Human Behavior in the Social Environment

Interweaving the Inner and Outer Worlds

Esther Urdang

• Publisher: Routledge
• Year: 2015
• eBook ISBN: 9781317699453
• Topic: Medicine
• Subtopic: Health Care Delivery

Human Behavior in the Social Environment: Interweaving the Inner and Outer Worlds is an essential human behavior textbook for social work students. The third edition emphasizes the biopsychosocial framework within a psychodynamic, developmental and life-course perspective and includes a brand new chapter on the psychosocial complexities of technological advances.

Written by an experienced classroom teacher, faculty advisor and clinician, the text approaches development through the life cycle, discussing the challenges, tasks, and problems of each stage. Presenting complex concepts in a clear and understandable way, Human Behavior in the Social Environment:

• Includes 16 chapters which cover the diverse nature of the circumstances that practicing social workers will be exposed to, including cultural differences, mental health issues, and disability;

  Analyses several different theories, including psychoanalytic, ego psychology, cognitive-behavioral, and postmodern theories in a manner that enables students to engage critically with the subject matter;
• Includes case vignettes and material from literary works, biographies and newspapers, intertwined with learning exercises and suggestions for additional readings, forming an engaging and practical volume.

Written specifically for social work students undertaking courses and modules on human behavior in the social environment, this book is also a valuable resource for beginning and advanced readers in human services, including nursing, medicine, public health, clinical psychology and counseling.

Section I
The biopsychosocial perspective

Chapter 1
Overview

Introduction

An aphorism widely attributed to H. L. Mencken observes that for every complex problem, there is a solution that is simple, neat … and wrong. Many times we all wish we would know just what to do, which way to turn, and could find the right answer. But living among complexities and uncertainties is part of the human condition; people are complex and so is the world in which we live. This book is full of complexities and conundrums; we find that we can’t look at specific dilemmas in isolation; our lives are intertwined with other lives, and we are affected by our environments, which are also part of us.

Sometimes, when writing this book, I would think about a topic, such as mentally ill people in prison; where does this belong in the book; under psychiatric problems, imprisonment, economic resources? Likewise, PTSD, a psychiatric problem, can be precipitated by so many social circumstances – children being abused, immigrants fleeing from terrorists, being in the midst of people dying from Ebola – and living in crime-infested neighborhoods. In trying to solve this dilemma I find the concept of interweaving invaluable; to demonstrate how people and problems are interwoven with other people and problems and the world around them.

In thinking of an individual’s inner world, we find that each person’s inner world has its own life and organization, with feelings and thoughts, fueled by the body and its physical states, in ongoing interactions with others.

Important concepts from both the inner and outer worlds are presented here, in discrete chapters, such as psychoanalytic and ego psychology theories in Chapter 2, and social systems and the community in Chapter 5. The life cycle is discussed in three chapters, and a section on special issues includes illness and disabilities, mental health, and life transitions, turning points, crises, and loss and death. A new chapter has been added to this edition: Psychosocial Complexities of Technological Advances, which discusses the digital age, reproductive technologies, and organ transplantation.

This overview chapter concludes with a presentation of the case of Mary, a 12-year-old girl whose eye surgery was unsuccessful. Her doctor asked for a social service evaluation, as he knew nothing about Mary and her family and felt this information would help him decide how to present her poor prognosis to the family. This book will help us think about some of the things we should look for to obtain a comprehensive picture of Mary and her family.

Structure of the book

This book is divided into four major sections. The first discusses its major psychological and social theoretical orientations; the second, human development and behavior over the life span; and the third, special issues, including the new chapter on the psychosocial complexities of technological advances. The concluding section integrates the major points in the book. Each chapter includes suggested readings and learning exercises.

Section I. The biopsychosocial perspective

This first section, with its eight chapters, explicates the major theoretical components that constitute the biopsychosocial perspective.

• 1 Overview
• 2 Psychoanalytic and ego psychology theories
• 3 Object relations, self psychology, and cognitive-behavioral theories
• 4 Postmodern theories: constructivism, relational therapy, narrative theory, and resilience
• 5 Social systems and the community
• 6 Culture and diversity
• 7 The family: forms and organization
• 8 The family: internal structures and special family problems

Section II. The life cycle

The second section of the book presents a picture of the life cycle, from conception through old age. Biological, social, cultural, and familial factors are interwoven into this discussion. Emphasis is given to issues of attachment and loss, separation/individuation, violence, resilience, sexuality, and creativity as they pertain to the different life stages. This section includes the following three chapters:

• 9 Reproductive issues, infancy, and early childhood development
• 10 Middle childhood and adolescence
• 11 Adult development

Section III. Special issues

The four chapters of this section include major issues that occur throughout life.

• 12 Life transitions, turning points, crises, and loss
• 13 Illness and disability
• 14 Mental health problems
• 15 Psychosocial complexities of technological advances

Section IV. Integration

In this final section, the perspectives discussed in this book are summarized and integrated.

Section I. The biopsychosocial perspective

Chapter 2. Psychoanalytic and ego psychology theories

This chapter discusses the major contributions of psychoanalytic theory as well as controversies surrounding it. Psychoanalytic theory stresses the power of the unconscious, the relevance of dreams, and how unconscious conflicts can cause a person to be “at war” with himself or herself. Freud’s bringing the deeper layers of the mind, with their seeming irrationality, under scientific scrutiny met with great opposition, and to some extent this criticism persists today. This chapter presents the historic case of Anna O., who was treated by Freud and his colleague, Joseph Breuer, for hysterical paralysis.

Ego defenses, first discussed by Freud and later elaborated by Anna Freud, were subsequently enlarged upon by object relations theorists. Freud’s model of defenses stressed internal drives and feelings, which the ego had to regulate and control. This chapter defines and illustrates the major ego defenses, such as denial and projection. Freud also described ego functions, and Anna Freud contributed to this work. Heinz Hartmann extended the discussion of ego functions to include such concepts as “autonomous ego functions” and the “average expectable environment.”

Chapter 3. Object relations, self psychology, and cognitive-behavioral theories

This chapter discusses object relations, self psychology theories, and behavioral and cognitive theories. Object relations theory reflected major departures from Freudian theory, although some theorists incorporated psychoanalytic concepts into their approaches. In the 1940s and 1950s, Ronald Fairbairn asserted that the main drive in life was for relationships, rather than the satisfaction of instincts. Object relations theory, focusing on identity development, emphasizes the importance of good nurturing and early secure attachment experiences. Through these early nurturing relationships, children develop internalized images of others (object representations), as well as internalized images of themselves (self-representations).

Donald Winnicott, another object relations theorist, has contributed many concepts, including the good-enough mother, transitional objects, play, the false self, the capacity to be alone, and the holding environment. Margaret Mahler, while also emphasizing attachment, added the concepts of separation/individuation, which is the ability of the child to separate from mother, becoming an autonomous individual while still maintaining connections with mother and others.

Self psychology, formulated by Heinz Kohut, focuses on the development of the self, asserting that children depend on affection and empathy from selfobjects, who are their parents, or parent substitutes; the need for selfobjects continues throughout life. In self psychology therapy, the emphasis is the therapist’s development of empathetic understanding of their patients.

Behavior modification focuses on a person’s observable behaviors; unconscious thoughts and motivations are not studied. Changing behaviors is its primary goal, and various techniques and procedures have been developed including: operant conditioning, positive reinforcement, systematic desensitization, modeling, and social skills training.

In 1976, Aaron Beck introduced cognitive theory, which emphasizes the way people think about themselves and examines their “beliefs, expectations, thoughts, opinions, evaluative standards, attributions and images” (Granvold, 1999, p. 63); it is faulty cognition that leads to emotional disturbances, and it is people’s changing their distorted cognitions for more accurate ones that is the key to cognitive therapy. Cognitive and behavioral approaches are often combined into cognitive-behavioral treatment (CBT), which is a major method of psychotherapeutic treatment today.

Chapter 4. Postmodern theories: constructivism, relational therapy, narrative theory, and resilience

Postmodern thought, discussed in Chapter 4, which is currently permeating many disciplines, argues for the subjective nature of knowing and rejects modernist beliefs that there is one objective reality; it asserts that there are many realities, subjectively experienced by the observer. Constructivism focuses on how individuals construct their perceptions of self and others, of the world around them, and the meanings and values they choose; meaning-making is a central concept. Additionally, the observer is always part of what is being observed, and is therefore a participant observer. From this perspective, the therapist is not considered an expert, and therapy is an interactive process between two people. This idea is fundamental to relational therapy, where it is posited that human relationships and the drive for attachment are fundamental in psychological life; therefore, the transactions between the clinician and the client become the major focus of treatment.

Narrative theory is also presented in this chapter, with its emphasis on telling stories and listening to stories, which are universal phenomena. It is through narratives that people begin to develop a sense of self, which begins in infancy and is closely related to the development of language and to stories one hears about oneself and begins to tell about oneself, and so develops an autobiographical consciousness. However, an additional point is that narrators are addressing their stories to audiences. Storytellers and audiences need each other, and their interaction, the development of their intersubjectivity, is the essential core of narrative theory. This concept is highly relevant to therapy.

The writing and reading of biographies is discussed, and the parallels between writing biographies and doing clinical work is highlighted: for example, the relationship of biographers to their subjects is fraught with meaning and emotion (as is the relationship between the clinician and patient). Finally, resilience is presented, and the question raised: Why is it that some children and adults exposed to extreme stress do not break down but instead become resilient?

Chapter 5. Social systems and the community

This chapter discusses the many environmental, economic, and social factors that affect our lives. Physical environments include natural resources, weather (global warming, earthquakes, hurricanes, and tornados), and the scarcity of affordable housing (and a large homeless population).The social environment encompasses economics – for example, the large disparity in incomes between the rich and poor and scarcity of funds for social services and psychiatric care, education, and child welfare services.

The ecological perspective is included, which emphasizes person–environmental relationships and their continuous reciprocal exchanges and transactions. Communities are discussed, including communities of interest as well as geographic communities, and relevant concepts are illustrated, such as social networks and support, adaptation, coping, and goodness-of-fit. Rural social work is described.

Social problems are addressed, including discrimination, violence, substance abuse, and imprisonment. Discrimination against various groups in our society, including racial minorities, women, homosexuals, the elderly, and the disabled, is considered. Advances made are also discussed, such as in civil rights and rights for women, the disabled, and gays, lesbians, and transgenders, which have led to legalization of gay marriages.

Chapter 6. Culture and diversity

A person’s culture is instrumental in the development of his or her values, relationships, worldview, and identity. Cultures can be based on race and/or ethnicity, and subcultures can exist within them. Some people join (or form) cultural groups later in life, based on common characteristics such as sexual orientation. Many deaf people belong to the deaf community, with its own values and rituals.

Race and ethnicity are discussed, with special reference to African Americans and American Blacks, Native Americans (descendants of the First Nations), Asian Americans, and Hispanics. Individuals may have multiethnic, multiracial, and mixed cultural backgrounds.

Some may be part of several cultures whose values conflict, such as black and gay cultures. Conflicts about values and lifestyles can occur within cultures as well as between cultures. Immigration poses many sociocultural challenges, such as acculturation. Immigration is a subject of intense current national debate.

Cultural attitudes toward emotional and relationship difficulties, trauma and abuse, as well as toward the use of therapy, impact clinical work in different ways. Additionally, cultural differences (as well as similarities) with regard to race, ethnicity, social class, and gender (as well as gender identity) between clinicians and clients can affect their relationships and the treatment process.

Chapter 7. The family: forms and organization

Families are vital for a child’s basic nurturance and socialization into society, and family members are involved (or not involved) with each other in varying degrees and patterns over the course of the life cycle. Chapter 7 discusses the many forms family life takes today. Tradit...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Contents
• About the author
• Preface
• Acknowledgements
• Section I The biopsychosocial perspective
• Section II The life cycle
• Section III Special issues
• Section IV Integration
• Index