that I was unsatisfied, that I was a pig, that I had problems. They could tell immediately that I was out of control. I always look around to see if there was anyone as fat as me. I always wondered when I saw a fat woman, "Do I look like that?" Stigma and the Warped Looking Glass

Hypervisible: Everyone notices you because of the mark—the facial disfigurement, the radiation-treatment hair loss, the wheel chair. Invisible : But people still seem to not see you. I am invisible, understand, simply because people refuse to see me....it is though I have been surrounded by mirrors of hard, distorting glass. When they approach me they see only my surroundings, themselves, or figments of their imagination—indeed, everything and anything except me. Ralph Ellison, Invisible Man, 1947 Being at Once Hyper-visible and Invisible

One of the most direct effects of stigma is threat to self-esteem. -- Defined in terms of stigma -- Avoided, shunned, ostracized -- Non-stigmatized features are overlooked Self-stigmatizing—internalizing other's negative view of oneself. Not just that one is fat or gay or blind or alcoholic, but rather that one is therefore fundamentally flawed as a person—sick, weak, immoral, or evil. In Goffman's terms, one has "a spoiled identity". Stigma Corrodes Self Esteem: The Darkened Looking Glass

How Disability Can Change Self Schema Popular SELF Athletic RunnerBiker Busy Many Opportunities X X X X X Popular SELF Athletic Runner Biker Busy Many Opportunities Paraplegic Dependent Avoided Anxious X

We depend on other's reactions to make sense of things, and of ourselves, when there is no other source of info. Stigmatized don't get this info. Why not? Stigma Deprives Person of Vital Information: The Absent Looking Glass a. Shunned, so don't see how others respond. b. Get a constant reaction to selves, either constantly (and falsely) positive or constantly negative. Stigma becomes a wall that blocks social information.

After acquiring a stigma (cancer,, AIDS, paraplegia, etc.) it can help to develop ties to others with similar condition. Why? a. Social comparison b. Recognition of one's own non-stigmatized features. c. Recognizing difference from others who share stigma. Creating New Reference Groups BUT, important to not belong ONLY to community of stigmatized. Why? a. Need to reenter mainstream. b. Need to get feedback from "markers", which may be more realistic

Some people are not fully stigmatized, not fully "normal" * Partially deaf, partially blind * Loss of one limb, but otherwise can walk These people are not fully accepted by mainstream, but also not fully accepted by the stigmatized group. The "unblinded"--and their unexpected social challenges. In-Between Stigma Status