Ejmh Vol 12 (2017) Issue 1 (June) by European Journal of Mental Health

00_Ejmh_12_eleje_Junius 2017.05.16. 9:06 Page 1

TANULMÁNY CÍM

European Journal of Mental Health Individual, Family, Community and Society VOLUME 12, NUMBER 1, JUNE 2017 Editor-in-Chief / Leitender Herausgeber Prof. JOZEF CORVELEYN, Katholieke Universiteit Leuven (Belgium)

Editorial Board / Beratende Herausgeber Dr. MILDA ALIŠAUSKIENĖ, Vytauto Didžiojo universitetas, Kaunas (Lithuania) Prof. JACOB A. BELZEN, Universiteit van Amsterdam (Netherlands) Prof. BEÁTA DÁVID, Semmelweis Egyetem, Budapest (Hungary) Prof. VALERIE DEMARINIS, Uppsala universitet (Sweden) Prof. EMMY VAN DEURZEN, Existential Academy, London (United Kingdom) Dr. JESSIE DEZUTTER, Katholieke Universiteit Leuven (Belgium) Dr. RITA FÓRIS-FERENCZI, Universitatea Babeş-Bolyai, Cluj-Napoca (Rumania) Dr. JÁNOS HARMATTA, Semmelweis Egyetem, Budapest (Hungary) Dr. ANDRÁS ITTZÉS, Corvinus Egyetem, Budapest (Hungary) Dr. GÁBOR ITTZÉS, Budapest (Hungary) Prof. JUTTA LINDERT, Hochschule Emden/Leer (Germany) Dr. DINKA MARINOVIĆ JEROLIMOV, Institut za društvena istraživanja u Zagrebu (Croatia) Prof. MARTIN JÄGGLE, Universität Wien (Austria) Prof. PAAVO KETTUNEN, Joensuun yliopisto (Finland) Dr. PETER RAEYMAECKERS, Universiteit Antwerpen (Belgium) Dr. GERGELY ROSTA, Westfälische Wilhelms-Universität Münster (Germany) Dr. habil. IGOR ŠKODÁČEK, Univerzita Komenského ve (Slovakia) Dr. habil. PÉTER TÖRÖK, Károli Gáspár Református Egyetem, Budapest (Hungary) Prof. ANDRÁS VARGHA, Károli Gáspár Református Egyetem, Budapest (Hungary) Prof. ANDREAS WITTRAHM, Caritasverband für das Bistum Aachen (Germany)

INSTITUTE OF MENTAL HEALTH Faculty of Health and Public Services Semmelweis University, Budapest

EJMH 7:1, June 2012

00_Ejmh_12_eleje_Junius 2017.05.16. 9:06 Page 2

SZERZŐ

Advisory Board / Wissenschaftlicher Beirat Dr. FRUZSINA ALBERT, Károli Gáspár Református Egyetem, Magyar Tudományos Akadémia, Budapest (Hungary) Dr. CLAIRE ARNOLD-BAKER, New School of Psychotherapy and Counselling, London (United Kingdom) Prof. GYÖRGY CSEPELI, Eötvös Loránd Tudományegyetem, Budapest (Hungary) Dr. ROB FISHER, Inter-Disciplinary.Net, Witney (United Kingdom) Dr. ERZSÉBET FÖLDHÁZI, Pázmány Péter Katolikus Egyetem, Budapest (Hungary) Dr. MIHAELA HARAGUS, Babeș–Bolyai Tudományegyetem, Cluj-Napoc (Rumania) Prof. JOZEF HASTO, Slovenská zdravotnícka univerzita, Bratislava (Slovakia) Dr. AIVA JASILIONIENE Max Planck Institute for Demographic Research, Rostock (Germany) Dr. BARNA KONKOLŸ THEGE, Waypoint Centre for Mental Health Care, Penetanguishene (Canada) Prof. AXEL LIÉGEOIS, Katholieke Universiteit Leuven (Belgium) Dr. RÓBERT MANCHIN, Felsőbbfokú Tanulmányok Intézete, Kőszeg (Hungary) Dr. TAMÁS MARTOS, Szegedi Tudományegyetem, Budapest (Hungary) Dr. RENÁTA NÉMETH, Eötvös Loránd Tudományegyetem, Budapest (Hungary) Dr. EDWARD PARTRAKOV, Ural Federal University, Ekaterinburg (Russia) Dr. GERGELY ROSTA, Károli Gáspár Református Egyetem, Budapest (Hungary) Dr. ÉVA SZÁNTÓ, Semmelweis Egyetem, Budapest (Hungary) Dr. MÁTÉ SZONDY, independent researcher, Budapest (Hungary)

Printing and binding Kapitális Kft. Balmazújvárosi út 14. H-4002 Debrecen Hungary Phone: (+36 52) 452 099 Fax: (+36 52) 531 098 E-mail: info@kapitalis.hu

Frontcover: The view of Delphoi (sanctuary, theater, and stadium) Titelblatt: Sicht auf Delphoi (Tempel, Theater und Stadion)

EJMH 7:1, June 2012

00_Ejmh_12_eleje_Junius 2017.05.16. 9:06 Page 3

TANULMÁNY CÍM

CONTENTS / INHALT STUDIES / STUDIEN Research Papers / Wissenschaftliche Arbeiten GÁBOR ITTZÉS, BERNADETT SIPOS-BIELOCHRADSZKY, ORSOLYA BÉRES & ATTILA PILINSZKI: Salvation and Religiosity: The Predictive Strength and Limitations of a Rokeach Value Survey Item ...................................................................... 3 LAURA SIMMONS, TIM JONES & ELEANOR BRADLEY: Reducing Mental Health Stigma: The Relationship between Knowledge and Attitude Change ....................................................................................... 25 CSABA BÁLITY & BÁLINT DURÁCZKY: Fertility Desires of Adolescents and Young Adults Living in Large Families: The Role of the Family of Origin and the Cultural Stereotypes..................... 41 ANSON AU: The Sociological Study of Stress: An Analysis and Critique of the Stress Process Model .................................. 53 TAMÁS MARTOS & VIOLA SALLAY: Self-Determination Theory and the Emerging Fields of Relationship Science and Niche Construction Theory...................................................................... 73 Common Past / Gemeinsame Vergangenheit EVA MOROVICSOVÁ, ANTON HERETIK SR., ANTON HERETIK JR. & IGOR ŠKODÁČEK: History of Psychotherapy in Slovakia ............................................................ 88 Short Communication / Kurzmitteilung MAHDI ABDOLAHZADEH RAFI, NARGES ADIBSERESHKI & MARYAM HASANZADEH AVAL: The Mediating Role of Early Maladaptive Schemas in the Relationships of Emotional Maltreatment and Emotional Disorders .............................................................................. 104 BOOK REVIEWS / REZENSIONEN ILDIKÓ ERDEI: Christian Scholars’ Understanding of the Soul and Spirit (A. SIMON-SZÉKELY, ed. (2015) Lélekenciklopédia: A lélek szerepe az emberiség szellemi fejlődésében, Vol. 1: Világvallások lélekképzetei) .............................................................. 119 KINGA BAKOS: Happy Workplace? (I. Robertson & C. Cooper (2011) Well-Being: Productivity and Happiness at Work) ....................................... 124 Contributors to This Issue / Autoren dieses Heftes.......................................... 129

EJMH 7:1, June 2012

00_Ejmh_12_eleje_Junius 2017.05.16. 9:06 Page 4

EJMH 7:1, June 2012

SZERZĹ?

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 1

SALVATION AND RELIGIOSITY

STUDIES / STUDIEN

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 2

G. ITTZÉS, B. SIPOS-BIELOCHRADSZKY, O. BÉRES & A. PILINSZKI

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 3

European Journal of Mental Health 12 (2017) 3–24 DOI: 10.5708/EJMH.12.2017.1.1

GÁBOR ITTZÉS*, BERNADETT SIPOS-BIELOCHRADSZKY, ORSOLYA BÉRES & ATTILA PILINSZKI

SALVATION AND RELIGIOSITY The Predictive Strength and Limitations of a Rokeach Value Survey Item (Received: 1 October 2014; accepted: 30 September 2015)

In this study we explore the possibilities and limitations of using the Salvation item of the Rokeach Value Survey (RVS) as a global indicator of religiosity. Our data come from the data collection connected to the 4th wave of the European Social Survey (2008; N = 1144). First we compare the Salvation item with four global indicators of religiosity. In the second phase of analysis we examine the relationship between the overall indicators of religiosity – including, especially, the RVS Salvation item – and two „classic“ aspects of religiosity, the ideological dimension (beliefs) and the consequential dimension (religious behaviour). In the third step, we analyse the similarities and differences of the behaviour of Salvation and the other indicators as a function of socio-demographic variables (gender, age, level of education, domicile, denominational affiliation) with ANOVA. On the whole, the Salvation item of the RVS is a somewhat weaker indicator of religiosity than the other global indicators. On the one hand, it seems to be a stricter measure than those, and, on the other hand, it is less suitable to identify non-traditional forms of religiosity. With these restrictions, however, it can be considered an adequate indicator of religiosity under the social conditions of Hungary in the twenty-first century. Keywords: categorical self-classification, denominational affiliation, dimensions of religiosity, ethics factor, indicators of religiosity, measuring religiosity, religion factor, Rokeach Value Survey (RVS), salvation Erlösung und Religiosität: Die Vorhersagekraft und Begrenzungen eines Items der RokeachWerteskala: Die Studie untersucht die Möglichkeiten und Grenzen bei der Frage, inwiefern das Erlösungsitem der Rokeach-Werteskala (RWS) als Indikator der Religiosität verwendet werden kann. Unsere Daten stammen aus der 4. Welle des ESS (2008, N = 1144). Das RWS-Erlösungsitem wurde zuerst mit vier globalen Religiositätskennwerten verglichen. In der zweiten Phase der Analyse wurde untersucht, wie das Verhältnis der umfassenden Religiositätsindikatoren – vor allem das Erlösungsitem der RWS – zu den zwei „klassischen“ Aspekten der Religiosität, zu der ideologi*

Contact author: Gábor Ittzés, Károli Gáspár University of the Reformed Church in Hungary, Budapest, Hungary; mental@ittzes.eu.

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 4

G. ITTZÉS, B. SIPOS-BIELOCHRADSZKY, O. BÉRES & A. PILINSZKI

schen Dimension (Glaube) und zu der konsequenziellen Dimension (religiöses Verhalten) ist. In einem dritten Schritt wurden die Ähnlichkeiten und Unterschiede der „Bewegung“ des Erlösungsitems und der anderen Indikatoren aufgrund von einigen soziodemografischen Variablen (Geschlecht, Alter, Bildung, Siedlungstyp, Religionszugehörigkeit) mit Varianzanalyse erforscht. Insgesamt ist das RWS-Erlösungsitem ein weniger starker Religiositätsindikator als die anderen von uns untersuchten Indikatoren. Einerseits schien es ein strengerer Maßstab als die anderen zu sein, andererseits ist es minder geeignet, die nicht traditionellen Formen der Religiosität zu erschließen. Mit diesen Einschränkungen ist das Erlösungsitem unter den gesellschaftlichen Umständen Ungarns im 21. Jahrhundert als adäquater globaler Religiositätsindikator zu betrachten. Schlüsselbegriffe: Erlösung, Ethikfaktor, kategoriale Selbsteinschätzung, Religionsfaktor, Religionszugehörigkeit, Religiositätsdimensionen, Religiositätsindikator, Religiositätsmessung, Rokeach-Werteskala (RWS)

1. Introduction After Durkheim’s and Weber’s pioneering explorations, religion began being studied as a multidimensional phenomenon from the 1960s on, especially in the wake of Gerhard E. LENSKI’s (1961), and Charles Y. GLOCK and Rodney STARK’s work (1965, 1966; STARK & GLOCK 1968). This resulted in a breakthrough in the history of sociological research. Glock and Stark developed a model of five different dimensions to assess religious commitment: (1) ideological dimension (i.e. religious beliefs), (2) ritual dimension (including religious practice), (3) experiential dimension (religious sentiments), (4) intellectual dimension (religious knowledge) and (5) consequential dimension (e.g. the impact of religion on lifestyle and moral perception, that is, religious behaviour). This model mirrors the internal complexity of religiosity, but it does not solve the problem of the measurability of various dimensions, nor is it capable of capturing different types of religiosity (FÖLDVÁRI & ROSTA 1998). Following the mid1960s, the recognition that religiosity cannot be grasped with the help of a single indicator and several independent variables are needed to describe it adequately became a widely held view exerting profound influence on empirical research. This enrichment of theoretical approaches and analytical tools did not, however, eradicate a desire to interpret religiosity as a unified concept. This can be seen not only in the fact that, already in the 1980s, Mady A. THUNG and Leo LAEYENDECKER (1985) began to reduce the number of religious dimensions to be studied but also in the consensus-building power of the religiosity types developed by Yves LAMBERT (1994; LAMBERT & MICHELET 1992). His threefold system of categories – confessional Christianity, cultural Christianity and secular humanism – is widely accepted today.1 In his highly influential essay on Hungary’s religious landscape (1999), Miklós TOMKA presented a multidimensional approach, but the five-point scale he had 1

Further on this chapter of the history of science, here sketchily outlined, see FÖLDVÁRI & ROSTA (1998); HUBER (2004); MAIELLO (2007), esp. 27–45; and TOMKA (1998).

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 5

SALVATION AND RELIGIOSITY

developed for the measuring of religiosity (1998) was also an essential part of his work. Based on the self-classification of respondents, the scale differentiates between people (1) who are religious according to the tenets of the church, (2) who are religious in their own way, (3) who cannot decide, (4) who are not religious, and (5) who are resolutely non-religious. In his analysis mobilising a serious mathematical apparatus and examining various dimensions, János SZÁNTÓ (1998) also summarises the results in terms of a few basic types. Religiosity is thus interpreted as a combination of several irreducible components. Yet at the same time, by identifying a few typical forms of religiosity, the sociology of religion seeks to give a manageably simple description of this extremely complex phenomenon. It is not afraid of developing categories that seem, on the basis of a quantitative criterion, to be linearly arrangeable and thus lead back to a simple one-dimensional scale to measure religiosity. This is, however, by no means to be considered a self-contradiction, for the simplifying step of model building does not disregard but, on the contrary, utilises the lessons learnt from the multi-dimensional analysis. From this hermeneutical stance, with a ‘post-critical naivety’ we may find a connection to the Salvation item of the Rokeach Value Survey as an indicator of religiosity. Milton ROKEACH developed his value survey nearly fifty years ago (1969a; 1973),2 and it was, within a short period of time, adapted to the Hungarian circumstances by Elemér HANKISS (1977; HANKISS et al. 1983). The Rokeach Value Survey (RVS), based on the ranking of eighteen terminal and eighteen instrumental values, has widely remained in use in the twenty-first century. But it has often been criticised, for example, for being ‘too general . . . and abstract, since individual values are thought to be attached to specific things and not to overall values’ (FÜSTÖS & TIBORI 2011, 46, our trans.).3 A further deficit associated with the survey is that it does not accurately define individual items (e.g. Self-respect, cf. FÜSTÖS & SZAKOLCZAI 1994, 62). Methodological criticism has centred on difficulties inherent in the ranking process such as reproducibility or the lack of a quantifiable distance of importance between the items. ‘Although many have criticised the Rokeach test, it has nonetheless proved to be the most usable’ (FÜSTÖS & SZAKOLCZAI 1994, 57, our trans.).4 It is a little-known fact today that one of the central issues in Rokeach’s early research was the examination of values in connection with religiosity and that his questions and results stirred up a considerable scholarly debate in the US at the turn of the 1960s and 1970s.5 In his study, ROKEACH (1969b) analysed the similarities and differences of the value systems of four groups: Protestants, Catholics, Jews and nonreligious people. He found significant differences between the groups in the case of eighteen of the thirty-six values examined. Of the eighteen terminal values, Salvation 2 3

4 5

For a review of its early reception history, see VÁRINÉ SZILÁGYI (1987) 150–71. In the original: ‘túl általános . . . és elvont, mivel az egyéni értékekről úgy tartják, hogy konkrét dolgokhoz kapcsolódnak nem pedig átfogó értékekhez’. In the original: ‘Jóllehet sok bírálat érte a Rokeach-tesztet, mégis ez bizonyult a leginkább használhatónak.’ One of the defining issues in the debate that took place on the pages of the Review of Religious Research was the correlation between religiosity and social sensitivity. That, however, is a topic that falls outside the scope of this paper.

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 6

G. ITTZÉS, B. SIPOS-BIELOCHRADSZKY, O. BÉRES & A. PILINSZKI

showed the biggest difference: on average, Protestants ranked it fourth, Catholics thirteenth, and Jews as well as non-religious people put it in the last place. Salvation, at the same time, also moved together with other indicators of religiosity that were independent of the RVS. In terms of the frequency of church attendance, the results were unambiguous. A strong link was displayed between participation at religious events and the ranking of Salvation (weekly: third place; almost weekly: fifth; 2–3 times a month: tenth; once a month: twelfth; a couple of times a year: thirteenth; 1–2 times a year: sixteenth; never: eighteenth place). Among regular church-goers of different Christian denominations, the difference in ranking remained the same. While those belonging to Protestant denominations ranked Salvation first to third place, Catholics and Anglicans placed it tenth and thirteenth, respectively. Another approach to religiosity (‘How important is religion for you in everyday life?’) led to similar results. Among those who deemed religion important, salvation finished in the first place, while in the case of medium or low importance, it became sixteenth and eighteenth. For all three religiosity criteria, Rokeach’s survey showed significant differences between the value systems of religious and non- (or less) religious respondents. The discrepancy was most consistently manifest in the case of the Salvation item. Other surveys also found correlations between the Salvation item of the RVS and other indicators of religiosity. E.D. TATE and G.R. MILLER (1971) examined the value systems of the members of a Protestant denomination on the basis of ALLPORT and ROSS’s (1967) categories of religious orientation. Salvation was ranked most important by those with an intrinsic religious orientation, and least important by those with an anti-religious orientation. In the median rankings, the latter placed the value ninth, and those who belonged to the other three groups, first or second. W.F. RUSHBY and J.C. THRUSH, in their survey examining the social sensitivity of Mennonite students, used the Salvation item of the RVS as a means of measuring religious orthodoxy (1973). Mennonite students ranked this value first, while a control group (students from a state university) ranked it last. The authors found the place of Salvation in the rankings an appropriate indicator of religiosity as long as that was narrowed down to traditional Christian religiosity. The restriction already points to some limitations of the approach, and there were indeed cautionary results. Bernard SPILKA called attention to the complexity of the concept of salvation as early as 1970, and also to the fact that the ranking of this terminal value may be incidental in the case of persons with different religious dispositions. The item cannot capture the colourfulness of religion (not to mention the shades of the various colours), but, according to Spilka, its application cannot be completely ruled out. Examining Unitarian Universalists, R.L.H. MILLER (1976) found that – unlike members of other denominations – they consistently ranked Salvation last. Salvation, in his opinion, can by no means be considered a measure of religiosity in the case of that denomination. Both theoretical considerations and empirical data thus give us pause and a warning signal that the Salvation item of the RVS cannot capture the full complexity of religiousness. That does not, however, render it altogether useless, for other data

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 7

SALVATION AND RELIGIOSITY

clearly point in that direction. It correlates with other important aspects of religiosity and, in the case of certain populations and certain types of religiosity, it not only functions as an indicator of its own special dimension (salvation orientation) but also has a predictive value to assess the overall religiousness of respondents – at least in the sense of basic types arrangeable along a quantitative scale. Through a secondary analysis of data from a national survey, we explore the possibilities and limitations of using the RVS Salvation item as a global indicator of religiosity in early twentyfirst-century Hungarian society. 2. Sample and methods The data we analyse were collected in connection with the 4th wave (2008) of the European Social Survey (ESS).6 The sample is representative of the population of Hungary. The number of respondents was 3,002, but some subsets of questions were administered to a smaller sub-sample (still meeting the requirements of representativeness). Our results are thus largely based on answers from a sample of 1,144 persons. The questionnaires were administered by interviewers, and answers to the questions included in our analysis were based on the self-classification of respondents. SPSS 21.0 software was used in data analysis. The original survey reflects developments in the sociology of religion over the past few decades in a limited way. Detailed questions related to different dimensions of religion that may be derived from various theoretical considerations are mostly, although by no means entirely, absent from the questionnaire. Only a few of those appear as coordinated subsets of questions. There are, however, several questions which attempt to capture the religiosity of respondents globally. In the first part of our analysis we compared four of those with the Salvation item of the RVS (R1_18)7: 1. ‘How religious do you consider yourself?’ (VAL1) – Respondents classified themselves with the help of cards. Answer categories included 1 = I am markedly anti-religious; an atheist. 2 = I am non-religious. 3 = To a certain degree, perhaps; religion has some role in my life. 4 = I consider myself religious, but I am not a regular church-goer. 5 = I am a regular church-goer. – We refer to this item as ‘categorical self-classification’8 in order to differentiate it from the following question: 6 7

We thank László Füstös for providing access to the original data for secondary analysis. As is reflected in our wording, we, in conformity with the general research practice, treated the rankings of the RVS as scores given on an eighteen-point scale. A peculiarity of the RVS is that the lower the value, the more important the item is considered by the respondent. In the case of the other variables analysed, the direction of the scoring was reverse. In order to ensure clarity and consistency, Salvation values were recoded. Two aspects of religiosity (religious self-classification and religious practice) appear in the answers which can be given to this question. As a result of the mixing, the answers are difficult to interpret on a single scale. Taking the limitations of the question into account, we nonetheless decided to treat it as an ordinal scale, since the attributes of the variable exhibit a certain kind of gradedness.

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 8

G. ITTZÉS, B. SIPOS-BIELOCHRADSZKY, O. BÉRES & A. PILINSZKI

2. ‘Regardless of whether you belong to any church or denomination, how much of a believer or how religious do you consider yourself?’ (VA4) – The response was given on the basis of an eleven-point Likert scale. A score between 0–10 indicates how religious respondents consider themselves: 0 = Not religious at all. . . . 10 = Very religious. 3. Interpreting each item of a thirty-question subset as a separate question, respondents could decide how important the given concept or attitude was for them. One of the variables was ‘Religion, faith’ (KV1_9). – The response was given on an eleven-point Likert scale: 0 = Not important at all. . . . 10 = Very important. 4. Interpreting each item of a six-question subset as a separate question, respondents could decide how much influence a given factor had on their fate. One of the variables was ‘I am in the hands of God; God9 directs, God decides’ (SZ2_1). – The response was given on a five-point Likert scale: 1 = Not at all. . . . 5 = To a very great extent. First, then, we examined the RVS Salvation item in the context of these four global indicators of religiosity. In order to standardise the comparison, we divided the values of the variables into three categories: religious; in-between/uncertain; non-religious.10 In cross tabulation analysis, we worked with the recoded variables. In this phase of the analysis, we also included the questions about denominational affiliation: 5. ‘Is there a religion or religious denomination to which you belong?’ (VA1) 6. If yes, the follow-up question was asked, ‘Which one?’ (VA2) In the second phase of our analysis we examined the relationship between the overall indicators of religiosity – including, especially, the RVS Salvation item – and certain aspects of religiousness. Available data allowed us to analyse two ‘classic’ dimensions – beliefs on the one hand and religious behaviour on the other – with the help of the following questions: 7. Interpreting each item of a ten-question subset as a separate question, respondents could decide whether they believed in the given religious concept or not: ‘God; eternal life after death; the human soul; Satan; hell; heaven; original sin; resurrection of the dead; reincarnation; angels’ (VAL2_1 . . . VAL2_10). – Answer categories included 0 = Item not chosen. 1 = Item chosen. 8. As the first nine items of a thirteen-question subset, respondents could decide how much they agreed with each of the Commandments (EM1_1 . . . EM1_9). – The response was given on a five-point Likert scale: 1 = Not at all. . . . 5 = To a very great extent. 9. ‘Do you live in the spirit of the Ten Commandments?’ (EM2) – The response was given by selecting of one of three categories: 1 = Yes, fully. 2 = Partly. 3 = No. 19 10

Hungarian is a non-gendered language. The original wording used a gender-neutral pronoun. With the five-point variables, we used a 2–1–2 grouping; and with the other variables, we defined those who chose the highest three values religious and those who chose the lowest three values non-religious.

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 9

SALVATION AND RELIGIOSITY

Finally, in the third step, we analysed the similarities and differences of the behaviour of Salvation and the other indicators as a function of socio-demographic variables (gender, age, level of education, domicile, denominational affiliation) with ANOVA. 3. Results 3.1. The relationship of the RVS Salvation item with other indicators of religiosity Following the categorisation of the results of the general indicators of religiosity on a three-point scale, in the case of the four variables – ‘I am in the hands of God’ (SZ2_1); categorical self-classification (VAL1); the importance of religion and belief (KV1_9); ‘How religious do you consider yourself?’ (VA4) – we got a value between 20% and 50% in all three groups of religiousness (religious, in-between/uncertain, non-religious). The most even distribution we found in the case of the categorical self-classification (approx. ⅓–⅓–⅓), while the results of the respondents’ evaluation of their own religiosity on a quantitative scale slightly move from the religious pole in the direction of the medial range. By contrast, results on the question about the importance of religion and belief in general without reference to personal faith or the classification of one’s own religiosity show just the opposite tendency, shifting from the non-religious pole towards the in-between/uncertain range. The question was asked in a set consisting of thirty items which also included work, family, money and the like. In the frequency table we can see that 38% of respondents rated the importance of religion 7 to 10. At the same time, respondents regarded religion and belief the least important (5.33) after politics. Family received the highest average score (9.74), followed by a few inner qualities such as love (9.18), happiness (9.12), peacefulness (9.03) and well-being (9.02). While on the two previous questions the inbetween/uncertain range is the strongest, on the fourth question – ‘I am in the hands of God’ (SZ2_1) – the non-religious pole stands out. This statement, implying personal involvement, was rejected by more than one in two respondents, who were therefore categorised as non-religious. Compared to the other global indicators in the survey, the RVS Salvation item acted as an extremely strict measure of religiosity. The in-between/uncertain group here also represents a proportion of about one third, but the proportion of the non-religious is outstanding (nearly two thirds), while only a fraction of respondents marked as religious by the other indicators got into the ‘religious’ category here, since more than half of the respondents (51.2%) ranked salvation eighteenth (i.e. last) among terminal values, while only 5.5% of them deemed this value very important (1–3) (Table 1). Respondents are almost equally distributed among the other scores (places 4–17), their proportion fluctuating mostly between 2–4%. The average score is 14.66.

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 10

G. ITTZÉS, B. SIPOS-BIELOCHRADSZKY, O. BÉRES & A. PILINSZKI Table 1 Level of religiosity as measured by different indicators (distribution of responses, %) RVS salvation (R1_1)

Categorical How religious The importance self-classifica- do you consider of religion and tion (VAL1) yourself? (VA4) faith (KV1_9)

‘I am in the hand of God’ (SZ2_1)

Religious

5.5

32.6

19.9

29.3

28.6

In-between/ uncertain

30.5

31.7

47.0

47.8

20.6

Non-religious

64.0

35.7

33.1

22.9

50.8

Respondents’ denominational affiliation was also analysed (VA1; VA2). Nearly one in two respondents (46%) do not belong to any denomination; 40% declared themselves Catholic, 13% Protestant, and 1% identified with other, non-Christian denominations. In line with the expectations, the fact that a person belongs to a certain religion/denomination or not shows significant correlation with each indicator of religiosity, including Salvation (Table 2). Between the indicators and specific denominational affiliations, however, there is no statistically verifiable correlation. Table 2 The strength of the correlation between indicators of religiosity and denominational affiliation (Cramer’s V)11 Indicator of religiosity

Do you belong to any denominations?

RVS salvation (R1_18)

0.176

Categorical self-classification (VAL1)

0.443

How religious do you consider yourself? (VA4)

0.548

The importance of religion and faith (KV1_9)

0.376

I am in the hand of God’ (SZ2_1)

0.347

The χ2 test is significant for each variable (p < 0.01).

The Cramer’s V measure of association takes values between 0 and 1. Its value is 0 if there is no association between the variables, and 1 if the association is function-like. Under 0.2 we talk about a weak association, over 0.5 a strong one.

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 11

SALVATION AND RELIGIOSITY

We generated a religiosity score by performing a principal component analysis of the original, non-categorised variables measuring religiosity without the Salvation item. We experienced a medium-strong correlation between the variables, the KMO value is 0.763, and Bartlett’s test is significant. By all relevant criteria (eigenvalue, explained variance, scree plot), all variables load onto one principal component. The communality of each variable exceeds 0.5, that is, the principal component explains more than half of the variance of each variable. The principal component preserved 66.8% of the information carried by the four variables. Examining the connection between the Salvation item on the one hand and the other variables measuring religiosity and the religiosity principal component on the other, we calculated the Pearson’s correlation coefficients (Table 3). Table 3 Connection between the indicators of religiosity (Pearson’s r) Indicator of religiosity RVS Salvation (R1_18) Categorical self-classification (VAL1) How religious do you consider yourself? (VA4) The importance of religion and faith (KV1_9) ‘I am in the hand of God’ (SZ2_1) Religiosity principal component

R1_18

VAL1

VA4

KV1_9 SZ2_1

RPC

1.00

0.36

0.33

0.29

0.47

0.45

1.00

0.58

0.48

0.64

0.83

1.00

0.59

0.52

0.84

1.00

0.48

0.80

1.00

0.81 1.00

The correlations are statistically significant (p < 0.01).

We mainly found moderate (min. 0.29; max. 0.64) correlations between the variables. The RVS Salvation item moves the least with the values of the other variables, but it still proved to be significant at a level of 0.01. A strong correlation (r = 0.643) can be seen between the categorical religious self-classification and ‘I am in the hands of God; God directs, God decides’. The religiosity principal component naturally displays a strong correlation with the four variables, for we created it by the reduction of them. The RVS Salvation variable correlates most strongly with the statement ‘I am in the hands of God’ (r = 0.465), but it shows a strong correlation with the principal component as well (r = 0.447).

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 12

G. ITTZÉS, B. SIPOS-BIELOCHRADSZKY, O. BÉRES & A. PILINSZKI

3.2. The ideological and consequential dimensions of religiosity The ESS questionnaire allowed for the examination of two classic religiosity dimensions. We were able to analyse the connection between what GLOCK and STARK (1965) called the ideological dimension (beliefs) and the consequential dimension (religious behaviour) on the other hand, and the global indicators of religiosity on the other. The dichotomous variables of the items in the religious beliefs subset (in each case, respondents were asked whether they believed in the given concept or not) significantly correlated with all indicators of religiosity (Table 4). Table 4 The strength of the connection between beliefs and the global indicators of religiosity (Cramer’s V)

Beliefs (VAL2_1 . . . VAL2_10)

Categorical selfRVS salvation (R1_18) classification (VAL1)

How religious do you consider yourself? (VA4)

The importance of religion and faith (KV1_9)

‘I am in the hand of God’ (SZ2_1)

God

0.275**

0.681**

0.424**

0.340**

0.505**

Eternal life after death

0.323**

0.462**

0.328**

0.266**

0.398**

Human soul

0.117**

0.308**

0.202**

0.209**

0.183**

Satan

0.241**

0.319**

0.216**

0.158**

0.318**

Hell

0.258**

0.343**

0.225**

0.195**

0.324**

Heaven

0.294**

0.528**

0.375**

0.339*

0.447**

Original sin

0.213**

0.355**

0.232**

0.225**

0.309**

Resurrection of the dead

0.331**

0.449**

0.322**

0.250**

0.410**

Reincarnation

0.091*

0.244**

0.173**

0.135*

0.170**

Angels

0.299**

0.402**

0.265**

0.218**

0.384**

The p values of the χ2 test: * p < 0.05; ** p < 0.01.

The italicised correlations are the strongest in the matrix. An especially strong correlation appears between the categorical self-classification and the statement ‘I am in the hands of God’ on the one hand and belief in God and heaven on the other. High values are also assigned to the resurrection of the dead and to eternal life after death.

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 13

SALVATION AND RELIGIOSITY

The weakest correlation can be observed with the items related to the soul, particularly with reincarnation (in the case of all indicators of religiosity). In terms of the strength of the connection, angels are in mid-range, and the Satan–hell–original sin concept group is in the lower mid-range of the scale. Categorical self-classification has the greatest predictive power for each variable. It is followed by the statement ‘I am in the hands of God’, and then the ‘How religious are you?’ (1–10) scale. The Salvation item of the RVS also shows significant correlations with the religious concepts, but its predictive power is the weakest of the five indicators, although with half of the items it is stronger than the (impersonal) importance of religion and faith. With medium-strong correlations, Salvation is, on the whole, only slightly behind the strength of the latter indicator. By analysing adherence to the Ten Commandments, we also examined the correlation between certain behaviours and the indicators of religiosity. The vast majority of respondents (89%) live, according to their self-assessment, at least partly in accordance with the spirit of the Ten Commandments, and only one in ten respondents said they did not follow the Ten Commandments at all. If we compare these data with the different indicators of religiosity, we find that each of the latter is in significant correlation with adherence to the Ten Commandments. The strength of the correlation varies, but each indicator exhibits a medium value (Table 5). Table 5 The strength of the correlation between the indicators of religiosity and adherence to the Ten Commandments (Cramer’s V) Indicator of religiosity

Do you live in accordance with the Ten Commandments? (EM2)

RVS salvation (R1_18)

0.197

Categorical self-classification (VAL1)

0.311

How religious do you consider yourself? (VA4)

0.250

The importance of religion and faith (KV1_9)

0.251

‘I am in the hand of God’ (SZ2_1)

0.330

The χ2 test is significant for each variable (p < 0.01).

Beyond the global assessment of their behavioural conformity, respondents were also asked to express their agreement with the individual commandments on a five-point scale. Answers differed significantly for each item, but their averages clearly demonstrate that the degree of agreement was the lowest for those commandments (1–3) (italicised in Table 6) which do not pertain to the general rules of human coexistence but have specifically religious content. With these commandments, the

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 14

G. ITTZÉS, B. SIPOS-BIELOCHRADSZKY, O. BÉRES & A. PILINSZKI

proportion of those who fully agree is strikingly lower than with the other group, where the rate of complete agreement may exceed 80% as in the case of ‘You shall not murder’. Table 6 The degree of agreement with the individual provisions of the Ten Commandments

Average

The proportion of those who fully agree (%)

I am the Lord your God.

3.02

25.4

You shall not make wrongful use of the name of the Lord your God.

3.26

29.9

Remember the sabbath day, and keep it holy.

3.13

25.9

Honour your father and your mother.

4.50

69.7

You shall not murder.

4.65

80.8

You shall not commit adultery.

4.13

55.7

You shall not steal.

4.46

70.7

You shall not bear false witness against your neighbour.

4.39

65.6

You shall not covet your neighbour’s house, possessions, wife.

4.33

62.5

Commandment (EM1_1 . . . EM1_9)

Factor analysis of the commandments clearly reveals a latent structure. The expressly religion-related items belong to one factor, while the others to another factor. The KMO value is 0.873, and Bartlett’s test is significant, which suggests that the variables in question are suitable for factor analysis. The MSA values are between 0.760 and 0.923. Each variable is therefore expected to fit well into the factor structure, which is also confirmed by the communalities: each shows a value over 0.45. In the analysis we used the maximum likelihood method and a varimax rotation. The analysis produced two factors with eigenvalues over 1. The explained variance was 70.8%. We named them ‘religion’ (Factor 1) and ‘ethics’ (Factor 2; see Table 7).

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 15

SALVATION AND RELIGIOSITY Table 7 Factor-weights of each of the Ten Commandments Factor 1 Religion

Factor 2 Ethics

I am the Lord your God.

0.916

0.140

You shall not make wrongful use of the name of the Lord your God.

0.867

0.247

Remember the sabbath day, and keep it holy.

0.762

0.170

Honour your father and your mother.

0.242

0.622

You shall not murder.

0.101

0.793

You shall not commit adultery.

0.329

0.704

You shall not steal.

0.118

0.902

You shall not bear false witness against your neighbour.

0.149

0.897

You shall not covet your neighbourâ&#x20AC;&#x2122;s house, possessions, wife.

0.206

0.840

Explained variance

27.0%

43.8%

Commandment

Examining the correlation between the factors and religiosity, we find that the religiosity principal component is in significant correlation with both factors, but it correlates only weakly with the ethics factor. If we look separately at the variables that constitute the principal component, we can see similar connections. Salvation moderately correlates (r = 0.352) with the religion factor of the Ten Commandments; with the ethics factor, however, it has no significant correlation (Table 8).

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 16

G. ITTZÉS, B. SIPOS-BIELOCHRADSZKY, O. BÉRES & A. PILINSZKI Table 8 The correlation of the indicators of religiosity with factors of the Ten Commandments (Pearson’s r) Ten Commandments Indicator of religiosity Factor 1: Religion

Factor 2: Ethics

RVS salvation (R1_18)

0.352**

0.042

Categorical self-classification (VAL1)

0.564**

0.185**

How religious do you consider yourself? (VA4)

0.080**

0.052

The importance of religion and faith (KV1_9)

0.437**

0.174**

‘I am in the hand of God’ (SZ2_1)

0.654**

0.115**

Religiosity principal component

0.642**

0.184**

p < 0.01

3.3 The correlation of the RVS Salvation item with demographic variables To ensure easier interpretability when comparing the effects of the Salvation item and those of the religiosity principal component, we worked with a standardised version of Salvation (Z-score). With both variables we find that the role of religiosity is increasing with age. While, in the case of the religiosity principal component, the Scheffe test shows that the youngest age group differs significantly from both quintogenarians (50–59) and those over sixty, we see only two homogeneous groups for Salvation (those under/over sixty) (Figure 1).

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 17

SALVATION AND RELIGIOSITY Age Group (Years)

0,500 0,458 0,400 0,320

0,300 0,200 0,100 0,000 -0,054

-0,082 -0,100 -0,200 -0,300

-0,052

-0,147 -0,138

-0,145

-0,146

-0,353

-0,400 18–29

30–39 RVS Salvation

p = 0,000; F(4;1138) = 11.87

40–49 50–59 Religiosity Principal Component

60–x

p = 0.000; F(4;1073) = 26.81

Figure 1 The connection of the religiosity principal component and of the RVS Salvation with age (average)

When examining the role of gender, we see the same result for the principal component and Salvation: women tend to be more religious. The correlation is significant in both cases, but the connection is weaker in the case of the Rokeach value. The differences of the averages are much clearer for the principal component (Table 9). Table 9 The connection of the religiosity principal component and the RVS Salvation with gender (average) Religiosity principal component

RVS salvation

Women

0.207

0.076

Men

–0.252

–0.091

0.000

0.005

59.697 (1;1076)

8.083 (1;1141)

F(df)

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 18

G. ITTZĂ&#x2030;S, B. SIPOS-BIELOCHRADSZKY, O. BĂ&#x2030;RES & A. PILINSZKI

The group of those with a low level of education significantly differ from the other groups in the case of both the principal component and Salvation. Those having the lowest level of education are the most religious as measured by the principal component. Skilled workers are the least religious, and then the score of religiosity increases with the level of education. As for Salvation, the Scheffe test shows that college graduates (and higher) do not significantly differ from any other group, and only those with a primary education show a significant difference from skilled workers and high school graduates (Figure 2). Educational Level

0,400

0,300

0,273

0,200 0,171 0,100 0,011 0,000

-0,100

-0,068

-0,154 -0,134

-0,146

-0,200

-0,300 -0,291 -0,400 Primary school and below

Technical school RVS Salvation

p = 0.000; F(3;1139) = 8.42

Secondary/vocational school

College or higher

Religiosity Principal Component

p = 0.000; F(3;1074) = 20.52

Figure 2 The connection of the religiosity principal component and the RVS Salvation with the level of education (average)

We find a weak but significant connection between the principal component and domicile: those living in Budapest significantly differ from those living in the other three types of settlement; their religiosity score is lower. In the case of Salvation, the differences between the groups are very small (can be measured in hundredths). It is not surprising, then, that the correlation is not significant (Figure 3).

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 19

SALVATION AND RELIGIOSITY Domicile

0,150 0,105 0,100 0,041

0,050 0,000

0,020 -0,010 -0,034 -0,051

-0,031

-0,050 -0,100 -0,150 -0,200 -0,250 -0,300 -0,350 -0,348 -0,400 Budapest

County seat RVS Salvation

p = 0.714; F(3;1139) = 0.455

Town

Village

Religiosity Principal Component

p = 0.001; F(3;1074) = 5.776

Figure 3 The correlation of the religiosity principal component and the RVS Salvation with domicile (average)

As we have already mentioned above, there is no statistically significant difference between the different denominations either in the case of Salvation or in the case of the other indicators of religiosity. This is also confirmed by the post-hoc test (Scheffe) applied during ANOVA, which showed that the fact of belonging or not belonging to a denomination determines significantly the scores of the principal component and of Salvation (Figure 4).

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 20

G. ITTZÉS, B. SIPOS-BIELOCHRADSZKY, O. BÉRES & A. PILINSZKI Denominational Affiliation

1,000 0,794 0,800 0,600 0,457 0,421 0,400

0,449

0,200 0,214 0,150 0,000 -0,200 -0,253 -0,400 -0,600 -0,706 -0,800 No affiliation

Catholic RVS Salvation

p = 0.000; F(3;1121) = 17.68

Protestant

Non-Christian

Religiosity Principal Component

p = 0.000; F(3;1051) = 161.96

Figure 4 The connection of the religiosity principal component and the RVS Salvation with denominational affiliation (average)

4. Discussion In the foregoing analysis we have compared the Salvation item of the RVS with other global indicators of religiosity. We have found that Salvation works as a particularly strict measure compared to the other indicators. On those scales, a considerably larger proportion of the sample proved to be religious, and a smaller part expressly non-religious. Just like the other indicators, the RVS Salvation item proved to be inadequate for the prediction of denominational affiliation. We have, however, found significant correlation with the fact of belonging (or not belonging) to a denomination. In this respect, Salvation behaved like the other global indicators. Our principal component analysis has led to a similar result. Salvation displays an at least moderate connection with all the indicators of religiosity, and it is in close correlation with one of the four (‘I am in the hands of God’) and the principal component. There is, thus, no significant difference between the behaviour of Salvation and the other four indicators included in the analysis. The data available through the ESS-related data collection constituted a limitation for the analysis of the religiosity dimensions. In the case of beliefs, one of the

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 21

SALVATION AND RELIGIOSITY

ten items (reincarnation) could not be clearly linked to traditional Christian doctrines, and, compared to the other items, it showed an expressly weaker correlation with Salvation. At the same time it is important to note that, on the one hand, even this connection is statistically significant, and, on the other, Salvation manifests clear similarities to the other global indicators, which also show a weaker than average connection with this item. It is also clear, however, that the predictive power of Salvation for beliefs is, on the whole, smaller than that of the other indicators. In fact, three of the four indicators have a considerably stronger predictive power for beliefs. We examined the consequential dimension of religion (religious behaviour) through adherence to the Ten Commandments. The available data limited the analysis in several respects. Nearly 90% of respondents claim to live partly in the spirit of the Ten Commandments, but we do not know what that actually means – whether they break only one commandment or they observe only one? Neither do we know what respondents exactly mean when they (11%) say that they do not live according to the Ten Commandments. It may mean that they do not observe all the commandments (strict interpretation), but it may also mean that they do not observe any of them. In view of the low occurrence rate of this answer, however, it seems most probable that the negative answer signals a rejection of deliberateness. The respondent does not seek to observe the Ten Commandments consciously, even if they probably observe some of them (e.g. the prohibition of killing and stealing) ‘fortuitously’ (that is, without the intention to follow the Ten Commandments playing any role in shaping their behaviour). The data may be further distorted by the fact that the wording of the first commandment in the questionnaire is not complete. It contains no imperative or prohibitive elements (it lacks the phrase ‘you shall have no other gods before me’), and the banning of images has also been left out of the questionnaire. These deficiencies were not compensated by the division, applied by certain denominations, of the last commandment against coveting another person’s possessions. Thus only nine commandments were actually included in the questionnaire. Since some versions of the text of the Ten Commandments are aligned with denominational divisions, the wording used in the questionnaire may have contributed to the fact that denominational affiliation did not prove to be a significant factor for any indicators of religiosity. As with most other aspects of religiosity, the RVS Salvation displayed the weakest correlation with the behavioural dimension as well. Yet it still proved significant and was not substantially weaker than that of the other indicators. The result of the factor analysis is particularly noteworthy because it showed that the indicators of religiosity have a much weaker connection with those commandments that can also be interpreted as general ethical rules than with those of expressly religious content. The difference is obvious in the case of Salvation as well. Moreover, here we found no significant correlation with the ethics factor at all. At this point Salvation deviates from the other indicators of religiosity with the exception of the question ‘How religious do you consider yourself?’ One possible reason for the difference is that Sal-

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 22

G. ITTZĂ&#x2030;S, B. SIPOS-BIELOCHRADSZKY, O. BĂ&#x2030;RES & A. PILINSZKI

vation is less suitable to identify non-traditional forms of religiosity, while the ethical commitment synthesised in the Ten Commandments is not restricted to traditional forms of religiosity (cf. KĂ&#x153;NG 1994). Salvation displays a somewhat weaker connection with the religion factor than do the other global indicators. That is in line with our results for other aspects of religiosity. Our analysis of variance has led to the result that RVS Salvation, considered as a function of the major demographic variables, behaves similarly to the religiosity principal component. Difference between them is only found in relatively minor details. While each background variable correlates significantly with the religiosity principal component, the connection between the Salvation item of the RVS and domicile is not significant. With the religiosity principal component we also find that only the respondents from Budapest differ from the others. With Salvation, however, this difference also disappears. A possible explanation for this may be that, as we have already pointed out, the Salvation item is a strict indicator of religiosity. The results of the F-test show that the religiosity principal component is in a stronger connection with the background variables than Salvation is. The individual steps of the ANOVA thus confirmed our general experience that the scores of the Salvation item fall somewhat below the corresponding scores of the principal component and the other indicators of religiosity. That, however, only qualifies but does not obliterate the fundamental similarities between the RVS Salvation and the other global indicators. 5. Conclusion To summarise, we can say that, according to our test criteria, the Salvation item of the RVS is a somewhat weaker indicator of religiosity than the other global indicators, but it is basically comparable to them. It is not suitable in itself to draw a detailed picture of the religiosity of a certain population, but, as our analysis has shown, it is suitable to provide an overall picture of it. We can basically assess the degree of religiosity of a sample with the help of this single question. Our analysis has identified two limitations of RVS Salvation as a global indicator of religiosity. On the one hand, it seems to be a stricter measure than the other global indicators analysed. The results showed that the RVS item behaves similarly to other indicators of religiosity, but the correlations are weaker in comparison and the variable is stricter in the sense that it indicates a lower level of religiosity in a given sample. Based on the Salvation criterion, we will probably find a smaller part of a population religious and a bigger part expressly non-religious than with other similar measures. On the other hand, Salvation proved to be less suitable than the other indicators to reveal non-traditional forms of religiosity. Thus one important boundary condition of its applicability is a low prevalence of non-traditional forms of religiosity in the sample. The critical edge of our conclusion is not a novelty, for it has been long known in the literature that the RVS Salvation item is not suitable to

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 23

SALVATION AND RELIGIOSITY

identify certain types of religiosity (MILLER 1976; SZÁNTÓ 1998). On the contrary, the most important result of our analysis is that under certain conditions, which still seem to apply in Hungary at the beginning of the twenty-first century, the RVS Salvation item can be successfully used as a global indicator of religiosity. References ALLPORT, G.W. & J.M. ROSS (1967) ‘Personal Religious Orientation and Prejudice’, Journal of Personality and Social Psychology 5, 432–43. FÖLDVÁRI, M. & G. ROSTA (1998) ‘A modern vallásosság megközelítési lehetőségei’, Szociológiai Szemle 8:1, 127–37. FÜSTÖS, L. & T. TIBORI (2011) ‘Értékindikátorok’ in T. ANTALÓCZY & L. FÜSTÖS, eds., Társadalmi füzetek 2011/2 (Budapest: MTA SZKI, PTI) 45–105. FÜSTÖS, L. & Á. SZAKOLCZAI (1994) ‘Értékek változásai Magyarországon, 1978–1993: Kontinuitás és diszkontinuitás a kelet-közép-európai átmenetben’, Szociológiai Szemle 4:1, 57–90. GLOCK, C.Y. & R. STARK (1965) Religion and Society in Tension (Chicago: McNally). GLOCK, C.Y. & R. STARK (1966) Christian Beliefs and Anti-Semitism (New York: Harper and Row). HANKISS, E. (1977) Érték és társadalom: Tanulmányok az értékszociológia köréből (Budapest: Magvető). HANKISS, E., R. MANCHIN, L. FÜSTÖS & Á. SZAKOLCZAI (1983) Kényszerpályán? A magyar társadalom értékrendszerének alakulása 1930 és 1980 között (Budapest: MTA Szociológiai Kutató Intézet). HUBER, S. (2004) ‘Zentralität und multidimensionale Struktur der Religiosität: Eine Synthese der theoretischen Ansätze von Allport und Glock zur Messung der Religiosität’ in Ch. ZWINGMANN & H. MOOSBRUGGER, eds., Religiosität: Messverfahren und Studien zu Gesundheit und Lebensbewältigung (Münster: Waxmann) 79–106. KÜNG, H. (1994) Világvallások etikája (Projekt Weltethos), trans. M. SZABÓNÉ RÉVÉSZ & E. GAÁLNÉ RÉVÉSZ (Budapest: Egyházfórum). LAMBERT, Y. & G. MICHELET, eds. (1992) Crépuscule des religions chez les jeunes? (Paris: L’Harmattan). LAMBERT, Y. (1994) ‘La religion: Un paysage en pleine évolution’ in H. RIFFAULT, ed., Les valuers des français (Paris: PUF) 123–62. LENSKI, G.E. (1961) The Religious Factor (New York: Doubleday). MAIELLO, C. (2007) Messung und Korrelate von Religiosität: Beziehungen zwischen Glaubensintensität und psychologisch, pädagogisch, soziologisch sowie medizinisch relevanten Variablen (Münster etc.: Waxmann). MILLER, R.L.H. (1976) ‘The Religious Value System of Unitarian Universalists’, Review of Religious Research 17, 189–208. ROKEACH, M. (1969a) Beliefs, Attitudes, and Values: A Theory of Organization and Change (2nd ed.; San Francisco: Jossey-Boss). ROKEACH, M. (1969b) ‘Part I. Value Systems in Religion’, Review of Religious Research 11, 3–23. ROKEACH, M. (1973) The Nature of Human Values (New York: Free Press). RUSHBY, W.F. & J.C. THRUSH (1973) ‘Mennonites and Social Compassion: The Rokeach Hypothesis Reconsidered’, Review of Religious Research 15, 16–28. SPILKA, B. (1970) ‘Religious Values and Social Compassion: A Problem in Theory and Measurement’, Review of Religious Research 11, 149–51.

EJMH 12:1, June 2017

01_Rokeach_Ittzes_Junius 2017.05.24. 11:21 Page 24

G. ITTZÉS, B. SIPOS-BIELOCHRADSZKY, O. BÉRES & A. PILINSZKI

STARK, R. & C.Y. GLOCK (1968) American Piety: Patterns of Religious Commitment (Berkeley & Los Angeles: U of Califomia P). SZÁNTÓ, J. (1998) ‘A vallásosság dimenziói egy szekularizált társadalomban’ in P.T. NAGY, ed., Vallásosság egy szekularizált társadalomban (Budapest: Új Mandátum) 98–113. TATE, E.D. & G.R. MILLER (1971) ‘Differences in Value Systems of Persons with Varying Religious Orientations’, Journal for the Scientific Study of Religion 10, 357–65. THUNG, M.A. & L. LAEYENDECKER (1985) Exploring the New Religious Consciousness: An Investigation of Religious Change by a Dutch Working Group (Amsterdam: Free UP). TOMKA, M. (1998) ‘A vallásosság mérése: Módszertani tépelődések’ in A. MÁTÉ-TÓTH & M. JAHN, eds., Studia religiosa: Tanulmányok András Imre 70. születésnapjára (Szeged: Bába) 18–31. TOMKA, M. (1999) ‘A magyar vallási helyzet öt dimenziója’, Magyar Tudomány 5, 549–59. VÁRINÉ SZILÁGYI, I. (1987) Az ember, a világ és az értékek világa (Budapest: Gondolat).

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 25

European Journal of Mental Health 12 (2017) 25–40 DOI: 10.5708/EJMH.12.2017.1.2

LAURA SIMMONS, TIM JONES* & ELEANOR BRADLEY

REDUCING MENTAL HEALTH STIGMA The Relationship between Knowledge and Attitude Change (Received: 18 March 2016; accepted: 10 December 2016)

The impact of how knowledge can effect attitude change is important in order to understand the consequences for stigma. The relationship between increasing subject knowledge of mental health and attitude change was explored. The sample comprised 39 students (18 male and 21 female) from a university in the West Midlands. Participants’ level of knowledge and stigma were recorded through pre- and post-tests using the Mental Health Knowledge Schedule (MAKS), Community Attitudes toward the Mentally Ill (CAMI) and the Opinions about Mental Illness (OMI) scale. Information about mental illness was provided between conditions followed by a distractor task. Responses were calculated and combined to give an overall score. A sign test with continuity correction was used to see whether there was a difference in attitudes. The pre- and post-test conditions were scored. Results demonstrate a statistically significant median decrease in stigma in the post-test condition (p = 0.03). Therefore, this research provides support for the success of providing knowledge and information about mental illness in order to reduce stigma. Keywords: mental health, stigma, knowledge, students, attitudes Minderung des Stigmas bei mentalen Problemen: Der Zusammenhang zwischen Wissen und einer Änderung der Einstellung: Es ist wichtig zu verstehen, wie sich Wissen auf eine Änderung der Einstellung auswirken kann, um die Folgen in Bezug auf das Stigma absehen zu können. Es wurde der Zusammenhang zwischen dem zunehmenden Wissen des/der Betroffenen über mentale Gesundheit und einer Änderung der Einstellung gesucht. Die Stichprobe bestand aus 39 Studenten (18 männlichen und 21 weiblichen) einer Universität in den West Midlands. Der Kenntnisstand und das Ausmaß des Stigmas der Teilnehmer wurden jeweils vor und nach der Anwendung der Mental Health Knowledge Schedule (MAKS) sowie der Skalen Attitudes toward the Mentally Ill (CAMI) und Opinions about Mental Illness (OMI) festgehalten. Informationen über psychische Erkrankungen wurden unter Krankheitsbedingungen mitgeteilt, darauf folgte eine Ablenkungsaufgabe. Die Antworten wurden berechnet und kombiniert, um einen Gesamtwert zu erhalten. Es wurde ein Zeichentest mit Kontinuitätskorrektur angewendet, um festzustellen, ob Unterschiede *

Corresponding author: Tim Jones, School of Psychological, Social and Behavioural Sciences, Faculty of Health and Life Sciences, Coventry University, Priory Street, CV1 5FB, Coventry, United Kingdom; tim.jones@coventry.ac.uk.

02_Stigma_Junius 2017.05.24. 11:23 Page 26

L. SIMMONS, T. JONES & E. BRADLEY

hinsichtlich der Einstellung bestanden. Die Bedingungen vor und nach der Befragung wurden bewertet. Die Ergebnisse zeigen eine statistisch signifikante Verringerung des Medians für das Stigma nach dem Test (p = 0.03). Somit belegt diese Studie den Nutzen der Vermittlung von Wissen bei der Minderung des Stigmas. Schlüsselbegriffe: psychische Gesundheit, Stigma, Wissen, Studenten, Einstellungen

1. Background 1.1. What is Stigma? GOFFMAN (1963) was the first to propose the foundation of stigma, which provided the discipline of psychology with a basis of its nature and the consequences of engaging in this type of behaviour. As time progressed, the psychological repercussions of stigma were investigated, leading to a conclusion that suggests stigma: • Is a source of negative psychological distress (MAJOR & O’BRIEN 2005; QUINN & CHAUDOIR 2009). • Has social and political consequences for those who are subject to it (DOVIDO et al. 2000). • Has a potentially detrimental effect on individuals (WAHL 1999). Stigma is characterised as an experience or activity composed of rejection or disparagement that is formed by a judgment about a person or group with a particular difficulty (WEISS & RAMAKRISHNA 2006). Stigma is the consequence of loading negative connotations onto a particular situation or quality an individual may possess. Therefore, when the term stigma is used, it is referring to the negative attitudes an individual has towards an object or person (PETTY et al. 1997). MAJOR and O’BRIEN (2005) suggested that stigma is an evolutionary adaptation. Primarily it allows humans to circumvent negative aspects of group living, which empowers them to ostracise individuals who the group believe to possess certain negative characteristics. Psychological theory has proposed that stigma serves as a function to human behaviour indicating that individuals embrace certain attitudes for particular purposes (PERLOFF 2003). This has been demonstrated throughout research suggesting that stigma serves as an expressive or evaluative function in order to communicate emotions towards a group or an individual (HOSSEINZADEH & HOSSAIN 2011). Evidence suggests this occurs as part of an evolutionary adaptation, which argues that stigma serves as a protective factor within natural selection. 1.1.1. Stigma and Mental Health: A problem Research has indicated that stigma represents an enduring behaviour and MARTIN, LANG and OLAFSDOTTIR (2008) highlight particular concerns about the application of

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 27

REDUCING MENTAL HEALTH STIGMA

stigma to specific groups. They conclude that individuals who suffer from mental health difficulties are the most likely group to experience stigmatising attitudes from others. Indeed, CRISP, GELDER, MELTZER and ROWLANDS (2000) discovered prevalent beliefs amongst the general public including the following: • That people who suffer from mental illnesses are dangerous • That mental health difficulties are self-inflicted • That individuals with mental health difficulties are difficult to communicate with. This is reinforced and represented regularly in the media with popular television shows portraying 74 cases of mental health utilising derogatory terms, e.g. ‘psycho’ and ‘basket case’ (‘Soaps and dramas’ 2008). However, this piece of research is relatively outdated and the portrayal of mental health in the media may have changed over the last six years, although there is a lack of evidence to support this. Nevertheless, the majority of media negatively portrays an incorrect view of mental health, illness and disorders. Individuals who are subject to this media collect a variety of incorrect knowledge and information, which has an impact on the stigma they form. This is evident when examining the evolution of stigma. LAM and colleagues (2010) discovered that stigma fundamentally evolves from a culture’s pre-determined beliefs. Members of the public commonly acquire these misrepresented views from the media. The press is deemed highly responsible for many distorted beliefs surrounding mental health (CRISP et al. 2000). Broadcasting agencies are paramount in shaping opinions and beliefs (BAUN 2009) and they often depict substantial inaccuracies about illnesses (INELAND et al. 2008). Within this research, it is evident that the overall portrayal of mental health is negative within the media. Nevertheless, contemporary research has discovered that these mediums are making progress in portraying mental illness in a more positive manner. GOULDEN and colleagues (2011) discovered that between 1992 and 2008 there was a substantial decrease in negative articles on mental health within local newspapers. GOULDEN and colleagues (2011) reported an increase in newspaper stories outlining and describing psychiatric disorders and the treatment of mental illness (WHITLEY & BERRY 2013). There is evidence to suggest that the true reality of mental illness is not being portrayed in the 21st century. Research has established that 40% of the portrayals of mental health within the media remain negative (WHITLEY & BERRY 2013). Despite this, Substance Abuse and Mental Health Services Administration (SAMHSA), has recently praised the film-making industry of accurately and positively representing mental illness and disorders. Most recently The Perks of Being a Wallflower was commended for its sensitive approach to depression, suicide and anxiety (PACKARD 2005).

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 28

L. SIMMONS, T. JONES & E. BRADLEY

1.1.2. The Impact of Stigma on those with Severe and Enduring Mental Illness (SMI) Negative attitudes towards mental health have a succession of serious and enduring consequences on diagnosed individuals, which can resonate throughout all aspects of life (MILEVA et al. 2013). This is reflected within statistics, which demonstrate that individuals who experience stigma are at a greater risk of completing suicide than those who are not (POMPILI et al. 2003). Therefore, it is reasonably evident that negative attitudes towards mental health have a profound impact on life and well-being. With reference to the overall impact stigma has on an individual diagnosed with a mental health problem, CORRY (2008) reported that nine out of ten individuals who had experienced mental health stigma abstained from partaking in certain activities, e.g. shopping. Other research has suggested that 55% of patients, who had recently been discharged from a psychiatric hospital, felt that they were viewed differently as a consequence of negative stigma (BJORKMAN et al. 2007). It is evident that stigmatised attitudes do have a major impact on an individual’s life and well-being. 1.1.3. Knowledge and its Effect on Decreasing Stigma DIJKSTERHUIS AARTS, BARGH and VAN KNIPPENBERG (2000) discovered that there is a strong link between memory and stereotyping behaviours, therefore, it has been suggested that an inability to retain or recall information may lead to stereotypes being formed. For that reason, the information an individual perceives about mental health may have an impact on stigma. HÖGBERG, MAGNUSSON, LUTZEN and EWALDS-KÜST (2012) reported that educated individuals exhibited an increased level of positive attitudes towards mental illness, consequently, these individuals possessed fewer stigmas. Further evidence suggests that a lack of understanding in a subject area is likely to induce negative attitudes (GRIFFITH et al. 2010). When providing an educational intervention strategy explicitly targeting this, participants' knowledge increased, which led to positive attitudes being developed (GUSTAFFSON & BORGLIN 2013). Fundamentally, research has concentrated primarily on the formation of stigma being due to a lack of knowledge an individual possesses. The World Health Organization (2013) explicitly stated that negative attitudes are generated due to a lack of subject knowledge. On reflection, there is potential to suggest an individual, who has limited knowledge about mental illness, may acquire negative attitudes relating to this subject. Concerning the knowledge that is required to eradicate stigma, it has been suggested that declarative knowledge is the most appropriate (ANDERSON 1976). This type of knowledge is important when forming stigmatised attitudes as it suggests that what an individual sees and hears, they deem to be true. Therefore, this suggests that any positive information about mental health will be substantial enough to obtain a positive view of mental health and illness. This is relevant when exploring the media’s

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 29

REDUCING MENTAL HEALTH STIGMA

influence on mental health stigma. However, as previously discussed, the media predominantly display mental illness and treatment inaccurately. This inexactitude leads to individuals’ believing incorrect information, which further enhances stigma. Despite the research suggesting that knowledge is a key component within the formation of stigmatised attitudes, the motivation of those who engage in stigmatising behaviour should be taken into consideration. A moderately educated individual working as a bus driver may not have the same level of mental health knowledge as an individual who works as a receptionist for a psychiatric hospital (FABREGA 1991). It is clear that the motivations of these individuals described above will differ. This has an effect on the theory of determinism, which argues that an individual has a choice of whether or not to establish a stigmatised view of mental health. There is potential to suggest that individuals are choosing to engage in stigmatising behaviour, despite understanding its consequences. This is supported by research conducted by CRISP and colleagues (2000) who proposed that negative beliefs about mental health are held by a large number of people, regardless of the mental health knowledge they possess. This is a problem when researching mental health stigma, as attitudes can only be manipulated to a certain extent, and it is the individual’s personal responsibility to ultimately decide whether they express those attitudes or not. As demonstrated, the issue of determinism will be a crucial factor to consider throughout this research. In regard to the levels of knowledge the general population possess about mental health, MAHTO and colleagues (2009) reported that the student demographic were the most uninformed about mental health. COVARRUBIAS and MEEKYUNG (2011), suggest stigmatised mental health views (e.g. dangerousness and mental health defining an individual’s identity) in social work students resulted in an increase desire for social distance and restrictions (e.g. social contact), whilst CHANDRA and MINKOVITZ (2006) report an early onset of stigma in adolescents alongside gender differences. Males demonstrated less mental health knowledge and experience and a higher mental health stigma than females. Additionally, CHANDRA and MINKOVITZ (2007) argue mental health stigma arises in adolescence when young people experience unsatisfactory personal experiences with mental health services, and have poor mental health knowledge. This is likely therefore to transcend through adolescence and into student populations. Importantly, O’DRISCOLL and colleagues (2012) argue that few studies have explored the way in which children and adolescents are regarded by their peers, despite the wide reporting of mental health problems in children and adolescents. They suggest that little is known about the nature of stigmatisation by peers, and no published research has focussed on implicit attitudes and as such stigma is not well understood. Their research concludes that children and adolescents demonstrate stigmatising responses to peers with common mental health problems and the extent of stigmatisation depends on the type of mental health problem. Taken together, previous research demonstrates that children, adolescents and young adults (comprising the target population group in the current study) all hold stigmatised attitudes towards mental health and that mental health problems are

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 30

L. SIMMONS, T. JONES & E. BRADLEY

highly prevalent within this demographic. Previous research e.g. CHANDRA and MINKOVITZ (2006), and O’DRISCOLL and colleagues (2012) would suggest that stigmatised attitudes are exacerbated in young males, and that this is likely to be further impacted by poor experience of mental health services, family attitudes and lack of knowledge about mental health. Importantly, when considering metal health problems and stigmatised attitudes these are not treated homogeneously but are instead disaggregated by problem type. Students, however, are not the only group who lack mental health knowledge. WEBB, JACOBS-LAWSON and WADDELL (2009) proposed that older adults also held stigmatising attitudes, more specifically those related to the responsibility of mental health. The most prevalent belief about mental health among older adults was that individuals are accountable for their mental illness. Furthermore, SADIK, BRADLEY, AL-HASOON and JENKINS (2010) reported that in developing countries, although the aetiology of mental illness was understood, it was demonstrated that understanding the nature of mental illness is less prevalent, consequently resulting in negative attitudes and stigma. Nevertheless, individuals who are required to have a large amount of mental health knowledge such as general practitioners, continued to demonstrate negative stigma towards diagnosed patients (HANSSON et al. 2013). An explanation as to why those who lack subject knowledge have a greater and more general stigmatising attitude towards mental health may be because they have more contact with media platforms. In 2010, The Telegraph newspaper reported that young people spend 7 hours and 38 minutes in contact with the media, specifically the Internet (KHAN 2010). In comparison, adults spend 1.5 hours a day on the Internet (CHALABI 2013). MAHTO and colleagues (2009) suggested that the student population were the most appropriate group to educate about mental health, due to the influence of adolescents today on future generations (SAWYER et al. 2006). Secondly, more contemporary research also indicates that students are restricted in regard to mental health awareness within education, which in turn has a definite impact upon the individual’s knowledge (WATSON et al. 2004). Consequently, as the trend in research suggests, this lack of knowledge creates a greater negative perception on mental health, which leads to further stigma (BOWERS et al. 2013). 1.1.4. Overview Throughout the research, there has been sufficient evidence to suggest that a lower level of knowledge leads to a stigmatised attitude toward mental health. Taking this into consideration, this study will aim to explore whether lower levels of knowledge do have a profound impact on mental health stigma. Consequently, this study predicts that as students’ levels of knowledge about mental health increase, there will be a large decrease in the level of stigmatisation. Therefore, by providing students with knowledge about mental health and illness, it will consequently change their attitudes towards mental health.

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 31

REDUCING MENTAL HEALTH STIGMA

By researching this particular area of interest, the study will aim to provide more information for individuals who work within the area of mental health and supply them with a better understanding of how stigmas are acquired in relation to knowledge, specifically with reference to students. This particular population has been restricted within their exposure to mental health education, and, considering the resources available, a considerable amount of students are unable to recognise symptoms of severe and enduring mental illness (REAVLEY et al. 2012). In addition, the onset of mental illness is prevalent in those aged 24 and under, the majority of which are students in higher education (REAVLEY & JORM 2010). Consequently, the aforementioned reasons produce a sound motive for research, which aims to implicitly educate the participants into adopting a more positive attitude towards mental health. This study aims to research studentsâ&#x20AC;&#x2122; attitudes towards mental illness through the use of The Attitudes to Mental Illness (2011) questionnaire, which was utilised for this study. This is a well-validated questionnaire, which is routinely used within clinical practice. 2. Method 2.1. Design The study employed a pre-test/post-test quasi-experimental design with knowledge as the independent variable (IV) and level of stigma as the dependent variable (DV). Stigma was measured using the Attitudes to Severe Mental Illness (ASMI) scale, which incorporates the Mental Health Knowledge Schedule (MAKS), Community Attitudes toward the Mentally Ill (CAMI) and the Opinions about Mental Illness scale (OMI). All 39 participants took part in both the pre- and post-test conditions. 2.2. Participants A total of 52 participants were initially recruited, however, only 39 individuals (18 males and 21 females) completed the questionnaire in full. Participants comprised of undergraduate psychology students aged 16 to 34 (92.3% aged 16 to 24 and 7.7% aged 24 to 35) from a university located in the West Midlands. The sample size was estimated by conducting a priori analysis using G* Power software (ERDFELDER et al. 1996). This preliminary consideration of the sample took into account the direction of the hypothesis, the proposed significance and power levels. It was established that for a one-tailed hypothesis with a significance level of Îą = 0.05 and a power level of 0.95, this study required a minimum of 28 participants, which was obtained.

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 32

L. SIMMONS, T. JONES & E. BRADLEY

2.3. Materials The questionnaire includes three sections: demographics, the Mental Health Knowledge Schedule (MAKS), the Community Attitudes toward the Mentally Ill (CAMI) and the Opinions about Mental Illness Scale (OMI). Participants’ levels of knowledge were assessed by the Mental Health Knowledge Schedule (MAKS), which consists of 12 items (α = 0.65) including stigmarelated knowledge (employment, help seeking, recognition, support, treatment and recovery) as well as the diagnostic criteria for severe and enduring mental illness (Appendix F). Attitudes towards severe and enduring mental illness were assessed using the Community Attitudes toward the Mentally Ill (CAMI) and Opinions about Mental Illness Scale (OMI), a validated tool used for research in the UK and Canada (EVANSLACKO et al. 2013). This scale consists of 26 items (α = 0.87), measuring attitudes towards social debarment, compassion and understanding of support and treatment within the community (Appendix G). An overall knowledge and stigma score for each participant was collated for these sections of the questionnaire. Both the knowledge and attitude components were scored so that a higher score on each represented greater knowledge and lower negative attitudes. An excerpt about the classification and diagnosis of mental disorders and illness entitled Mental Health Problems (Mind 2011) was also provided to participants. A distractor task similar to the Brown-Peterson technique was utilised in the form of a clock face (Appendix I). This method was utilised in order to study the effects of knowledge on stigma over a short period of time and to prevent high levels of attrition (SIMKINS-BULLOCK et al. 1994). 2.4. Procedure The independent variable of knowledge was manipulated by providing participants with an extract describing some of the most commonly diagnosed mental illnesses as well as their treatment processes, which was acquired from Mind (2011). To counteract memorisation of this material, a distractor task following the pattern of the Brown-Peterson distractor paradigm was utilised (JOHNSON et al. 1998). For this study, participants were required to count backwards in threes, anti-clockwise from midnight, ending at 3 o’clock whilst observing the static clock face. Once these sections were completed, the participants were asked to repeat the MAKS and CAMI section of the questionnaire again, in order to establish a post-test measure.

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 33

REDUCING MENTAL HEALTH STIGMA

3. Results 39 participants took part in this study to understand whether increasing knowledge about mental health has an impact on attitudes towards mental illness. Data are medians unless otherwise declared. The participants’ level of knowledge reduced in the post-test condition (Mdn = 5.28) compared to the pre-test condition (Mdn = 9.43) with a median difference of 4.13. At the same time, the level of stigma in the pre-test condition (Mdn = 12) reduced compared to the post-test condition (Mdn = 14) with a median difference of –2. Out of the 39 participants who took part in the study, an increase in stigma levels were seen in 24 participants. There were 12 participants whose levels of stigma did not improve and 3 whose did not change. A sign test with continuity correction was utilised to compare the differences between stigma levels pre- and post-test. The analysis reported a statistically significant median decrease in stigma in the post-test condition, z = 1.83, p = 0.03, suggesting that subsequent to the study, participants had lower levels of stigma compared to the pre-test condition. This leads to the hypothesis – as students’ levels of knowledge about mental health increase, there will be a large decrease in the level of stigmatisation – being accepted. 4. Discussion Primarily, this study has given evidence in accordance with literature surrounding severe and enduring mental illness, demonstrating that mental health stigma is prominent within the student population (EISENBERG et al. 2009). This piece of research is distinctive to previous literature as it combines the construct of knowledge, which was not previously investigated. As a result, this study has provided an opportunity to understand how stigma can be eradicated, by recognising what information and knowledge individuals need to be provided with in order for stigma to be eliminated. The research findings are also paramount to students themselves, with previous research suggesting severe and enduring mental illness is not often recognised by students (REAVLEY et al. 2012), this study highlights a prominent feature within mental health education; providing knowledge to young people. This is particularly important with reference to the media influences young individuals are often subjected to (‘Soaps and dramas’ 2008; CRISP et al. 2000; INELAND et al. 2008), which increases the importance for accurate and frequent mental health education in order for negative attitudes to be counteracted. This study further supports and strengthens existing research on the impact of knowledge on stigmatised attitudes, which suggest that stigma develops due to a lack of knowledge (PINE 2012; The World Health Organization 2013). In particular, the study can deduce the pattern of attitudes students possess about mental illness. The majority of individuals who took part in this study expressed a negative and stigma-

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 34

L. SIMMONS, T. JONES & E. BRADLEY

tised attitude towards severe and enduring mental illness in the pre-test condition. This is contradictory in reference to the suggestions HÖGBERG, MAGNUSSON, LUTZEN and EWALDS-KÜST (2012) made about those who are in education, who demonstrate more positive attitudes towards those with severe and enduring mental illness. However, this confirms MAHTO and colleagues’ (2009) suggestion that students are the most misinformed population when it comes to mental health knowledge. Although this research does not provide a comparison to the general population, it can be proposed from the results that attitudes towards mental health consist of negative beliefs (BJORKMAN et al. 2007; WHITLEY & BERRY 2013). Despite the encouraging conclusions this research has produced, an element of the study is open to question. Primarily, how the level of knowledge reduced in the post-test compared to the pre-test. This suggests that individuals did not gain any knowledge due to reading the information from Mind (2011). Firstly, due to the lengthy and repetitive questionnaire provided to participants, this may have contributed to cognitive fatigue (MACMAHON et al. 2014), consequently individuals may have randomly selected their answers, resulting in a lower knowledge score being calculated. In addition, the length of time an individual was exposed to and the type of information about mental health should be considered. Within this study, participants were in contact with the excerpt from Mind (2011) for an unlimited period of time, which was not measured or recorded. Consequently, the research cannot draw conclusions as to whether some participants changed their level of knowledge because they read and digested the given knowledge more than other participants. Similarly, conclusions cannot be drawn that all participants read the knowledge given; some may have skipped this section without reading the information. Therefore, this study cannot accurately suggest that knowledge was a factor in changing and decreasing attitudes towards mental health. Further, a level of knowledge reduction in the post- compared to pre-test condition could be accounted for by a partial failure to attend to information since some individuals may read ‘mental health’ and reduce their level of attention as they believe they already have all of the information required to make a decision/perceive themselves to be in a pre-existing position of knowledge. A subsequent study could focus entirely on this to replicate and disaggregate this result. An eye tracking study for example would lend itself well to measuring attention duration and a pupilometer could measure cognitive load as an indicator of processing. As the study population were students, stigma is relatively prominent within this population (e.g. CHANDRA & MINKOVITZ 2006; 2007) despite the age group being high risk for mental health problems. Attending to, and assimilating, new information regarding mental health may place the individual at odds with their pre-existing beliefs and as such lead to a state of cognitive dissonance. One way of reducing potential dissonance is via explicit attention failure or through implicit processing of information but without demonstrating explicit acquisition of knowledge. Both are worthy of future exploration.

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 35

REDUCING MENTAL HEALTH STIGMA

An alternative explanation is that the medium used to reduce stigma should have been varied. Research by NGUYEN, CHEN and O’REILLY (2012) suggests faceto-face (direct) contact between pharmacy students and individuals with a mental health problem vs. film contact (indirect method) between the same populations, was significantly more successful in reducing mental health stigma. Future studies could focus on varying levels of direct and indirect contact to find a suitable medium for use with heterogeneous rather than specialist student populations. Furthermore, a question raised within this research is the difficulty of how to accurately measure stigmatising attitudes within psychological research. This research utilised the Community Attitudes toward the Mentally Ill (CAMI) and Opinions about Mental Illness Scale (OMI). Both of these scales were used within previous research, therefore the validity of each scale could be assumed (EVANS-LACKO et al. 2013). Concerns were raised about the internal consistency of the Mental Health Knowledge Schedule, which received a Cronbach’s alpha of 0.65, which is relatively low. However, KLINE (1999) suggested that differing alphas might be more appropriate depending on the type of questions being assessed for reliability. For research addressing psychological constructs, such as mental health and illness, the Cronbach’s alpha may measure below 0.7, which is acceptable as psychological constructs are diverse. As a result, the MAKS was still utilised within this study, despite its apparent low alpha level. Nevertheless, the importance of this type of research being conducted is paramount, especially when the impact of stigma on individuals with severe and enduring mental illness has been profoundly documented (POMPILI et al. 2003; BJORKMAN et al. 2007; CORRY 2008). This research has provided a basic foundation for further research to investigate the consequences of mental health education on students. One element has been demonstrated within the research by examining the way information about severe and enduring mental illness is disseminated. This study relied on participants reading and digesting information individually, although this study would have benefited from a combination and comparison of teaching the information to students, which could be an area for future research. Furthermore, it could be expected that students in tertiary education, who have a high level of education and therefore knowledge, would have lower levels of stigma. This notion is an area, which should be further addressed within the research, to identify the specific types of knowledge that contribute to the reduction in stigma. This would further positively impact the development of mental health education within schools and higher education institutions. However, in regard to the knowledge necessary for the education of mental health, the type of knowledge, which individuals require in preventing stigma has been evaluated throughout this study. A number of questions in the MAKS, CAMI and OMI scales have been subject to individual experience. Originally, ANDERSON (1976) proposed that declarative knowledge was crucial in regard to stigma, however, this study has discovered that there may be other types of knowledge involved.

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 36

L. SIMMONS, T. JONES & E. BRADLEY

When information is received, which in this case was through an excerpt from Mind (2011), individuals can relate to it, which translates to personal knowledge that they can identify with or empirical knowledge, which they may have seen and/or experienced. As a result, the knowledge they are provided with combines with their already existing experiences, some which may be conflicting. As a result, the strength of the information they are given depends upon the source it is derived from. Therefore, this study has ascertained that when mental health education is provided, existing experiences should be accounted for and the source of the information must be influential otherwise stigma will not be successfully eradicated. On reflection, the study could have adapted the way in which the knowledge section was provided to participants. Previous research suggested that the most effective time frame in which information is learnt and memorised is over a 9-week period (GRIFFITH et al. 2010). This study expected participants to complete the questionnaire and acquire knowledge of mental health in less than 20 minutes. By examining the time frame in which participants undertook the study, it is evident that a majority of the individuals completed the questionnaire at a fast pace and may not have provided accurate and true answers. This has an important influence on the stigma scores derived from participants as it could be suggested that if participants had accurately digested the information on severe and enduring mental illness, stigma scores could have been reduced further. However, research that instructs participants to learn knowledge over certain intervals of time is in possession of its own limitations. Firstly, there is the potential for high levels of attrition (GUSTAFFSON & BORGLIN 2013). This study eliminated selective attrition by including a distractor task, similar to the Brown-Peterson technique, rather than providing the questionnaire to participants at another point in time e.g. after a week. By eliminating attrition, this study can establish higher levels of validity. Secondly, it may not be appropriate for participants to be involved in a group-learning environment due to the possibility that they will communicate with one another. As a result of this, participantâ&#x20AC;&#x2122;s responses within the research may be influenced, therefore, to avoid this, individual sessions may be more appropriate. The research has demonstrated that it is possible to change attitudes that are related to mental health stigma in particular by modifying negative beliefs about mental illness and treatment. The research provides a basis for strategies that can be implemented to reduce mental health stigma. Educational programs for schools, universities and work places could be introduced in order to educate individuals on mental illness diagnosis and treatment. The research conducted provides a basis for this by presenting evidence in order for development and progress to be made on potential campaigns aimed at reducing stigma. Previous research has given evidence to suggest that in order to successfully decrease levels of stigma, a change in behaviour is also required (HAWKE et al. 2013). This study was not concerned with whether the behavioural aspects of an individual had changed. Therefore, they were not included within the research. Previous studies conducted into behaviour change suggested that it is a complex

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 37

REDUCING MENTAL HEALTH STIGMA

process that requires more than the alteration of attitudes towards mental illness (ROLLNICK et al. 2005). Research into the area of mental health stigma is regarded highly in the current psychological climate. This is due to the recognition that mental illness prevalence has increased within the student population (YOUNIS 2014). Furthermore, charities such as Time to Change have recently launched several campaigns, which target the issue of mental health stigma within the general public. Most commonly known is the ‘Time to Talk, Time to Change’ action, which encourages individuals with mental illness to speak openly to family and friends about their experiences with mental health. Through doing this, the charity is actively adapting the way in which people view mental health. Because this research contributed to the understanding of stigmatised attitudes, this will further support these campaigns, by providing them additional and worthy factors to consider. Overall, this research has contributed to the comprehensive understanding of mental illness stigma in relation to knowledge being a factor that can influence and bring about change. In addition, this study demonstrates the implications of this type of research not only for further advances in psychological research but for schools, universities and in the workplace that may implement strategies to reduce mental health stigma. In this instance, it has been suggested that knowledge plays a vital role in aiding this process. References ANDERSON, J.R. (1976) Language, memory and thought. Hillsdale, NJ: Erlbaum. BAUN, K. (2009) Stigma Matters: The Media’s Impact on Public Perceptions of Mental Illness; retrieved 04 April 2017 from www.ontario.cmha.ca/wp-content/files/2012/07/olm_stigma_ matters_200902.pdf; Ottawa Life Magazine (February), 31–33. BJORKMAN, T., B. SVENSSON & B. LUNDBERG (2007) ‘Experiences of Stigma among People with Severe Mental Illness: Reliability, Acceptability and Construct Validity of Two Stigma Scales Measuring Devaluation/Discrimination and Rejection Experiences’, Nordic Journal of Psychiatry 61, 332–38 (DOI: 10.1080/08039480701642961). CHALABI, M. (2013) ‘Do we Spend More Time Online That Watching the TV?’, retrieved 04 April 2017 from http://www.theguardian.com/politics/reality-check/2013/oct/08/spend-more-timeonline-or-watching-tv-internet; The Guardian (8 Oct 2013) np. CHANDRA, A. & C.S. MINKOVITZ (2006) ‘Stigma Starts Early: Gender Differences in Teen Willingness to Use Mental Health Services’, Journal of Adolescent Health 38, 754.e1–754.e8 (DOI: 10.1016/j.jadohealth.2005.08.011). CHANDRA, A. & C.S. MINKOVITZ (2007) ‘Factors that Influence Mental Health Stigma among 8th Grade Adolescents’, Journal of Youth and Adolescence 36, 763–74. CORRY, P. (2008) ‘Stigma Shout: Service User and Carer Experiences of Stigma and Discrimination’, Time to Change, retrieved 3 Feb 2014, from http://www.time-to-change.org.uk/files/ Stigma%20Shout.pdf. COVARRUBIAS, I. & H. MEEKYUNG (2011) ‘Mental Health Stigma about Serious Mental Illness among MSW Students: Social Contact and Attitude’, Social Work 56, 317–25. CRISP, A.H., M.G. GELDER, H.I.MELTZER & O.J. ROWLANDS (2000) ‘Stigmatisation of People with Mental Illness’, The British Journal of Psychiatry 177, 4–7 (DOI: 10.1192/bjp.177.1.4).

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 38

L. SIMMONS, T. JONES & E. BRADLEY

DIJKSTERHUIS, A., A. AARTS, J.A. BARGH & A. VAN KNIPPENBERG (2000) ‘On the Relationship between Associate Strength and Automatic Behaviour’, Journal of Experimental Social Psychology 36, 531–44 (DOI: 10.1006/jesp.2000.1427). DOVIDO, J.F., B. MAJOR & J. CROCKER (2000) ‘Stigma: Introduction and Overview’ in T.F. HEATHERTON, R.E. KLECK. & M.R. HEBL, eds., The Social Psychology of Stigma (New York: Guildford). EISENBERG, D., M.F. DOWNS, E. GOLBERSTEIN & K. ZIVIN (2009) ‘Stigma and Help Seeking for Mental Health among College Students’, Medical Care Research and Review 66, 522–41 (DOI: 10.1177/1077558709335173). ERDFELDER, E., F. FAUL & A. BUCHNER (1996) ‘GPOWER: A general Power Analysis Program’, Behavior Research Methods, Instruments, & Computers 28, 1–11. EVANS-LACKO, S., C. HENDERSON & G. THORNICROFT (2013) ‘Public Knowledge, Attitudes, and Behaviour Regarding People with Mental Illness in England 2009–2012’, The British Journal of Psychiatry 55, 51–57 (DOI: 10.1192/bjp.bp.112.112979). FABREGA, H. (1991) ‘Psychiatric Stigma in Non-Western Societies’, Comprehensive Psychiatry 32, 534–51. GOFFMAN, E. (1963) Stigma: Notes on the Management of Spoiled Identity (Englewood Cliffs, NJ: Prentice Hall). GOULDEN, R., E. CORKER, S. EVANS-LACKO, D. ROSE, G. THORNICROFT & C. HENDERSON (2011) ‘Newspaper Coverage of Mental Illness in the UK: 1992–2008’, BMC Public Health 11, 796–804 (DOI: 10.1186/1471-2458-11-796). GRIFFITH, J.D., C.L. HART & M. BRICKEL (2010) ‘Using Vignettes to Change Knowledge and Attitudes about Rape’, College Student Journal 44, 515–27. GUSTAFSSON, M. & G. BORGLIN (2013) ‘Can a Theory-Based Educational Intervention Change Nurses’ Knowledge and Attitudes Concerning Cancer Pain Management? A Quasi-Experimental Design’, BMC Health Services Research 13, 328–39 (DOI: 10.1186/1472-6963-13328). HANSSON, L., H. JORMFELDT, P. SVEDBERG & B. SVENSSON (2013) ‘Mental Health Professionals’ Attitudes towards People with Mental Illness: Do they Differ from Attitudes Held by People with Mental Illness?’ International Journal of Social Psychiatry 59, 48–54 (DOI: 10.1177/0020764011423176). HAWKE, L.D., S.D. PARIKH & E.E. MICHALAK (2013) ‘Stigma and Bipolar Disorder: A Review of the Literature’, Journal of Affective Disorders 150, 181–91 (DOI: 10.1016/j.jad.2013. 05.030). HÖGBERG, T., A. MAGNUSSON, K. LÜTZEN & B. EWALDS-KUST (2012) ‘Swedish Attitudes towards Persons with Mental Illness’, Nordic Journal of Psychiatry 66, 86–96. (DOI: 10.3109/ 08039488.2011.596947). HOSSEINZADEH, H. & S.Z. HOSSAIN (2011) ‘Functional Analysis of HIV/AIDS Stigma: Consensus or Divergence’, Health, Education and Behaviour 38, 584–95 (DOI: 10.1177/ 1090198110386180). INELAND, L., L. JACOBSSON, R.E. SALANDER & P. SJOLANDER (2008) ‘Attitudes towards Mental Disorders and Psychiatric Treatment Changes over Time in a Swedish Population’, Nordic Journal of Psychiatry 62, 192–97 (DOI: 10.1080/08039480801962855). JOHNSON, S.K., J. DELUCA, B.J. DIAMOND & B.H. NATELSON (1998) ‘Memory Dysfunction in Fatiguing Illnesses: Examining Interference and Distraction in Short-Term Memory’, Cognitive Neuropsychiatry 3, 269–85. KHAN, U. (2010) Children Spend 7 Hours 38 Minutes a Day Online’, retrieved 4 Apr 2017 from http://www.telegraph.co.uk/technology/news/7118354/Children-spend-7-hours-38-mins-aday-online.html; The Telegraph (1 Feb 2010) np.

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 39

REDUCING MENTAL HEALTH STIGMA

LAM, C.S., H.W.H. TSANG, P W. CORRIGAN, Y. LEE, B. ANGELL, K. SHI, S. JIN & J.E: LARSON (2010) ‘Chinese Lay Theories and Mental Illness Stigma: Implications for Research and Practices’, Journal of Rehabilitation 76, 35–40. MACMAHON, C., L. SCHÜCKER, N. HAGEMANN & B. STRAUSS (2014) ‘Cognitive Fatigue Effects on Physical Performance during Running’, Journal of Sport and Exercise Psychology 36, 375– 81 (DOI: 10.1123/jsep.2013-0249). MAHTO, R.K., P.K. VERMA, A.N. VERMA, A.R. SINGH, S. CHAUDHURY & K. SHANTNA (2009) ‘Students’ Perception about Mental Illness’, Industrial Psychiatry Journal 18, 92–96 (DOI: 10.4103/0972-6748.62267). MAJOR, B. & L.T. O’BRIEN (2005) ‘The Social Psychology of Stigma’, Annual Review of Psychology 56, 393–421. MARTIN, J.K., A. LANG & M.A. OLAFSDOTTIR (2008) Rethinking Theoretical Approaches to Stigma: A Framework Integrating Normative Influences of Stigma (FINIS)’, Social Science and Medicine 67, 431–40 (DOI: 10.1016/j.socscimed.2008.03.018). MILEVA, V.R., G.H. VÁZQUEZ & R. MILEV (2013) ‘Effects, Experiences, and Impact on Patients with Bipolar Disorder’, Journal of Neuropsychiatric Disease and Treatment 9, 31–40 (DOI: 10.2147/NDT.S38560). Mind (2011) Understanding mental health problems, retrieved 7 Feb 2014, from http://www. mind.org.uk/information-support/. NGUYEN, E., T.F. CHEN & C.L. O’REILLY (2012) ‘Evaluating the Impact of Direct and Indirect Contact on the Mental Health Stigma of Pharmacy Students’, Social Psychiatry and Psychiatric Epidemiology 47, 1087–98. O’DRISCOLL, C., C. HEARY, E. HENNESSY & L. MCKEAGUE (2012) ‘Explicit and Implicit Stigma towards Peers with Mental Health Problems in Childhood and Adolescence’, Journal of Child Psychology and Psychiatry 53, 1054–62. PACKARD, E. (2005) ‘Voice awards Honor Positive Portrayals of Mental Disorders’, Monitor on Psychology 36, 17–18. PERLOFF, R. (2003) The Dynamics of Persuasion: Communication and Attitudes in the 21st Century (3rd ed. Mahwah, NJ: Lawrence Erlbaum). PETTY, R.E., D.T. WEGENER & L.R. FABRIGAR (1997) ‘Attitudes and Attitude Change’, Annual Review of Psychology 48, 609–47 (DOI: 10.1146/annurev.psych.48.1.609). PINE, D. (2012) ‘Stigma Caused by a Lack of Information’, DNA Learning Center, retrieved 4 Feb 2014, from www.dnalc.org/view/2297-Stigma-Caused-by-a-Lack-of-Information. html. POMPILI, M., I. MANCINELLI & R. TATARELLI (2003) ‘Stigma as a Cause of Suicide’, British Journal of Psychiatry 183, 173–74 (DOI:10.1192/bjp.183.2.173-a). QUINN, D.M. & S.R. CHAUDOIR (2009) Living with a Concealable Stigmatized Identity: The Impact of Anticipated Stigma, Centrality, Salience and Cultural Stigma on Psychological Distress and Health’, Journal of Personality and Social Psychology 97, 634–51 (DOI: 10.1037/a0015815). REAVLEY, N.J. & A.F. JORM (2010) ‘Prevention and Early Intervention to Improve Mental Health in Higher Education Students: A Review’, Early Intervention in Psychiatry 4, 132–42 (DOI: 10.1111/j.1751-7893.2010.00167.x). REAVLEY, N.J., T.V. MCCANN & A.F. JORM (2012) ‘Mental Health Literacy in Higher Education Students’, Early Intervention in Psychiatry 6, 45–52 (DOI: 10.1111/j.1751-7893.2011. 00314.x). ROLLNICK, S., C.C. BUTLER, J. MCCAMBRIDGE, P. KINNERSLEY, G. ELWYN & K. RESNICOW (2005) ‘Consultations about Changing Behaviour’, British Medical Journal: Clinical Research 331, 961–63 (DOI:10.1136/bmj.331.7522.961).

EJMH 12:1, June 2017

02_Stigma_Junius 2017.05.24. 11:23 Page 40

L. SIMMONS, T. JONES & E. BRADLEY

SADIK, S., M. BRADLEY, S. AL-HASOON & R. JENKINS (2010) Public Perception of Mental Health in Iraq’, International Journal of Mental Health Systems 4, 26–37 (DOI: 10.1186/17524458-4-26). SAWYER, B.G., J. HUBBARD & L. RICE-SPEARMAN (2006) ‘Introducing Clinical Laboratory Science: CLS Students Help Shape the Future’, Clinical Laboratory Science: Journal of the American Society for Medical Technology 19, 206–13. SIMKINS-BULLOCK, J., G. BROWN, M. GREIFFENSTEIN, G. MALIK & J. MCGILLICUDDY (1994) ‘Neuropsychological Correlates of Short-Term Memory Distractor Tasks among Patients with Surgical Repair of Anterior Communicating Artery Aneurysms’, Neuropsychology 8, 246–54. ‘Soaps and dramas’ (2008) Time to Change, retrieved 3 Feb 2014, from www.time-to-change. org.uk/media-centre/media-advisory-service/soaps-dramas#research. WAHL, O.F. (1999) ‘Mental Health Consumer’s Experience of Stigma’, Schizophrenia Bulletin 25, 467–78. WATSON, A.C., E. OTEY, A.L. WESTBROOK, A. L. GARDNER, T.A. LAMB, P.W. CORRIGAN & W.S. FENTON (2004) ‘Changing Middle Schoolers’ Attitudes about Mental Illness through Education’, Schizophrenia Bulletin 30, 563–72. WEBB, A.K., J.M. JACOBS-LAWSON & E.L. WADDELL (2009) ‘Older Adults’ Perception of Mentally Ill Older Adults’, Aging and Mental Health 13, 838–46 (DOI: 10.1080/ 13607860903046586). WEISS, M. & J. RAMAKRISHNA (2006) ‘Stigma Interventions and Research for International Health’, The Lancet 367, 367–536 (DOI: 10.1016/S0140-6736(06)68189-0). WHITLEY, R. & S. BERRY (2013) ‘Trends in Newspaper Coverage of Mental Illness in Canada: 2005–2010’, Canadian Journal of Psychiatry 58, 107–12. World Health Organization (2013) ‘Stigma: A Major Barrier to Suicide Prevention’, International Association for Suicide Prevention, retrieved 3 April 2014 from http://iasp.info/ wspd/pdf/ 2013/2013_wspd_brochure.pdf. YOUNIS, J. (2014) ‘Mind Matters: The Mental Health Taboo at Universities’, retrieved 4 April 2017 from http://www.theguardian.com/education/2014/mar/31/mind-taboo-mental-health-university, The Guardian (31 Mar 2014) np.

EJMH 12:1, June 2017

03_Fertility_Desires_Junius 2017.05.23. 8:54 Page 41

European Journal of Mental Health 12 (2017) 41–52 DOI: 10.5708/EJMH.12.2017.1.3

CSABA BÁLITY* & BÁLINT DURÁCZKY

FERTILITY DESIRES OF ADOLESCENTS AND YOUNG ADULTS LIVING IN LARGE FAMILIES The Role of the Family of Origin and the Cultural Stereotypes** (Received: 1 October 2014; accepted: 30 September 2015) In our study, we aimed at examining the childbearing desires of adolescents and young adults living in Hungarian large families. Two different methods were used during the dyadic data analysis. On the one hand, correlation between the fertility desires of siblings, on the other hand, the absolute difference in the planned number of children was measured. The data indicate that in two out of the three dyads of siblings, created by the order of birth, significant correlation can be measured. Pseudo-dyads were created in order to test if the above mentioned parallel data can be explained by the similar socio-demographic characteristics of the sample families. The correlation disappeared in case of the randomly paired adolescents and young adults. All in all, family background is likely to have a more important impact on fertility desires of youngsters than similar social environment. Keywords: large family, dyad, fertility, family of origin Fertilitätswünsche von Heranwachsenden und jungen Erwachsenen, die in großen Familien leben: Die Rolle von Ursprungsfamilie und kulturellen Stereotypien: In unserer Studie wollten wir die Kinderwünsche von Heranwachsenden und jungen Erwachsenen erforschen, die in ungarischen großen Familien leben. Bei der dyadischen Datenanalyse haben wir zwei verschiedene Methoden angewandt. Zum einen haben wir die Korrelation zwischen den Kinderwünschen von Geschwistern und zum anderen die Unterschiede bezüglich der absoluten Zahl der geplanten Kinder ermittelt. Die Daten zeigen, dass bei zwei von drei Geschwisterdyaden, die nach der Reihenfolge der Geburt gebildet wurden, eine signifikante Korrelation besteht. Es wurden Pseudodyaden gebildet, um zu prüfen, ob sich die genannten Parallelen durch ähnliche soziodemographische Merkmale der Familien in der Stichprobe erklären lassen. Die Korrelation war bei einander zufällig zugeordneten Heranwachsenden und jungen Erwachsenen nicht mehr vorhanden. Insgesamt ist es wahrscheinlich, dass die Familienverhältnisse einen stärkeren Einfluss auf die Kinderwünsche junger Menschen haben als ein ähnliches soziales Umfeld. Schlüsselbegriffe: große Familie, Dyade, Fertilität, Ursprungsfamilie **

Corresponding author: Csaba Bálity, Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2., H-1125 Budapest, Hungary; bality@emk.sote.hu. Supported by the ÚNKP 16-3 New National Excellence Program of the Ministry of Human Capacities.

03_Fertility_Desires_Junius 2017.05.23. 8:54 Page 42

CS. BÁLITY & B. DURÁCZKY

1. Introduction When making our most important private decisions, besides personal motivations and individual peculiarities, the social environment we live in also plays an essential role. Morel raises the question ‘whether people act differently than it is expected from them by the norms of contemporary society and social environment with reason’ (MOREL 1989, 60; our trans.).1 The plans and desires about family life are influenced by many factors, which are in complicated interaction with each other. The present study aims at examining the childbearing desires of a special population, adolescents and young adults living in large families. Before reviewing the scholarly literature relevant to the topic, it should be noted that social sciences differentiate between fertility intentions and fertility desires. While the first term refers to childbearing within a relatively short time period (usually three years), the latter one indicates how many offspring the questioned person wants in his or her lifetime. Referring to completed fertilities, which are of high importance regarding demography, fertility intention allows the setting of more accurate prognoses; although the number of children eventually born almost always lags behind the desired number. Although measuring fertility intentions is usually preferred by demographers, the importance of fertility desires should not been ignored. Desires are always present in theories in a way that explains actual fertility behaviour. The Theory of reasoned action, one of the most often cited theories was elaborated by Icek AJZEN and Martin FISHBEIN (1980). A further developed version of this model, Theory of planned behaviour, was devised by the same author. (AJZEN 1991; FISHBEIN & AJZEN 2010). The fundamental concept of this theory is fertility intentions. These are affected by three main determinants: attitudes, subjective or perceived norms and perceived behavioural control. Although hypothetical variables, such as fertility desires and ideals, are not explicit components of the model, these are relevant background factors which influence intentions indirectly via attitudes, norms and perceived behavioural control. Some authors assume that the primary determinants of fertility are personal desires and preferences in the number of children. In his theoretical framework, Miller developed a motivational sequence that drives reproductive behaviour. According to Miller’s model, fertility behaviour is influenced by motivational factors. The name of this concept is Traits – Desires – Intentions – Behaviour (MILLER 2011). This three-step motivational sequence drives childbearing behaviour. During the first step of the process, these unconscious factors result in desires and ideals. Desires lead to fertility intentions and these intentions will be realised in childbearing. Positive and negative motivations should be distinguished, as the first facilitates childbearing, and the latter increases the likelihood of contraceptive behaviour.

Original text: ‘egyáltalán tesz-e az ember mást, cselekszik-e másként, mint ahogy kora társadalmában, szociális környezetében a normák előírásai szerint az embernek tenni illik’.

EJMH 12:1, June 2017

03_Fertility_Desires_Junius 2017.05.23. 8:54 Page 43

FERTILITY DESIRES OF ADOLESCENTS...

Fertility behaviour is influenced by macro and micro level factors. While the macro level refers to social entities and forces, at the micro level the individual’s free agency, personal decisions and his interactions with other individuals appear. To illustrate the relationship between the two levels, Coleman created a model, often referred to as Coleman’s boat, since the graphically illustrated process resembles a schematic boat (COLEMAN 1986; 1990; RAUB et al. 2011; MATSUEDA 2013). A macro-micro model of fertility and its determinants, which was inspired by Coleman’s model, was elaborated by LIEFBROER and his co-workers (2015). The decision making process with the consequence of a certain number of children is not only influenced by the macro level conditions, but also by the attitudes of family members, friends and peers. These factors can either negatively or positively motivate individuals or couples. Observing the processes at the social level, a traceable connection between views regarding the ideal number of children and actual fertility can be noticed. The norm of ideal family size plays an important role in the intention of wanting a child – especially when having one or more (SPÉDER & KAPITÁNY 2007). In Hungary, since the first half of the 70’s, there has been information on the transformation of norms regarding the number of children. Between 1974 and 2009, the average of ideal number of children decreased with almost one child, i.e. it declined in the same measure as actual fertility (S. MOLNÁR 2011). This can partly be explained by the fact that intentional childlessness, which was barely measurable in the 70’s, gained ground. In 2009, the number of those who preferred not to have children more than doubled compared to those who wished to have at least four. (3.3% and 1.5%) (S. MOLNÁR 2009) The appearance of the two-child model can be dated before the political transition. In the first sequence of data, the respondents’ absolute majority preferred three children, 25% more than those who preferred two children. This ratio substantially changed until 1987, when six out of ten respondents thought two children to be ideal (S. MOLNÁR 2011). For three and a half decades, the ratio of those preferring large families declined dramatically. While formerly seven out of ten people had wished to have three children, this ratio decreased to 16% until 2009 (S. MOLNÁR 2011). This is reflected in the answers given to the question whether those questioned consider it good if there are three children in a family. Within two decades, after the transition, the ratio of those who thought it to be good or very good declined to 20%. By comparing the considered ideal number of children with actual fertility, we see how much the norms regarding family size in a given society differ from the actual act. If the indicator, derived from the average ratio of the two, converges to one, it means that childbearing is realised in harmony with the accepted norms and ideals (GIRARD & ROUSSEL 1982). In Hungary, the ideal number of children decreased less than the actual fertility, so it can be stated that the gap between the value system and the actual act increased in the last decades. Among the older age groups, the ideal number of children is slightly higher than among the younger ones; however, as S. MOLNÁR (2011) indicates, the transition in public thinking has a stronger influence than ageing. Based on quasi-cohort analyses

EJMH 12:1, June 2017

03_Fertility_Desires_Junius 2017.05.23. 8:54 Page 44

CS. BÁLITY & B. DURÁCZKY

we see that respondents did not embrace their parents’ thinking, but they have adjusted their preferences to the transition of norms by modifying them downwards. It should be mentioned that the desired number of children is not always stable; due to the effects of changes in circumstances, those involved often modify the desired number. In a panel study, LIEFBROER (2009) has examined how constant the desired number of children is. During the 18 years, the participants were asked six times and it was found that the plans changed by the ageing of the respondents, the average desired number of children decreased from 2.42 (women) and 2.3 (men) to two. RAY and co-workers (2016) found that the personal ideal number of children was stable for about 70% of women, and the remaining 30% were equally likely to decrease or increase the desired number of children in the examined period. The majority of changes can be explained by a change of partner, studies or carrier. If a woman delays giving birth to her 30s it becomes more likely that she will plan less children. It is generally true that discrepancy among individuals also grows with age; in this respect young age groups are the most homogeneous. According to LIEFBROER (2009), less than half of those questioned have reached the desired number of children. The rate of those who had more children was below 15%, while 44% of women and 37% of men had fewer offspring. Those who cohabit without marriage wish to have fewer children than those who are married and the plans of married couples are the most stable, they seldom change their plans. The family of childhood is of high importance among the factors that affect the preferences about having children. The study of intergenerational transmission in the research of the connections between the values of the family of origin and the attitudes towards family life has a history of a hundred years (PEARSON et al. 1899), the connection between the fertility of parents and their children, and the similarity in the planned number of children have been proved by several researches (JENNINGS & LESLIE 2013; BRAS et al. 2013; RIJKEN & LIEFBROER 2009; BERNARDI 2016). Empirical studies that focus on the effect of the family of origin on fertility found positive correlation between the number of children of successive generations in the same family as well as the age of mothers and daughters entering into parenthood (MANLOVE 1997; BARBER 2000). Mothers’ preferences also have a strong and proximate effect on their children’s behaviour (AXINN et al. 1994). This correlation is usually explained by the transmission of values, preferences and socialisation (AXINN & THORNTON 1993; BERNARDI 2013). The correlation between the number of siblings and that of own offspring has also been proved by researches (SOLAZ & BEAUJOUAN 2014). The influence of the parental home on shaping the behaviour of children is known for decades (THORTON 1980). Far less research has been carried out that concentrated on the correlation of the fertility of siblings than on that of successive generations. Some studies pointed out that siblings have an effect not only on the timing of childbearing (LYNGSTAD & PRSKAWETZ 2010), but also on the success of adult family life and the likeliness of divorce (BOBBIT-ZEHER et al. 2016). The similitude between the values and behaviour of siblings cannot only be explained by the effect of the family. The common home and the same social status

EJMH 12:1, June 2017

03_Fertility_Desires_Junius 2017.05.23. 8:54 Page 45

FERTILITY DESIRES OF ADOLESCENTS...

make the similarity of values very likely per se. The expression of stereotype accuracy first appeared in literature in the middle of the previous century to explain the similarity in the values of those living in identical cultural and normative environments (CRONBACH 1955). Since then, several researchers have tried to measure it. Considerable differences can be shown regarding both the term (stereotype accuracy, cultural stereotype, shared cultural values, zeitgeist) and the methodology (OKAGAKI & BEVIS 1999; GLASS & POLISAR 1987; ROHAN & ZANNA 1996; KNAFO & SCHWARTZ 2003; BOEHNKE 2001). The present study aims at examining whether significant correlation can be shown between the fertility desires of siblings living in the same household, in a group which is homogeneous regarding the variables relevant to the attitudes towards having children. Provided that a correlation can be shown between the preferences in the number of children of siblings, the question arises whether this can be explained by the similarity of the families questioned or the correlation is rather in connection with the characteristics of the family of origin. 2. Sample and methods During our own data collection, we questioned 570 adolescents and young adults between ages 15–29 who live with their parents in large families about their future plans regarding the number of children they wish to have during their life. The number of cases in the three sub-samples of the siblings were 322, 166 and 82. The main focus was on the value system of those living in large families. In order to familiarise ourselves with that value system, the question regarding fertility desires is a more appropriate tool. The question was the following: ‘How many children do you want in your entire life?’ The families involved were chosen from the members of the National Association of Large Families with probability sampling. A family raising or having raised at least three children can become a member of the Association. Three forth of the sample families are intact families, 87% of them are with two parents. Half of the respondents are youngsters between the age of 15 and 19, 36% are between 20 and 24, and 14% between 25 and 29. When questioned, half of the respondents claimed to have a vocational degree, four out of ten people had a matura examination, and 11% had a university degree. 54% of those questioned had two siblings, 27% had three, while every fifth participant had more than three. When sampling, a maximum of three youngsters being 15 years of age or older were asked per family. (Also in the case of families with more children belonging to this age group.) Couple-centred methods were used to measure the similarity between 2

The variable-centred methods would have only been suitable for measuring the correlation between the number of children of the three sub-samples (oldest, middle and youngest child). Thus, this would have been competent to describe the samples, not the dyads.

EJMH 12:1, June 2017

03_Fertility_Desires_Junius 2017.05.23. 8:54 Page 46

CS. BÁLITY & B. DURÁCZKY

siblings (KENNY et al. 2006).2 The method we used analyses the similarity of the answers of real siblings. To measure the correlation between siblings, we used Kendall’s tau-b coefficient. Pseudo-dyads were created to measure cultural stereotypes. In case of the pseudo-dyads, in accordance with Little and Rubin, we counted the rates five times and used their mean. (LITTLE & RUBIN 1987) During previous observations, measuring absolute difference scores proved to be more effective than ordinary correlations (ROEST et al. 2009), so we used both methods. 3. Results In case of the question regarding fertility desires, there were only five among the 570 respondents who do not wish to have any offspring in their current life stage. Although their opinion might change in the future, it should be mentioned that in modern society intentionally chosen childlessness is gaining more ground. In our sample, this ratio remains below 1%, which is significantly lower compared to the national data of Hungarian Youth 2012 (MAKAY 2013). The proportion of those who do not desire any children is of the same proportion as that of those who want more than five children. The popularity of the two-child family model, characteristic of modern societies, can also be detected among those raised in a large family; half of the respondents claimed that they wanted two children. The ratio of those, with a large family background, who plan only one child is 12%. Every third child living in a large family plans to have a large family as well. 27% plan to have three children, but 6% want four children, 2% five and every 100th child wishes to have more than five offspring. The respondents’ gender does not significantly influence the planned number of children; men wish to have slightly more offspring, but the difference is only three hundredth. The average planned number of children was 1.7. (The standard deviation was 0.958 among men and 0.911 among women.) If we examine the adolescents and young adults between 15–29 by age groups, it can be stated that the youngest (between 15–19) plan to have the most children, 2.45 on average (SD = 1.088). In the age group of 20–24, the average is slightly lower, 2.32 (SD = 0.967), while in the age group of 25–29 it further decreases, 2.17 (SD = 0.806). If we include birth order while analysing adolescents from large families, it can be seen, that fourth born children plan to have the most offspring (3.09 SD = 1.998). However, we should be careful while interpreting this information since the number decreases dramatically from children who were born third or later. Regarding the three oldest children, there is no significant difference in numbers (first 2.32; SD = 0.960; second 2.31; SD = 0.990; third 2.36; SD = 0.807), so it can be stated that birth order does not have a significant influence on the respondents’ wished number of children. It is remarkable that adolescents and young adults living in large families desire significantly more offspring than their peers (MAKAY 2013).

EJMH 12:1, June 2017

03_Fertility_Desires_Junius 2017.05.23. 8:54 Page 47

FERTILITY DESIRES OF ADOLESCENTS...

3.1. The fertility plans of siblings The greatest similarity was found between the plans of the first and the second child (Table 1). The ratio of those sibling dyads where both members of the dyad wanted the same number of children exceeded 45%. The ratio was similar by siblings (43.9%) where one member of the dyad wishes to have one child more than his or her sibling. The difference was two by 9.3%, while in 1.4% of the cases the two siblings’ plans differed significantly (±3 or more). Among siblings this was the only pairing where we found the highest ratio of dyads where both siblings want to have the same number of children. In case of dyads formed by the first and third born child those pairs were in a majority where one of the siblings wants to have one offspring more than his or her sibling (53.2%). The ratio is also relatively high among first and third born children where the plans are the same (39.1%). Only a few pairs of siblings were found where the difference between the planned number of children was two (4.6%) or more (3.1%). In case of dyads formed from the second and third born children the highest ratio is by pairs where the difference between the siblings’ planned number of offspring is more than one. In 14% this number is two, while in 1.6% it is three or more. Similar to the pairs of the first and third born children the biggest group of dyads among the pairings of second and third born children is where the difference is one (43.8%). Only slightly does the ratio of those second and third born siblings who want to have the same number of children lag behind. It is detectable that the desired number of children of siblings from the same family is similar and there is a significant measurable correlation. However, the question whether this similarity derives from the family of origin’s attributes or from the unified value system that characterises the population of large families, due to which the sample is homogeneous – which fact would explain the measured connection by the dyads – cannot be answered clearly. In order to verify this, random dyads were created from the three subsamples (first, second and third born children). Similar to the siblings, we calculated the pseudo-dyads’ values of absolute differences. In case of the latter, there were slightly less instances where both members of the dyad planned the same number of children. The highest ratio, where there was no difference between the two members, was in the pseudo-dyads formed from first and second born children; however, the ratio of such pairs still slightly exceeded 36%. In case of all three pairings, the highest ratio was there where the difference of the two values was one. Regarding pseudo-dyads formed from first-third and secondthird born children, these were in absolute majority. In contrast to the sibling dyads, the ratio of those pairs was significantly higher where the planned number of offspring’s difference reached, or even exceeded, two. Then, during the analysis, we were not only interested in how large the difference between the planned numbers of offspring among siblings is, but also whether there is a verifiable correlation among sibling-dyads. In order to measure this we counted with the Kendall correlation (Table 2). Calculating with a 10% p-value, in all three types of

EJMH 12:1, June 2017

03_Fertility_Desires_Junius 2017.05.23. 8:54 Page 48

CS. BÁLITY & B. DURÁCZKY

dyads we measured a significant correlation, but with the exception of the second and third born children dyads, the connection was significant even on the generally accepted five-percent level. We measured the highest tau-b value (0.381; p = 0.000) by the dyads of the first and second born children. The value of coefficient (0.275; p = 0.014) was slightly lower by the first and third born children dyads. The weakest correlation was in the case of second and third born children (0.195; p = 0.079). We also examined the Kendall’s correlation between the desired number of children of randomly paired adolescents and young adults. We did not find a significant correlation by any of the pairs; in none of the cases did the tau-b value reach 0.1. By dyads, formed from the second and third born children, the coefficient took a negative value (–0.059). In case of the first and third born children pseudo-dyads, the pvalue exceeded 0.9; i.e., the two values are entirely independent of each other. The strongest correlation, by siblings, was measured between the first and second born children. While in the case of siblings the p-value was 0.000, by pseudo-dyads, formed from first and second born children, it was 0.261. All in all, it can be stated that in the case of pseudo-dyads, created by a random selection of the sample, correlation cannot be verified. 4. Conclusion Social sciences, for a long time, have been paying careful attention to the analysis of those factors that have an effect on childbearing plans and, eventually, on fertility. It is easy to see that individuals’ decisions and preferences are influenced by processes on the macro level and even more so by parental models, values and attitudes of nuclear and more extended family members. A large number of studies within this topic deal only in part (also due to methodological reasons) or not at all with the effects of the family of origin, as a small community, on the individual plans and value systems. Throughout our research we aspired to examine the effects of social factors and that of the close family. In order to be able to do that we used a sample taken from a special population that received less attention than actually deserved, the circle of large families. While examining the correlation between the planned numbers of children of siblings who live in the same family, we stated that in the majority of the cases correlation is statistically verifiable. However, its strength varies from dyad to dyad. From this it can be concluded that it is not just the family of origin’s characteristics that have an influence on the fertility desires but the position within the family due to birth order, as well. In order to test whether the measured significant correlation can only be explained by the similarity of the examined families, or not, we created random dyads from three subsamples based on birth order. The p value was not only higher than 0.05, but in some cases it almost reached one, which would refer to a random distribution. The fact that the similarity between the members of the dyads disappeared when we paired

EJMH 12:1, June 2017

03_Fertility_Desires_Junius 2017.05.23. 8:54 Page 49

FERTILITY DESIRES OF ADOLESCENTS...

respondents randomly shows that the role of the shared cultural values, or, in other words, the role of cultural stereotypes cannot be justified statistically. We got similar results when analysing the absolute difference of the planned number of children. Although the ratio of siblings who plan to have exactly the same number of children does not reach absolute majority by any of the dyads, it can be clearly seen, that there are only relatively few families where the difference among the plans of siblings is significant. A key limitation of this research is that the data are only representative regarding the National Association of Large Families, thus inference can only be drawn very prudentially. The member families of NOE differ significantly from other Hungarian large families in term of residence and the education of the parents. Families living in Budapest and other major cities are overrepresented in our sample. The proportion of respondents with a university degree is also above the national average. When sampling, we asked only a maximum of three youngsters per family, so it cannot be excluded that there might be a difference in the planned number of children of those living in households of different sizes. The number of samples did not allow us to analyse the dyads separately according to the size of the family, but no statistically significant connection between the family members living in the household and the desired number of children was measured. As a conclusion, we can say that there are significant differences among large families, and they cannot be considered as one homogeneous group. In order to explore the peculiarities that explain the individual differences and the small differences of similarities among siblings, further research is needed. Table 1 The distribution of the Sibling- and the Pseudo-dyads based on the absolute difference of the desired number of children of the members (%) Dyads

Same No.

Âą1

Âą2

Âą 3 or more

SIBLING DYADS First-Second

45.4

43.9

9.3

1.4

First-Third

39.1

53.2

4.6

3.1

Second-Third

40.6

43.8

14.0

1.6

PSEUDO-DYADS First-Second

36.2

43.9

17.1

2.8

First-Third

32.8

50.8

12.0

4.4

Second-Third

25.8

54.6

13.6

6.0

EJMH 12:1, June 2017

03_Fertility_Desires_Junius 2017.05.23. 8:54 Page 50

CS. BÁLITY & B. DURÁCZKY Table 2 The coefficients and significance values of tau-b Kendall correlation between the desired numbers of children of the dyad members First born child tb

sig.

Second born child tb

Third born child

sig.

0.000

0.275

0.014

0.195

n.s

SYBLING DYADS –

First born child

0.381

Second born child

0.381

0.000

Third born child

0.275

0.014

– 0.195

n.s

–

LARGE FAMILY PSEUDO-DYADS –

First born child

0.083

Second born child

0.083

n.s

Third born child

0.010

n.s

n.s –

–0.059

n.s

0.010

n.s

–0.059

n.s –

References AXINN, W.G. & A. THORNTON (1993) ‘Mothers, Children, and Cohabitation: The Intergenerational Effects of Attitudes and Behavior’, American Sociological Review 58, 233–46. AXINN, W.G., M.E. LARKBERG & A. THORNTON (1994) ‘Family Influences on Family Size Preferences’, Demography 31,65–79. AJZEN, I. & M. FISHBEIN (1980) Understanding Attitudes and Predicting Social Behavior (Englewood Cliffs, NJ: Prentice Hall). AJZEN, I. (1991) ‘The Theory of Planned Behavior’, Organizational Behavior and Human Decision Processes 50, 179–211. BARBER, J. (2000) ‘Intergenerational Influences on the Entry into Parenthood: Mothers’ Preferences for Family and Nonfamily Behavior’, Social Forces 79, 319–348. BERNARDI, L. (2013) ‘From Mothers to Daughters: Intergenerational Transmission of Family Norms’ in A.L. ELLINGSAETER, A-M. JENSEN & M. LIE, eds., The Social Meaning of Children (London: Routledge) 153–69. BERNARDI, L. (2016) ‘The Intergenerational Transmission of Fertility’ in R. SCOTT, M.C. BUCHMANN & S.M. KOSSLYN, eds., Emerging Trends in the Social and Behavioral Sciences: An Interdisciplinary, Searchable, and Linkable Resource (New York: Wiley) 1–16. BOBBIT-ZEHER, D., D.B DOWNEY & J. MERRY (2016) ‘Number of Siblings During Childhood and the Likelihood of Divorce in Adulthood’, Journal of Family Issues 37, 2075–94. BOEHNKE, K. (2001) ‘Parent-Offspring Value Transmission in a Societal Context’, Journal of Cross Cultural Psychology 32, 241–55.

EJMH 12:1, June 2017

03_Fertility_Desires_Junius 2017.05.23. 8:54 Page 51

FERTILITY DESIRES OF ADOLESCENTS...

BRAS, H., J. VAN BAVEL & K. MANDEMAKERS (2013) ‘Unravelling the Intergenerational Transmission of Fertility: Genetic and Shared-Environment Effects during the Demographic Transition in the Netherlands, 1810–1910’, The History of the Family 18, 116–34. COLEMAN, J.S. (1986) ‘Micro Foundations and Macro Social Theory’ in S. LINDBERG, J.S. COLEMAN & S. NOWAK, eds., Approaches to Social Theory (New York : Russell Sage) 345–63. COLEMAN, J.S. (1990) ‘Foundations of Social Theory’ (Cambridge, MA : Belknap Press of Harvard UP). CRONBACH, L.J. (1955) ‘Processes Affecting Scores on “Understanding Of Others” and “Assumed Similarity” ’, Psychological Bulletin 52, 177–93. FISHBEIN, M. & I. AJZEN (2010) ‘Predicting and Changing Behavior: The Reasoned Action Approach’ (New York: Psychology). GIRARD, A. & L. ROUSSEL (1982) ‘Ideal Family Size: Fertility and Population Policy in Western Europe’, Population and Developmental Review 82, 323–45. GLASS, J. & D. POLISAR (1987) ‘A Method and Metric for Assessing Similarity among Dyads’, Journal of Marriage and the Family 49, 663–68. JENNINGS, J.A. & P.W. LESLIE (2013) ‘Differences in Intergenerational Fertility Associations by Sex and Race in Saba, Dutch Caribbean, 1876–2004’, The History of the Family 18, 135–53. KENNY, D.A., D.A. KASHY & W.L. COOK (2006) Dyadic Data Analysis (New York: Guilford). KNAFO, A. & S.H. SCHWARTZ (2003) ‘Parenting and Adolescents’ Accuracy in Perceiving Parental Values’, Child Development 74, 595–611. LIEFBROER, A. (2009) ‘Changes in Family Size Intentions across Young Adulthood: A Life-Course Perspective’, European Journal of Population 25, 363–86. LIEFBROER, A.C., J.E. KLOBAS, D. PHILIPOV & I. AJZEN (2015) ‘Reproductive Decision-Making in a Macro- Micro Perspective: A Conceptual Framework’ in D. PHILIPOV, A.C. LIEFBROER & J.E. KLOBAS, eds, Reproductive Decision-Making in a Macro-Micro Perspective (New York: Springer). LITTLE, R.J. & D.B. RUBIN (1987) Statistical Analysis with Missing Data. (New York: Wiley). LYNGSTAD, T.H. & A. PRSKAWETZ (2010) ‘Do Siblings’ Fertility Decisions Influence Each Other?’ Demography 47, 923–34. MAKAY, Zs. (2013) ‘Párkapcsolati magatartás és családalapítás a fiatalok körében’ in L. SZÉKELY, ed., Magyar Ifjúság 2012 (Budapest: Kutatópont). MANLOVE, J. (1997) ‘Early Motherhood in an Intergenerational Perspective: The Experiences of a British Cohort’, Journal of Marriage and Family 59, 263–79. MATSUEDA, R.L. (2013) ‘Rational Choice Research in Criminology: A Multi-Level Framework’ in R. WITTEK, T.A.B. SNIJDERS & V. NEE, eds., The Handbook of Rational Choice Social Research (Stanford, CA: Stanford UP) 283–321. MILLER, W.B. (2011) ‘Differences between Fertility Desires and Intentions: Implications for Theory, Research and Policy’, Vienna Yearbook of Population Research 2011 9, 75–98. MOREL, Gy. (1989) Szociológia (Vienna: OMC). OKAGAKI, L. & C. BEVIS (1999) ‘Transmission of Religious Values: Relations between Parents’ and Daughters’ Beliefs’, Journal of Genetic Psychology 160, 303–18. PEARSON, K., A. LEE & L. BRAMLEY-MOORE (1899) ‘Mathematical Contributions to the Theory of Evolution. VI. Genetic (Reproductive) Selection: Inheritance of Fertility in Man, and of Fecundity in Thoroughbred Racehorses’ Philosophical Transactions of the Royal Society of London. Series A, Containing Papers of a Math. or Phys. Character (1896-1934), 192, 257– 330 (DOI: 10.1098/rsta.1899.0006). RAUB, W., V. BUSKENS &M. VAN ASSEN (2011) ’Micro-Macro Links and Microfoundations in Sociology’, The Journal of Mathematical Sociology 35, 1–25 (DOI: 10.1080/0022250X. 2010.532263).

EJMH 12:1, June 2017

03_Fertility_Desires_Junius 2017.05.23. 8:54 Page 52

CS. BÁLITY & B. DURÁCZKY

RAY, C., S. HARCEY & S. TIEMEYER (2016) ‘What’s Ideal got to do with it? Stability and Change in Ideal Number of Children’, Lecture at the European Population Conference 2016, Mainz, Germany retrieved 20 March 2017 from http://epc2016.princeton.edu/abstracts/161106. RIJKEN, A.J. & A.C. LIEFBROER (2009) ‘Influences of the Family of Origin on the Timing and Quantum of Fertility in the Netherlands’, Population Studies 63, 71–85. ROEST, A.M., J.S. DUBAS, J.R.M. GERRIS & R.C.M. ENGELS (2009) ‘Value Similarities among Fathers, Mothers, and Adolescents and the Role of a Cultural Stereotype: Different Measurement Strategies Reconsidered’, Journal of Research on Adolescence 19, 812–33. ROHAN, M.J. & M.P. ZANNA, (1996) ‘Value Transmission in Families’ in C. SELIGMAN, J.M. OLSON & M.P. ZANNA, eds., The Psychology of Values: The Ontario Symposium on Personality and Social Psychology, 8 vols. (Mahwah, NJ: Erlbaum) 8:253–76. S. MOLNÁR, E. (2009) ‘A gyermekszám-preferenciák alakulása Magyarországon az elmúlt évtizedekben’, Demográfia 52, 283–312. S. MOLNÁR, E. (2011) ‘A közvélemény gyerekszám-preferenciáinak alakulása Magyarországon az elmúlt évtizedekben’ in T. PONGRÁCZ, ed., A családi értékek és a demográfiai magatartás változásai (Budapest: KSH Népességtudományi Kutatóintézet) 69–94. SOLAZ, A. & E. BEAUJOUAN (2014) ‘Is Fertility Still Correlated to the Number of Siblings? A Cross-Generational Study Including Half Siblings’ Lecture at the European Population Conference 2014, Budapest, Hungary, retrieved 20 Mar 2017 from http://epc2014.princeton. edu/papers/140152. SPÉDER, Zs. & B. KAPITÁNY (2007) ‘Gyermekek – vágyak és tények. Dinamikus termékenységi elemzések’ (Budapest: KSH Népességtudományi Kutatóintézet). THORTON, A. (1980) ‘The Influence of First Generation Fertility and Economic Status on Second Generation Fertility’, Population and Environment 3, 51–72.

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 53

European Journal of Mental Health 12 (2017) 53–72 DOI: 10.5708/EJMH.12.2017.1.4

ANSON AU*

THE SOCIOLOGICAL STUDY OF STRESS An Analysis and Critique of the Stress Process Model** (Received: 26 May 2016; accepted: 10 December 2016)

The stress process model in the sociological study of stress has changed over the thirty years of its use, developed continually to reflect changes in society and to include intellectual refinement. This paper represents a review that aims to do the same, filling the gaps in the original model with the inclusion of major developments in its structure and new social dimensions. An examination of the model’s key components reveals: its causes and manifestations, the intervention of resources that moderate its effects, and its consequences on an individual in terms of mental health and social adversities. In visitation of the dynamics of the stress process, I present a critical analysis that involves an investigation of the findings of research literature while considering recent trends, including the decline of the nuclear family and the influence of non-Western cultures among immigrants and minority groups. Thus, asserted on the case that the considerations undertaken by literature are again at a point requiring intellectual reform, this critique endeavours to articulate an updated, foundational version of the original model and to offer appraisals that could lend themselves as points for further development and study. Keywords: stress process, mental health, coping, review, sociology Die soziologische Untersuchung von Stress: Eine Analyse und Kritik des Stressprozessmodells: Das Stressprozessmodell für die soziologische Untersuchung von Stress hat sich in den 30 Jahren seiner Anwendung verändert und stetig weiterentwickelt, um den gesellschaftlichen Veränderungen Rechnung zu tragen und Verbesserungen zu integrieren. Dieser Beitrag ist eine Überarbeitung, die ebenfalls Lücken des Originalmodells füllen soll, indem wichtige Entwicklungen in seinem Aufbau berücksichtigt und neue gesellschaftliche Dimensionen eingearbeitet werden. Die Untersuchung der Hauptkomponenten des Modells zeigt seine Anliegen und Manifestationen, die Intervention von Ressourcen, die seine Auswirkungen mäßigen, und seine Folgen für das Individuum in Bezug auf psychische Gesundheit und gesellschaftliche Widrigkeiten. Anhand der Dynamik des Stressprozesses nehme ich eine kritische Analyse vor, die auch die Untersuchung der Erkenntnisse der Forschungsliteratur umfasst, wobei gleichzeitig aktuelle Trends, darunter der Nie**

Anson Au, LSE Health & Social Care and Department of Methodology, London School of Economics and Political Science, Houghton Street, WC2A 2AE, London, United Kingdom; anson.au@alumni.lse.ac.uk. The author is grateful to Professor Scott Schieman for his insightful comments and critiques.

04_Stress_Process_Junius 2017.05.24. 11:27 Page 54

A. AU

dergang der Kernfamilie und der Einfluss nichtwestlicher Kulturen unter Immigranten und Minderheitengruppen, aufgezeigt werden. Somit versucht diese Kritik, da ich mich darin bestärkt sehe, dass die Erwägungen der Literatur erneut an den Punkt gelangt sind, wo sie einer Reform bedürfen, eine aktualisierte, grundlegende Version des Originalmodells zu erarbeiten und Bewertungen anzubieten, die als Ausgangspunkte für weitere Entwicklungen und Studien geeignet sein können. Schlüsselbegriffe: Stressprozess, psychische Gesundheit, Bewältigung, Überarbeitung, Soziologie

1. Introduction Every individual is inevitably immersed in a social environment comprised of his or her memberships in a plethora of different social settings that require interaction with its operations, such as family, work, friends, etc. Stress, therefore, occurs in an instance where the relationship between an individual and his or her environment suffers from a lack of congruity, defined by ANESHENSEL (1996) as a state of arousal resulting from the presence of socio-environmental demands that tax the ordinary adaptive capacity of the individual or from the absence of means to attain soughtafter ends (ANESHENSEL 1992). Thus, as PEARLIN and BIERMAN (2013) observe, stress is not a fundamental characteristic of any number of conditions, but arises from dissonance between conditions and an individual’s ability to adapt to them. The stress process model is divided into origins, mediators, and manifestations whose understandings rely on that of social relationships (PEARLIN et al. 1981). This paper draws from prominent studies within the sociology of mental health to articulate the dynamics of the stress process in the construction of a sociological paradigm for understanding stress, at the same time critiquing its usage in the literature and highlighting gaps for future research. In doing so, this paper fundamentally attempts to reassemble the stress process model by integrating major developments in its structure since its original conception by PEARLIN and colleagues (1981). I review a collection of the most prominent articles that have theorised about the model in a way that adds to its structure, excluding the majority of articles that have simply applied (elements of) the model to case studies without attempting to reconceptualise it. What results is an exploration into the original model that expanded its conceptions of stressors – levels of stressors, role strains –, resources – the categories of social support –, and the effects of stressors – the call for multiple-outcome studies of antecedents of mental health problems. Throughout, the manuscript critiques elements of the model’s theoretical structure, and suggests areas for future research. Given the rise of mental health studies purporting to apply the stress process model, ensconced within the rise of the sociology of mental health, this manuscript offers a timely contribution to the literature by clearly articulating a more updated, foundational version of the model that includes key developments to its structure. It should be noted that, in the face of the tens of thousands of studies that reference

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 55

THE SOCIOLOGICAL STUDY OF STRESS

elements of the stress process model, my aim is not to build a conclusive profile on the model that includes all of these studies, but to provide a pedagogical tool for mental health researchers to better understand the foundational structure of the model in order to utilise it more completely and articulate deeper dimensions of mental health issues that extend from levels of stressors to multiple-outcomes. 2. Methodology and article selection In this article, I conducted a critical review, wherein I reviewed sociological studies on the theoretical structure of the stress process model. To this end, my data sources included computerised and manual searches of the literature on the topic. Studies were selected that evaluated the theoretical structure of the stress process model, excluding those predicated on ‘applications’ of the model. The massive (and growing) size of the literature on the stress process model indicates the popularity of its application as a theoretical tool, indicating that studies of the stress process model are being heavily structured by the stress process model itself (WHEATON 2010). That is, its ‘application’ has become a loanword for predicting or understanding observations of a study in terms of the model – essentially recognising elements of the stress process model (i.e. coping) in the observations. These trends most markedly appeared where the utility of the stress process for understanding stress in other disciplines was documented empirically, such as caregiving and family dynamics (PEARLIN et al. 1997), and, later, ‘the health sciences and other disciplines concerned with familybased care’ (AVISON et al 2010, vii). The exponential surge in research based on the stress process paradigm is visible in the sheer volume of articles that reference the stress process model after 2010 alone (n = greater than 25,0001), but which shunts the feasibility of conducting a systematic, comprehensive review of the area without mobilising costly human resources or time. The close associates of Leonard Pearlin and pioneers of the model do not conflict with, but rather corroborate, this assessment (AVISON et al. 2010). In the Festschrift for Pearlin (AVISON et al. 2010), the authors admittedly produced essays that elaborate how the stress process model has influenced their work. In doing so, they articulated ‘what future lines of inquiry might be and how Leonard Pearlin’s ideas have shaped these new directions’ (AVISON et al. 2010, vii). What resulted were largely reviews of applications of the stress process model to elaborate social roles and processes in different contexts, including parenting in late life, socioeconomic environments, and child victimisation (ANESHENSEL 2010; AVISON 2010; BIERMAN 2010; FAZIO 2010; TURNER 2010). I do not attempt to review or provide detailed examples of each application, but rather, I incorporate only those parts of their find1

Collectively from the most popular social science and health research databases: JSTOR, PsycINFO, Sociological Abstracts, PubMed, Scopus, Web of Science, Medline, Embase, Social Work Abstracts, International Bibliography of the Social Sciences (IBSS).

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 56

A. AU

ings that carried implications for the theoretical structure of the original stress process model. The relevant main results were then extracted from studies, which were then summarised and described in terms of their theoretical contribution to the stress process model. The alternative â&#x20AC;&#x201C; a systematic review that does attempt to uncritically scope and incorporate all articles for every application of the stress process model â&#x20AC;&#x201C; would hamper the utility of this article as a pedagogical tool for mental health researchers. Already, the concept of stress has suffered misinterpretations in the surge of articles claiming to apply the stress process model. This tendency, according to MCLEOD (2012), consists of underevaluating the meanings of stress. Simply collating which topics the stress process model has been or can be applied in would encourage this problematic tendency. It follows that a critical review is best suited for the purpose of helping mental health researchers appreciate the diverse meanings of stress and formulate their own meanings of stress specific to their study. This is accomplished by providing an overview (i) which avoids the conceptual clutter of mass applications of the framework and (ii) covers the foundational systematic components of the stress process model that resulted from a combination of Pearlinâ&#x20AC;&#x2122;s early program of empirical research and associated original works on resources, social and economic structures, and origins of stress in everyday life and roles in 1981, 1989, and 1999 (AVISON et al. 2010). 3. A hierarchy of stressors: scale and duration The conditions from which stress can develop, called stressors, must then challenge adaptive capabilities (ANESHENSEL 1996) and require behavioural adjustment (THOITS 1995). Stressors can differ in terms of the duration of their application to an individual. WHEATON (1994; WHEATON et al. 2013) identifies five major types of stressors that position along a continuum between being continuous (occurring on a long-term basis) and being discrete (occurring once or on a short-term basis): chronic, traumatic, nonevents, daily hassles, and life events. Furthermore, to account for the different overarching levels on which stress can be perceived, WHEATON and colleagues (2013) distinguish three major ones: micro, meso, and macro. Micro refers to exposure on personal levels. Examples include discrimination or divorce, each constituting a stressor with a different extent of effect, chronic versus discrete respectively. It is also on the micro-level that the idea of daily hassles as a stressor presides. It suggests that the troublesome elements of everyday life are in themselves chronic stressors, drawing to attention a specification of a level of social reality often ignored (ANESHENSEL 1992). However, it must be recognised that it incorporates both discrete and continuous forms of stressors, such as misplacing belongings or encountering traffic problems, which are elements that fluctuate unpredictably between the two forms. Thus, this uncovers an important revelation in

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 57

THE SOCIOLOGICAL STUDY OF STRESS

the study of micro-level stress: the two forms of stressors are not mutually exclusive in everyday life, but dispels daily hassles as strictly one form of chronic or discrete (ANESHENSEL 1992; WHEATON 1994; WHEATON et al. 2013). This trend is not confined to the micro-level, but is existent on all levels. Furthermore, stressors on any level can still be experienced by or affect an individual and translate to a form of personal stress, one that is internalised and responded to with a personal, emotional reaction. Meso refers to the range of levels between those in which we are integrated to those delimited by social boundaries like networks, such as the prevalence of neighbourhood crime (more chronic) or even natural disasters (more discrete) that strain these networks. Macro refers to issues concerning larger political entities such as states and nations. Within this level are the stressors affiliated with a larger system, including economic recessions (chronic) and nation-level crises, like the September 11 attacks (discrete). These examples embody and further testify to the ubiquitous presence of both discrete and continuous stressors at any level (ANESHENSEL 1992; WHEATON 1994). Following the idea that continuous and discrete stressors are not mutually exclusive, one stressor can actually establish the other. Life events and trauma are the most likely candidates for this pattern. Life events (i.e. a divorce) are stressors perceived to be less stressful than traumatic events (i.e. victimisation in sexual assault), defined by circumstances of a severe situation (WHEATON 1994; WHEATON et al. 2013). For example, the trauma from being raped is initially discrete in the eventâ&#x20AC;&#x2122;s singular occurrence, but can easily be seen as percolating into an emotional scar or memory that constitutes a continuous or chronic stressor. The interconnectedness highlighted in this example also illustrates the potential causal relationships between stressors, such as trauma becoming chronic, which in turn can become nonevent (THOITS 1983; WHEATON 1994). Lack of change can be as stressful as change (GERSTEN et al. 1974). Nonevents refer to stressors caused by the lack of something, such as the absence of favourable conditions or of goal attainment. Role captivity, explained later, is an example of this, where a person is not necessarily dissatisfied with their current position but with their inability to obtain a higher goal (WHEATON 1994; WHEATON et al. 2013). Nonevents can also be likened to anticipatory stressors, where the expectation of something that has not or may not even happen causes stress. Thus, following the example of a rape victim, the chronic stressor of an emotional scar can become a nonevent stressor through resilient fear of the recurrence of rape regardless of its likelihood. Chronic stressors are those that exist on a long-term basis in an individualâ&#x20AC;&#x2122;s life or ongoing difficulties (ANESHENSEL 1992). WHEATON (1997) classifies seven forms of chronic stressors: (1) perceived threat; (2) structural constraints, lack of access to opportunity to achieve ends; (3) under-reward, relational deprivation where outputs are disproportionately lower than inputs or in contrast with others giving the same level of input; (4) uncertainty, desire to have a conclusion when an outcome is not possible yet; (5) conflict, regular and without resolution; (6) demands, where expectations cannot be realised with available resources. This involves the presence of

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 58

A. AU

aversive socio-environmental conditions or the absence of benign socio-environmental conditions, which may include the absence of means for fulfilling aspirations (ANESHENSEL 1996). DRESSLER (1998) identifies three major types of environmentindividual discrepancies that are part of this chronic type of stressor: status (disparity between occupation and income), goal-striving (disparity between aspiration and actual accomplishment), and life-style (disparity between consumption behaviour and social class). These three types of discrepancies represent the presence of aversive conditions that prevent individual happiness, reflected in structural barriers inhibiting upward mobility. For example, a worker with an uncompromising manager may be drawn into a status discrepancy if he/she is assigned continual job enlargement (i.e. an expanding variety of tasks) without a similar addition reflected in his/her income. (7) Complexity, number of sources of demands or clash of responsibilities across roles. Following this idea, one of the most important forms of chronic stressors is that of roles and their strains. 4. The role of roles The importance of life events with respect to the rise of stressors is undeniable, but equal attention must also be assigned to the analysis of social roles. Social roles include a structural aspect that facilitates the stress caused by events. The interest in roles is bolstered by their enduring nature (PEARLIN 1983). Because they themselves are long-term involvements, so too would be the stress that affects them. Life events can cause stress that alters the role of an individual, possibly creating a chronic type of stressor (PEARLIN et al. 1981). For example, job loss can cause stress for an individual, but it may be more prominent if experienced by one who bears the role of a parent. In this instance, the role of parenthood intensifies the stress from job loss with regard to the parent’s responsibility to provide for his/her children and family. Furthermore, people attach notable importance to roles and their activities (PEARLIN 1983), as they are socialised to devote themselves to institutional roles that also contribute to society’s maintenance. Such is the case with enduring roles like those related to families, occupation, economy, and education (i.e. parenthood, marriage, work etc.). Thus, it is difficult for a person to remain apathetic to stress from within their roles or to that which affects their roles. Roles also reflect larger contexts in which they are located, offering insight to social arrangements. PEARLIN (1983) uses the example of the occupational role, where the consequences of arrangement, values, and social status in an organisation are revealed through how people are affected by their jobs. The theoretical purchase of viewing roles as contexts calls attention to social status, which exists not only as an attribute of the individual, but can be conceptualised as part of ‘contextual social inequality . . . as existing across multiple layers of the social hierarchy’ (ANESHENSEL 2010, 35: refers to WHEATON & CLARKE 2003).

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 59

THE SOCIOLOGICAL STUDY OF STRESS

4.1. The family: an exception The case of the family is unique, however, in that it has multiple facets related to stress (AU 2017). First, it can be a major source of problems themselves, such as those found in marital or parent-child relations. Second, it is also the location where external problems are shifted to. Third, it serves as the environment in which people relieve their strains. While this idea highlights the familyâ&#x20AC;&#x2122;s distinct position, one point of critique on this idea is that it assumes the case of a heterosexual nuclear family. The popularity of the nuclear family is declining, being replaced by trends of common-law relationships and fewer children (FOX & YIU 2009). The appeal of the common-law relationship is in the financial and work autonomies given to each member, where the responsibilities of domestic chores are not administered to women, but divided by negotiation (FOX & YIU 2009). Thus, either member of a common-law relationship share in a sense of equity, reducing the onset of problems experienced in marital relations related to finance or work. Same-sex unions may also fall into this pattern, being without gendered perceptions of roles and responsibilities, and which have grown over the years to now accounting for 0.82% of all couples (Statistics Canada 2011). The growing diversity of families includes long-distance families that would also be less likely to align with the three dimensions PEARLIN (1983) suggests, for example where distance prevents access to the physical family, making it less likely to be a place where problems could be transplanted or resolved. 4.2. Role Strain PEARLIN (1983) identifies six types of role strain, which he defines as simply the hardships and problems experienced through participating in social roles: (1) problems between an individual and the nature of a roleâ&#x20AC;&#x2122;s tasks. Here the intervention of personal attributes is emphasised. Strains that appear objective actually involve a subjective evaluation component. Stress from work required for a job, for example, is actually dependent on interpretation. Work assigned by others can become role overload, characterised by an overload of work that is not self-chosen, but imposed by others (PEARLIN 1983). A point of critique in response to this is the weighted focus on subjectivity. If stress experienced by an individual not only depends on different factors, but on an innumerable amount of them, then it must be asked whether stress can even be studied. If the stress of each person depends on too many things, then a study of stress should be untenably complex as it points to a plethora of possible routes that cannot be mapped. However, this is not the case. Patterns can be established between the subjective and the objective. Socioeconomic status is a clear example of this, where disadvantaged people consistently encounter more strenuous circumstances that cause more stress than advantaged people due to lack of access to mediator resources and cultural capital (MIROWSKY & ROSS 1999). Thus, as much as subjective interpretations are relevant, there is a correlation between objective con-

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 60

A. AU

ditions and stress (mediated by subjectivity) that represent predictable trends which offer insight to the sources of stress and to potential solutions for them. (2) Interpersonal conflict. This type of strain arises from the relations between people involved in the same role set. Some examples of how this manifests include unequal effort being committed to something, disagreements in values, breakdown in communication, and depersonalisation through absence of appreciation or acknowledgement (PEARLIN & LIEBERMAN 1979). In light of disagreement in values, personal values factor into the arousal of strain via their translation into conflicting practices. This is evident in the case of alienation in a workplace, in which it occurs with those who disagree with supervisors and exhibit low obeisance (PEARLIN 1962). The disconnection in values leads to segregation in the workplace. (3) Role captivity, in which a person experiences a discrepancy between his/her current role and a desired one, facilitated through lack of means. It should be noted that the strain arises not from dissatisfaction with current roles, but from the desire to be something else (PEARLIN 1983). (4) The loss and gain of roles that demands adaptation. Gaining a role entails adaptation that may be strenuous, such as having a child and becoming a parent. Following this example however, the strain from the acquisition of new roles may be mitigated by pre-socialisation or preparation for it with classes and learning about child-rearing (PEARLIN 1983). Losses can be more commonly sudden, as with divorce or involuntary job loss, which encompasses trauma or transitions that cause significant stress. PEARLIN (1983) accredits this to a lack of anticipatory socialisation. An argument of critique on this, however, is that anticipatory socialisation may actually shape existing relations and affect the outcome of certain contexts. Expectations of a divorce for example, may influence a spouse’s behaviour, creating paranoia over trivial events or causing a decrease in the amount of effort invested (the mentality that ‘it’s going to end anyway’) that may impact his/her partner and marriage. Thus, the outcome may be influenced by anticipatory socialisation, becoming a self-fulfilling prophecy. (5) Role restructuring, which is brought about involuntarily or with redistribution of status, privilege, or influence and is therefore more stressful than simply gaining or losing roles. A notable example deals with aging and the subsequent shift in responsibilities and behaviours as parents become cared for by their children. Autonomy and reliance are reversed: where the parent was once in charge, the child has now taken over the responsibilities and authority of caretaking. Thus, both parties may become stressed by the change in personal values as their roles become restructured. This point lends itself to underscore a point of critique, the changing nature of stressors in consideration of factors like aging (PEARLIN & BIERMAN 2013). The stressors a young person experiences are associated with performance in school and finding jobs. That is not to say, despite the lack of recognition, that these roles and their stressors are constant, for they will obviously change over time. Hence, the nature and the identity of a person’s stressors both change as he/she ages, constituting role transitions as well as role restructuring.

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 61

THE SOCIOLOGICAL STUDY OF STRESS

(6) Multiple roles and intrapersonal conflict. Participation in multiple roles may create strains as demands from each collide. Contagion can also be observed within the multitude of roles a person is involved with (PEARLIN 1983). Stress can be proliferated via direct or indirect experience in roles. On the point of direct experience, strains in one role (a job) may stimulate more strains in another role (a marital role). The introduction of technology has further thinned the borders that once segregated a person’s social life. For example, communication technologies increasingly enable the expansion of interactions between work and family life where one role’s demands can project onto another, a phenomenon called role-blurring (GLAVIN et al. 2011) or spillover to address the lateral extension of stress across roles (THOITS 1995; PEARLIN & BIERMAN 2013). Furthermore, a role is often integrated as part of a role set that allows for indirect proliferation (PEARLIN 1983). For example, an occupational office role requires interaction with other roles like administration, clients, staff, etc. Hence, problems in one of these would translate into problems for others, constituting another avenue in which stress can be proliferated. 5. Stress proliferation Naturally, there are other ways in which stress is proliferated. Stress does not necessarily require direct exposure by a person to be effectuated. It may be transmitted through interaction with social environment and the subsequent projection of problems onto the self. In the example of a rape victim, the stress that a rape victim feels is anticipatory, characterised by fear of precedence or by an event in the future that has not happened or may not happen (PEARLIN & BIERMAN 2013). To illustrate anticipatory stressors further, AGNEW’s (2002) research in criminology details a rise in individuals’ fear of being victims of crime following a criminal act inflicted on someone within their social networks. On a larger or macro level, the similar proliferation of anticipatory stressors is assumed by PEARLIN and BIERMAN (2013) to be observable in economic conditions and effects on citizens, where financial strains learned through media (i.e. the hardships associated with recessions) stimulate fear for personal economic outlooks. This is similar to how stress can be acquired through others via a contagion effect (ANESHENSEL 1996). Stress is often not restricted to a single individual, but imposes on others around them. This contagion effect is more prominent in the context of families, where people experience the effects of stress encountered by those emotionally close to them. COYNE and associates (1987) examined spouses of two groups of depressed patients, where one was in recovery. Though they found that spouses of the two groups were stressed for different reasons, both were stressed regardless and not free from hardship. Their results shed light on the nature of the contagion effect in terms of stress, where stress in one person leads to that in others. Stress proliferation can also occur across roles in the forms of role-blurring or spillover as previously explained. Stressors that arise from other stressors are called

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 62

A. AU

secondary and primary respectively (ANESHENSEL 1996; PEARLIN & BIERMAN 2013). They are not named in light of their significance, but of their chronology (ANESHENSEL 1996). Secondary stressors may arise from primary ones; following COYNE and associates’ (1987) work with spouses of patients, a spouse may find the demands of caregiving for patients take away from or interrupt other domains of life. 6. Resources While a person’s social conditions and subjective proclivities may be stressors, they could also be tools for mitigating stress. Resources are thus things that are drawn upon in reaction to stress, with the quality of reducing the impact of stressors (ANESHENSEL 1996; PEARLIN & BIERMAN 2013; THOITS 1995). However, the nature of the effect of resources can be variable. For instance, according to PEARLIN and BIERMAN (2013), resources may affect the impact of stressors in a beneficial manner (called moderating the effect of stressors) or be themselves influenced by stressors to aggravate the situation (a process that mediates primary and secondary stressors). A resource is not confined to be either positive or negative, but rather depends on circumstances. ENSEL and LIN (1991) illustrate three models that capture the potential relationships between stressors and resources: a stress-counteractive model, where resources successfully offset the impact of stressors; a stress-deterioration model, where stressors gradually reduce resources; and finally, a stress-deterrent model, where there is actually no causal association between stressors and resources. Looking further into the idea of a resource, there are perhaps four that stand out: coping, social support, mastery, and belief systems (PEARLIN & BIERMAN 2013). 6.1. Coping Coping has been the most extensively studied resource, a cognitive response to a stressor that prevents the harm caused by it (PEARLIN & BIERMAN 2013). PEARLIN and BIERMAN (2013) outline possible functions, including avoiding or eliminating the stressor, preventing stress proliferation (secondary stressors), altering the meaning of a situation, or confining the emotional impact. With the case of coping resources, avoidance is one such example of the point mentioned above on the ambivalence of resources. Avoidance is useful for reducing the impact of short-term stressors and generally produce positive psychological outcomes (TAYLOR & STANTON 2007), but in a long-term context, avoidance could translate to emotional suppression, where frustration builds up to a point of aggravated release. Points of critique on the study of coping resources involve PEARLIN and BIERMAN’s (2013) assessment that states the social conditions of coping resources have not been investigated thoroughly. For example, while coping resources are effective in moderating stressors, PEARLIN and BIERMAN (2013) pose the case that a form of coping that alleviates personal stress can cause strain in others. A

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 63

THE SOCIOLOGICAL STUDY OF STRESS

spouse’s choice of avoidance may lead to detached behaviour that impacts his/her spouse and their relationship. Furthermore, the social conditions for which resources work differ, such as the discovery of how coping resources are more effective in the workplace than with individuals (PEARLIN & BIERMAN 2013). 6.2. Social Support Social support refers to the functions performed for a person by significant others (THOITS 1995) and is divided into three categories by HOUSE and KAHN (1985): emotional, informational, and instrumental. Found to be inversely proportional to psychological disorders, within these three types of social support are the satisfaction of one’s emotional and social needs for affection, identity, security, and assistance (THOITS 1982). Hypotheses for this pattern include the assumption that social support imparts a sense of mattering, where one’s identity is important to someone else (PEARLIN & BIERMAN 2013). A person consequently feels comforted with a sense of identity and of an emotional bond of affection. Another possibility is the legitimating effect of social support that reaffirms the validity of a person’s choices or the validity of their feeling stressed. Support from others conveys confidence in identity and esteem, reassuring the person that the stress they experience is reasonable per the circumstances and is not the product of personal defects (PEARLIN & BIERMAN 2013; THOITS 2011). Yet another potential reason is the actual effect caused by others, where the influence of others has a visible impact on a person’s lifestyle or values that mitigate disorders (THOITS 1995). As outlined by THOITS (1995), social support resources in the form of emotional support have been found to directly correlate with mental health and buffer the impact of stressors. It is best measured by the existence of an intimate relationship where greater intimacy means greater efficacy (i.e. spouse or lover is stronger than friendship). 6.3. The Stress of Social Support: Life Changes However, social support resources, like all resources, may be depleted over time (ANESHENSEL 1996). A person’s social group may find the person annoying and distance themselves from him/her, lowering the insulation that this social support would normally provide against stressors. Following this idea, a point of critique is the possible transition of social support from being a resource to an actual stressor. Reduction in social support may not only represent the growing absence of a mediator, but the growing presence of a stressor. While assumptions are commonly made that a person who steadily loses friends is simply more exposed to the original stressors, this presumes that this person is indifferent to this loss. In other words, this trend of losing friends itself may become an actual new stressor for the person through the act of self-attribution (ANESHENSEL 1996) such as ruminating on self-depreciative

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 64

A. AU

thoughts like ‘why am I so pathetic that I lost my friends?’. This self-prescribed trait of being pathetic could then cause the person to retreat from seeking social support, heightening the deleterious effects of the original stressors. Three further points should be noted: first, social support resources may not be used even if available. For instance, males usually do not have as strong ties with a social circle as females do, per societal norms surrounding a man’s image of independence and strength (TURNER & LLOYD 1999). Secondly, in light of a previous point of critique on the change in stressors caused by aging, an adherent point of critique holds that any likewise alterations in available resources must also be recognised. As a person ages, the nature of their resources change in addition to that of their stressors. This is particularly evident in the case of social support, where a person’s social circles and connections diminish over time as they age, causing a subsequent drop in availability of social support resources. Children also become part of the social support that is available to aging parents, further underlining the role reconfiguration in the inversion of dependence and autonomy between children and parents in the process of aging. Lastly, just as a person’s coping resources can be detrimental to others (as with the example of someone becoming more avoidant in his marriage, thereby affecting his spouse), so too can social support resources cause more problems for others. A person may choose to draw from a form of social support that in itself is problematic by nature. Participation in a subculture that endorses illicit activities for example, creates disorder on a larger scale. The appeal of a deviant subculture is in the creation of a domain that allows for new opportunities to obtain the prestige, recognition, and satisfaction which a person might not otherwise receive in other areas of life (DOWNES 2011). For example, a person could join a drug-user or gang community to achieve a sense of escapism or empowerment, regardless of any damage to the larger community. 6.4. Mastery Mastery refers to the individual perception of ability to handle stress (PEARLIN & BIERMAN 2013). A common variable affiliated with mastery is socioeconomic status, where the higher a person’s socioeconomic status is, the more education and occupational background and prospect he/she would have, and consequently the higher his/her sense of mastery (PEARLIN & BIERMAN 2013; SCHIEMAN & PLICKERT 2008) would be. Thus, personal control may at times be less associated with individual characteristics and more with availability of privileges in higher statuses (PEARLIN & BIERMAN 2013). It should be emphasised that this positive correlation between mastery as a resource and socioeconomic status is shared by all moderating resources (MIROWSKY & ROSS 1999; THOITS 1995; TURNER & LLOYD 1999) simply due to the advantageous background a higher socioeconomic status affords that better facilitates progression in society than a lower one (i.e. more cultural capital such as better education, better job prospects, more finance for endeavours).

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 65

THE SOCIOLOGICAL STUDY OF STRESS

There are four ways in which mastery is assumed to lessen the effect of stressors: first, the threat from particular stressors are perceptually minimised or neutralised, following which secondly, the reduced threat contributes to a sense of self-confidence in abilities to overcome the stressors (PEARLIN & BIERMAN 2013). Thirdly, mastery has been found to encourage social learning and flexibility that improve the probability of effective behaviour rather than escape behaviour in addition to learning to prevent the occurrence of stressful events (ANESHENSEL 1996; SEEMAN et al. 1988; TURNER & LLOYD 1999). Lastly, it is indicated that a sense of control reduces the impact of stressors via promoting problem solving in their consequences (TURNER & LLOYD 1999; PEARLIN et al. 1981). Resources, like stressors, are not independent of one another. Findings by GREEN and RODGERS (2001) suggest that social support resources influence and are influenced by mastery. Their studies following low-income African-American mothers revealed that social support resources can add to a person’s sense of self-efficacy, where higher perceived support contributed to higher self-efficacy and less perceived stress. The reverse was also found to be true. Higher self-efficacy led to perceived higher social support, thereby enabling people to actually reach out and establish this social support. Connections can therefore also be made between other resources, such as a greater sense of control (self-efficacy) leading to better coping strategies. For example, a person believing in their own power to influence the situation may create more confidence to manage their emotions. 6.5. The Stress of Mastery: Delusion An argument of critique on mastery as a resource can be made on the premise of its ability to be beneficial or deleterious. The question must be posed that at what point does mastery become delusion? A sense of control in moderation may be beneficial for the reasons described above. Having a low sense of control could be less insulative against stressors, where a person believes he/she is incapable of overcoming the stressor and thus not only is impacted more in terms of mental health, but also stops putting effort into resolving problems, believing in a fatalistic future (i.e. ‘if I’m going to fail anyway, why should I try?’) (ANESHENSEL 1996; WHEATON 1980). More interestingly however, having too much mastery could establish the conditions for deleterious effects. When a person with a high sense of control encounters a stressor beyond the scope of his expectations, the impact is suddenly more intensified than it would be for a person with a lower mastery. For instance, a person who firmly believes in the stability of his/her job would face more trauma and require more adaptation to a job loss than a person who wanted or expected to quit anyway.

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 66

A. AU

6.6. Belief Systems Belief systems comprise hierarchical systems of values and meanings (PEARLIN & BIERMAN 2013). A hierarchical system of importance can help assuage the effect of stressors through a misalignment between reality and perceived importance. Perhaps most notably in institutionalised systems like religion, faith and devotion to ritual are paramount, creating less strain in the case of a studentâ&#x20AC;&#x2122;s receiving a poor grade (reducing its potency as a stressor). Under religious determinism, a person is reassured that everything is planned and will be good, leading him/her to more willingly strive to overcome stressors. 6.7. The stress of belief systems: clashes against immigrant culture However, conversely, a belief system can amplify the effects of stressors if important values and reality align. In a culture with a heavy emphasis on education, the case of a poor grade for a student would be aggrandised in the stress it inflicts on the student. To rehash the interconnectedness of resources, belief systems may create the conditions for a social support system. In the case of an institutionalised religion, membership in the institution enables social integration and access to social support that could improve mental health and buffer the effects of stressors. An additional critique on the topic of resources, though also applicable to much of the study of the stress process model, is the lack of focus on minority groups, specifically those with recent immigration histories (NOH & AVISON 1996). The majority of research is done under the premise of a Western culture assumed to be inherently understood by and manifested in individuals. However, this neglects the minority that exists in North America which does not come from a world with similar features (i.e. Europe), but from a place that embodies a different culture and history. In the case of social support and other resources, the question of where an immigrant tends to seek this out if at all must be asked and investigated. Furthermore, the stressors an immigrant faces are likely to include more chronic ones, such as language barriers, adapting to lifestyles and cultures, and potentially discrimination (NOH & AVISON 1996). Drawing from an excerpt on roles, role restructuring is also different for the immigrant as it occurs at a much earlier stage for immigrant parents, the consequences of which, in terms of social relations within and without the family, should be further studied. A minority culture and associated beliefs must also be evaluated in terms of whether it acts or can act as an adequate buffer for never encountered stressors in North America (AU 2015). For example, social support and its exchange may be perceived more positively in cultures rooted in collectivism or interdependence (GREEN & RODGERS 2001). However, culture may work against a personâ&#x20AC;&#x2122;s benefit by stifling the enactment of coping resources. Korean immigrants, for instance, do not readily seek out mental health support from fear of the stigma associated with it

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 67

THE SOCIOLOGICAL STUDY OF STRESS

by their culture (NOH & AVISON 1996). In this case, regardless of the perceived availability of resources, culture has affected the perception of the resource itself. Extrapolating from the discussion on the impact of immigrant culture, second generation immigrants comprise another level of inquiry on the link between culture and stressors, who, as the children of first generation immigrants, are immersed in two different cultures at home and outside in society. The subsequent friction thus experienced by the second generation immigrant (if at all), for example, in personal beliefs, relationships with the family, or influences on resources, lends itself as a point for further study. Another distinction between a Western individualistic culture and a minority collectivistic culture draws on the form of social support that a person seeks out. SAGRESTANO and colleagues (1999) found that a collectivist culture, such as African American and Latino, advocates social support by the family more than an individualistic culture, such as the Western one. Conversely, Western or white people report more social support from friends and social circles, as well as having more friends (more expansive networks) than do African American or Latino people (SAGRESTANO 1999). However, the latter typically report higher quality in the interactions they have, albeit fewer (VEGA 1995). Explanations for this can include: first, differing levels of comfort with the idea of dependency. The favouring of family for the minority as a source of social support could be based on cultural-historical roots in co-habitation of multi-generational and/or extended nuclear families. Furthermore, the socioeconomic conditions that instituted the need for co-habitation simultaneously fostered the need for interdependency in physical, financial, and emotional support. This contrasts with the Western culture, individualistic in its disapproval of dependence and focusing instead on the importance of independent success. Thus, culture not only affects the perception of social support itself, but can delimit or influence the form of social support that a person chooses to draw from. Ultimately, the effects of culture can be beneficial or deleterious in relation to coping resources, the mapping of which constitutes a point requiring further study. 7. Effects of Stressors 7.1. Single and Multiple Outcomes Stressors must invariably be studied in terms of their effect on an individual. As previously established, stressors challenge adaptive capabilities, causing strenuous experiences that inflict damage to mental, well-being, behavioural, and/or social aspects. Thus, stress arises when this strain is internalised by a person, whereby the damage or disorder it inflicts can be measured by a study of its psychological, physical, and behavioural manifestations (PEARLIN 1989), and, as was discussed throughout this paper, its influences on social aspects.

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 68

A. AU

Psychological consequences of stress most commonly refer to mental health outcomes. These are all possible consequences of the aforementioned stress-deterioration model or stress-deterrent model, where stress eventually erodes or is unaffected by available resources (ENSEL & LIN 1991). If a person is unable to manage stress, he/she may suffer from a loss of confidence, identity, affection, and sense of control. Through this, they may be led to believe they are alone, unwanted or unimportant, and incapable of overcoming difficulties or succeeding. Such thoughts, characterising the traits of anxiety, anger, and depression (PEARLIN & BIERMAN 2013), can translate into a frustration towards the self and surrounding social conditions and can thrust people into a stasis of unhappiness made perpetual not only by their circumstances but also by their emotional responses. Much focus of stress research has been dedicated to single-outcome studies of the social antecedents of mental health problems (PEARLIN & BIERMAN 2013). It should be noted that, as some researchers have pointed out previously, the act of equating mental health effects of stress with specific disorders may misrepresent ‘the power of stressors and of group differences in reaction to stress’ (PEARLIN & BIERMAN 2013), while shifting the concentration of stress outcomes disproportionately to mental health in neglect of other areas (ANESHENSEL 1996). 7.2. Physiological Stress: A Critique Physical consequences of stress follow a pattern of physiological alertness and exhaustion, outlined by the biological stress model which WHEATON and colleagues (2013) describe as lacking in the necessary considerations of context, experience, and social ramifications. This critique does not deny the existence of a physiological or even psychological impact, but rather illustrates the importance of the social aspects of stress. Furthermore, the biological response to stress is constant. For example, whether a person suffers a breakdown from a divorce, an uncompromising boss, or bankruptcy, the breakdown entails the same chemical and hormonal responses regardless of the source of stress. Since the biological response is unchanging, it acts solely as a consequence of stress and, thus, not as a factor in the determination of stress. Behavioural patterns can also obviously emerge from the stress experienced by a person. Perhaps most commonly, this includes behavioural practices of escapism such as alcohol or substance abuse. For example, high powerlessness and low mastery have been found to lead to heavier drinking habits (SEEMAN et al. 1988). Other patterns may include delinquency or deviance, as described previously by a person’s pursuit of social support from participation in deviant subcultures. Social consequences of stress, as outlined previously, can include the six forms of role strains (PEARLIN 1983): problems between individuals and nature of tasks, interpersonal problems, intrapersonal problems and multiple roles, role captivity, gain/loss of roles, and role reconfiguration. Furthermore, the newfound effect of role blurring with innovations in technology causes the lateral expansion of stress and can

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 69

THE SOCIOLOGICAL STUDY OF STRESS

influence a personâ&#x20AC;&#x2122;s performance in each role. The social aspect also includes the stress influence on resources such as social support, the potency of which can be mitigated or bolstered by underlying social conditions like socioeconomic status. Thus, the social aspect is arguably the highest level of analysis in stress research, so much so that the other aspects fall under its influence and are interactions within this larger framework (i.e. mental fortitude can be a product of cultural capital garnered from socioeconomic status). Hence, the dynamics and causes of stress cannot be evaluated solely based on mental health outcomes, and neither can it be understood to be found simply within biological or chemical components of the body. They must be assessed in conjunction with the social aspect, for while these two constituents are important, they cannot be allowed to overshadow the higher-level social framework of the roots and indications of stress and stressors that sets the stage for analyses on lower levels, as this paper has tried to demonstrate. 8. Conclusion The stress process model is an adept framework that enables the mapping of stress on multiple levels. It provides an interpretive understanding of stress in different contexts and under the influence of different domains. However, there are intellectual gaps in the framework that stem from the introduction of new trends and lack of connections within research literature. Here I have offered a critique of the established model in light of such considerations based on its dynamics captured in key components: the different types and levels of stressors, their implications in context of roles, the means of their proliferation, the interventions with which a person responds to stress, and the subsequent effects of stress on a person in terms of mental and social impact. Using role-blurring or spillover, a final point of counsel can be proffered on the focus adopted by the stress process model. Perhaps the most common interpretation of the effects of stress is understood in terms of mental health (ANESHENSEL 1996). The interruption of one role by another carries implications beyond mental health, like how the duties of a caregiver for a spouse may tax performance in oneâ&#x20AC;&#x2122;s work environment. Thus, that stress constitutes a link between health and work or social performance illuminates an untapped potential of the stress process model as a tool for broader examinations of social life and its issues. I trust, therefore, that this critique addresses the underlying need for a refinement of the model with the induction of appraisals that develop or highlight necessary points of development for future study.

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 70

A. AU

References AGNEW, R. (2002) ‘Experienced, Vicarious, and Anticipated Strain: An Exploratory Study on Physical Victimisation and Delinquency’, Justice Quarterly 19, 603–32. ANESHENSEL, C.S. (1992) ‘Social Stress: Theory and Research’, Annual Reviews of Sociology 18, 15–38. ANESHENSEL, C.S. (1996) ‘Consequences of Psychosocial Stress: The Universe of Stress Outcomes’ in H.B. KAPLAN, ed., Psychosocial Stress: Perspectives on Structure, Theory, LifeCourse, and Methods (New York: Academic) 111–36. ANESHENSEL, C.S. (2010) ‘Neighborhood as a Social Context of the Stress Process’ in W.R. AVISON et al. (2010) 35–52. AU, A. (2015) ‘Coming Out’, Stigma, and Support: Distress and Health Consequences among Sexual Minorities within a Stress Process Model Framework’, Health Perspectives 6, 1–16. AU, A. (2017) ‘Low Mental Health Treatment Participation and Confucianist Familial Norms among East Asian Immigrants: A Critical Review’, International Journal of Mental Health 46, 1–17. AVISON, W.R. (2010) ‘Family Structure and Women’s Lives: A Life Course Perspective’ in W.R. AVISON et al. (2010) 71–92. AVISON, W.R., C.S. ANESHENSEL, S. SCHIEMAN & B. WHEATON, eds. (2010) Advances in the Conceptualization of the Stress Process; Essays in Honor of Leonard I. Pearlin (New York: Springer). BIERMAN, A. (2010) ‘Stress Valuation and the Experience of Parenting in Late Life’ in AVISON et al. (2010) 189–206. COYNE, J.C., R.C. KESSLER, M. TAL, J. TURNBULL, C.B. WORTMAN & J.F. GREDEN (1987) ‘Living with a Depressed Person’, Journal of Consulting and Clinical Psychology 55, 347–52. DOWNES, D., P. ROCKE & C. MCCORMICK (2011) Understanding Deviance: Second Canadian Edition (Don Mills, Ontario: Oxford UP). DRESSLER, W.W. (1988) ‘Social Consistency and Psychological Distress’, Journal of Health and Social Behaviour 29, 79–91. ENSEL, W.M. & N. LIN (1991) ‘The Life Stress Paradigm and Psychological Distress’, Journal of Health and Social Behaviour 32, 321–41. FAZIO, E.M. (2010) ‘Sense of Mattering in Late Life’ in AVISON et al. (2010) 149–76. FOX, B. & J YIU (2009) ‘As Times Change: A Review of Trends in Family Life’ in B. FOX, ed., Family Patterns, Gender Relations (3rd ed., Toronto: Oxford UP Canada) 180–208. GERSTEN, J.C., T.S. LANGNER, J.G. EISENBERG & L. ORZECK (1974) ‘Child Behavior and Life Events: Undesirable Change or Change Per Se?’ in B.S. DOHRENWEND & B.P. DOHRENWEND, eds., Stressful Life Events: Their Nature and Effects (New York: Wiley) 159–70. GLAVIN, P., S. SCHIEMAN & S. REID (2011) ‘Boundary-Spanning Work Demands and their Consequences for Guilt and Psychological Distress’, Journal of Health and Social Behavior 52, 43–57. GREEN, B.L. & A. RODGERS (2001) ‘Determinants of Social Support among Low-Income Mothers: A Longitudinal Analysis’, American Journal of Community Psychology 29, 419–40. HOUSE, J.S. & R.L. KAHN (1985) ‘Measures and Concepts of Social Support’ in S. COHEN & S.L. SYME, eds., Social support and health (New York: Academic) 83–108. MCLEOD, J.D.( 2012) ‘The Meanings of Stress: Expanding the Stress Process Model’, Society and Mental Health 2, 172–86. MIROWSKY, J. & C.E. ROSS (1999) ‘Economic Hardship across the Life Course’, American Sociological Review 64, 548–69.

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 71

THE SOCIOLOGICAL STUDY OF STRESS

NOH, S. & W.R. AVISON (1996) ‘Asian Immigrants and the Stress Process: A Study of Koreans in Canada’, Journal of Health and Social Behaviour 37, 192–206. PEARLIN, L.I. (1962) ‘Alienation from Work: A study of Nursing Personnel’, American Sociological Review 27, 314–26. PEARLIN, L.I. (1983) ‘Role Strains and Personal Stress’ in H.B. KAPLAN, ed., Psychosocial Stress: Trends in Theory and Research (New York: Academic) 3–32. PEARLIN, L.I. (1989) ‘The Sociological Study of Stress’, Journal of Health and Behavioural Science 30, 241–56. PEARLIN, L.I. & A. BIERMAN (2013) ‘Current Issues and Future Directions in Research into the Stress Process’, Handbook of the Sociology of Mental Health (2nd ed., New York etc.: Springer) 325–40 (DOI: 10.1007/978-94-007-4276-5_16). PEARLIN, L.I. & LIEBERMAN, M.A. (1979) ‘Social Sources of Emotional Distress’ in R. SIMMONS, ed., Research in Community and Mental Health (Greenwich, Conn: JAI) 217–48. PEARLIN, L.I., M.A. LIEBERMAN, E.G. MENAGHAN & J.T. MULLAN (1981) ‘The Stress Process’, Journal of Health and Social Behavior 22, 337–56. PEARLIN, L.I., C.S. ANESHENSEL & A.J. LEBLANC (1997) ‘The Forms and Mechanisms of Stress Proliferation: The Case of AIDS Caregivers’, Journal of Health and Social Behavior 38, 223–36. SAGRESTANO, L.M., P. FELDMAN, C.K. RINI, G. WOO & C. DUNKEL-SCHETTER (1999) ‘Ethnicity and Social Support during Pregnancy’, American Journal of Psychology 27, 869–98. SCHIEMAN, S. & G. PLICKERT (2008) ‘How Knowledge is Power: Education and the Sense of Control’, Social Forces 87, 153–83. SEEMAN, M., A.Z. SEEMAN & A. BUDROS (1988) ‘Powerlessness, Work, and Community: A Longitudinal Study of Alienation and Alcohol Use’, Journal of Health and Social Behaviour 30, 206–19. Statistics Canada (2011) 2011 Census of Canada: Conjugal Status and Opposite/Same-sex Status (7), Sex (3) and Age Groups (7A) for Persons Living in Couples in Private Households of Canada, Provinces, Territories and Census Metropolitan Areas, 2011 Census, retrieved 20 Mai 2016 from http://www12.statcan.gc.ca/census-recensement/2011/dp-pd/tbt-tt/Rpeng.cfm?LANG=E&APATH=3&DETAIL=0&DIM=0&FL=A&FREE=0&GC=0&GID=0& GK=0&GRP=1&PID=102574&PRID=0&PTYPE=101955&S=0&SHOWALL=0&SUB=0 &Temporal=2011&THEME=89&VID=0&VNAMEE=&VNAMEF=. TAYLOR, S.E. & A.L. STANTON (2007) ‘Coping Resources, Coping Processes, and Mental Health’, Annual Review of Clinical Psychology 3, 377–401. THOITS, P.A. (1982) ‘Conceptual, Methodological, and Theoretical Problems in Studying Social Support as a Buffer against Life Stress’, Journal of Health and Social Behavior 23, 145– 59. THOITS, P.A. (1983) ‘Dimensions of Life Events that Influence Psychological Distress: An Evaluation and Synthesis of the Literature’ in H.B. KAPLAN, ed., Psychosocial Stress: Trends in Theory and Research (New York: Academic) 33–103. THOITS, P.A. (1995) ‘Stress, Coping, and Social Support Processes: Where are we? What Next?’ Journal of Health and Social Behaviour (Extra Issue) 53–79. THOITS, P.A. (2011) ‘Mechanisms Linking Social Ties and Support to Physical and Mental Health’, Journal of Health and Social Behavior 52, 145–61. TURNER, J.R. (2010) ‘Understanding Health Disparities: The Promise of the Stress Process Model’ in AVISON et al. (2010) 3–22. TURNER, J.R. & D.A. LLOYD (1999) ‘The Stress Process and the Social Distribution of Depression’, Journal of Health and Social Behaviour 40, 374–404.

EJMH 12:1, June 2017

04_Stress_Process_Junius 2017.05.24. 11:27 Page 72

A. AU

VEGA, W.A. (1995) ‘The Study of Latino Families: A Point of Departure’ in R.E. ZAMBRANA, ed., Understanding Latino Families: Scholarship, Policy, and Practice (Thousand Oaks, CA: Sage) 3–17. WHEATON, B. (1980) ‘The Sociogenesis of Psychological Disorder: An Attributional Theory’, Journal of Health and Social Behaviour 21, 100–24. WHEATON, B. (1994) ‘Sampling the Stress Universe’ in W.R. AVISON & I.H. GOTLIB, eds., Stress and Mental Health: Contemporary Issues and Prospects for the Future (New York: Plenum) 77–114. WHEATON, B. (1997) ‘The Nature of Chronic Stress’ in B.H. GOTTLIEB, ed., Coping with Chronic Stress (New York: Plenum) 43–73. WHEATON, B. (2010) ‘The Stress Process as a Successful Paradigm’ in AVISON et al. (2010) 231– 52. WHEATON, B. & P. CLARKE (2003) ‘Space Meets Time: Integrating Temporal and Contextual Influences on Mental Health in Early Adulthood’, American Sociological Review 68, 680–706. WHEATON, B., M. YOUNG, S. MONTAZER & K. STUART-LAHMAN (2013) ‘Social Stress in the Twenty-First Century’, Handbook of the Sociology of Mental Health (2nd ed., New York etc.: Springer) 299–323.

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 73

European Journal of Mental Health 12 (2017) 73–87 DOI: 10.5708/EJMH.12.2017.1.5

TAMÁS MARTOS* & VIOLA SALLAY

SELF-DETERMINATION THEORY AND THE EMERGING FIELDS OF RELATIONSHIP SCIENCE AND NICHE CONSTRUCTION THEORY** (Received: 17 October 2017; accepted: 2 April 2017)

In this paper we summarise the basic tenets of Self-Determination Theory (SDT). As a special occasion for this overview, we review two recently published edited books on relationship motivation (WEINSTEIN 2014) and work motivation (GAGNÉ 2014) because both of them rely extensively on SDT concepts and principles while they extend the conceptual frames of the theory to several directions and applied fields. Furthermore, we argue that the basic propositions of SDT may contribute to the emerging field of the so called Relationship Science, the continuously forming interdisciplinary knowledge base on close relationships. On the other hand we propose that SDT could and should be further enriched by broader system theoretical approaches. Therefore we outline the evolutionary theoretical principles of human agency as represented in Niche Construction Theory and its applications in social sciences. While a complete theoretical integration exceeds the frames of a review, we draw a series of conclusions that may point in this direction. Keywords: Self-Determination Theory, Relationship Science, Niche Construction Theory, motivation, human relationships Selbstbestimmungstheorie und die neu entstehenden Bereiche der Beziehungswissenschaft und der Nischenkonstruktionstheorie: In diesem Artikel fassen wir die grundlegenden Lehrsätze der Selbstbestimmungstheorie (SDT) zusammen. Der besondere Anlass für die Besprechung sind zwei kürzlich erschienene Bücher über die Beziehungsmotivation (WEINSTEIN 2014) und die Arbeitsmotivation (GAGNÉ 2014), weil sich beide sehr stark auf Konzepte der SDT stützen, während sie den Begriffsinhalt der Theorie in mehrere Richtungen und auf diverse Anwendungsbereiche ausweiten. Darüber hinaus behaupten wir, dass die grundlegenden Thesen der SDT einen Beitrag zu der im Entstehen begriffenen sogenannten Beziehungswissenschaft, dem sich ständig wandelnden interdisziplinären Wissen über enge Beziehungen, leisten können. Andererseits sind wir der Ansicht, dass die SDT durch ein weiter gefasstes System theoretischer Ansätze weiter **

Tamás Martos, Institute of Mental Health, Semmelweis University, Nagyvárad tér 4., H-1089 Budapest, Hungary; Institute of Psychology, University of Szeged, Egyetem tér 2., H-6722 Szeged, Hungary; martos. m.tamas@gmail.com. Preparation of the manuscript was partly funded by the Hungarian National Research Fund (OTKA NKFIH) under the grant number PD 105685.

05_SDT_review_Junius 2017.05.23. 9:13 Page 74

T. MARTOS & V. SALLAY

bereichert werden könnte und sollte. Deshalb skizzieren wir die theoretischen evolutionären Grundsätze des menschlichen Handelns, wie sie in der Nischenkonstruktionstheorie vorkommen, und ihre Anwendungen in den Gesellschaftswissenschaften. Da eine vollständige theoretische Integration den Rahmen einer Besprechung sprengen würde, ziehen wir eine Reihe von Schlussfolgerungen, die in diese Richtung weisen können. Schlüsselbegriffe: Selbstbestimmungstheorie, Beziehungswissenschaft, Nischenkonstruktionstheorie, Motivation, zwischenmenschliche Beziehungen

1. Introduction There is a famous – although imprecise – quote attributed to Freud saying that mental health would mean the ability ‘to love and work’. While the quote cannot be found in Freud’s works1 it does reflect the common human experience that enriching human relationships and satisfying work are both important ingredients of a life fully lived. Consequently, these topics are important for contemporary personality and social psychological theories as well. Therefore, below we outline the basic tenets of SelfDetermination Theory (SDT; cf. RYAN & DECI 2000a; 2000b), a prominent example of these theories. As a parallel of the ‘love and work’ thematic in SDT, we will refer to two recently published edited books on relationship motivation (WEINSTEIN 2014) and work motivation (GAGNÉ 2014) because both of them rely extensively on SDT concepts and principles while they extend the conceptual frames of the theory to several directions and applied fields. In addition, we will present two lines of theoretical and empirical approaches that we consider important for further development of SDT and the psychology of relationships in general: relationship science (RS) and niche construction theory (NCT). 2. Self-determination Theory: overview and basic tenets Self-Determination Theory (SDT) is a growing and flourishing psychological metatheory of human self-regulation, motivation, personal growth and well-being. The founding fathers are Edward Deci and Richard Ryan from Rochester University. Since its origins go back to the 80’s, concepts of SDT are well grounded both theoretically and methodologically and are organised around some major themes. Last but 1

‘This formula was cited by Erik Erikson but it is not to be found in Freud’s works, although the sentiment is sometimes implied. During his long engagement Freud stated that his own ambition in life was to have Martha as his wife and to be able to work (e.g. ‘Couldn’t I for once have you and the work at the same time?‘ Freud-Martha Bernays 21 Oct. 1885). Freud also referred to Eros and Ananke [Love and Necessity] as the foundations of society. In ‘Civilization and Its Discontents’ (1930) he wrote: ‘The communal life of human beings had, therefore, a two-fold foundation: the compulsion to work, which was created by external necessity, and the power of love’. (S.E. XXI.101) see https://www.freud.org.uk/about/faq/.

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 75

SELF-DETERMINATION THEORY

not least, SDT inspired a great number of studies and by now it has a growing international community of scholars and practitioners as well. A quick search on Google Scholar demonstrates this. If we search only for those publications that have in their title the explicit term ‘self-determination theory’, we get 165 hits from 2014, 158 hits from 2015 and 115 hits from 2016 (21 Sept 2016), mostly in the form of ‘a self-determination theory perspective’, ‘a self-determination theory approach’ or ‘a self-determination theory analysis’. Obviously, an inclusion of more fine-graded search criteria for SDT based studies and search in the non-English language literature would come up with even more results. This alone indicates that SDT is a viable and inspiring framework for the psychological and behavioural sciences. Therefore, first we give a rough outline of the main tenets of the theory. Theoretically, SDT has a series of features that make this approach unique. 2.1. Foundations in humanistic psychology SDT holds a humanistic view of the psychological Self and the person and directly refers to the psychology of Carl Rogers. The human person is seen embedded in social systems and relationships while at the same time functioning according to an intrinsically developing and self-organising self-system. 2.2. Evolutionary framework SDT refers to evolutionarily based principles of human functioning and assumes that basic psychological needs (as outlined below) are universally evolved human phenomena that are independent of culture. The Self as a self-organising system is connected to the evolutionary heritage of the human species, and more proximally, to the brain and the functioning of the body. 2.3. Individual variations While the recognition of universal human tendencies is clearly present in SDT, the existence of individual differences and cultural variations is also recognised. The basic question is whether they may lead to different outcomes in terms of mental health and positive functioning. For example, importance of life goals that individuals and communities pursue may depend on the cultural and interpersonal context but excessive striving for materialistic goals may undermine well-being (MARTOS & KOPP 2012).

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 76

T. MARTOS & V. SALLAY

2.4. Modularity SDT may be regarded as a continuously developing conceptual network of theoretical modules, also called ‘mini-theories’. These modules describe different basic premises and hypotheses that are yet in connection with each other. Up to the present day, six such modules have been developed but there is no definitive reason to assume that later development could not add further modules as well. We outline the most important propositions below. 2.5. Methodology On the methodological side of research, SDT researchers have developed a series of psychometrically sound scales and questionnaires to assess SDT-related concepts, experiences and characteristics. Indeed, the great majority of SDT research was conducted by means of self-administered questionnaires. On the SDT homepage www.selfdeterminationtheory.org more than 40 questionnaires are available for free use and translation and there may be lots of adaptations of these measures to different research topics and questions. 3. Examples of mini theories in SDT While it is an almost impossible mission to make a short list of the major topics of SDT, in the following points below we summarise those themes that have been under much scrutiny. 1. Focus on intrinsic motivation. Intrinsically motivated states are characterised by behaviours and inner processes that are pursued without any external reward. In this way, intrinsic motivation is close to the ‘flow’ state of mind as described by Mihály CSÍKSZENTMIHÁLYI (1991; PRIVETTE 1983). Along with the investigation of intrinsically motivated processes much scientific effort has been given to understand its sustainability as well. Indeed, the roots of SDT go back to the studies on the paradoxical effect of external reinforcement of intrinsic motivation and performance (the ‘undoing effect’). 2. Later, theorising extended the intrinsic-extrinsic dichotomy. The concept of ‘perceived locus of causality’ (PLoC) posited an extrinsic-intrinsic continuum of the subjective motivation. Instead of two distinct motivational states (intrinsic or extrinsic), the PLoC approach defines different types of external motivations (external, introjected, identified and integrated regulation) that are all forms of more or less externally fuelled self-regulation; however, they differ substantially in the subjective experience of autonomy, causation and internalisation. Identified and integrated regulations represent autonomously regulated motivation and behaviour that contribute to optimal human functioning. Moreover, more

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 77

SELF-DETERMINATION THEORY

autonomous types of motivation were found to be personally more satisfying and more efficient and creative at the same time (DECI & RYAN 1985; WEINSTEIN et al. 2012; WONG 2000). 3. The concept of basic psychological needs (BPN) is another core assumption in SDT. Basic psychological needs are those conditions that are necessary for the human person to grow psychologically and to actualise their full potential. To put it in another way, BPNs are those ‘nutriments’ that are necessary for a healthy development and functioning. In SDT three basic psychological needs are postulated: autonomy (the need for free, volitional acts and existence), competence (the need for being an active and efficient agent in one’s pursuits) and relatedness (the need for supporting, caring relationships). Another assumption of SDT is that an equally high level of satisfaction of these needs is indispensable for healthy functioning. It is also important to note that the need concept of SDT differs considerably from other concepts that treat needs as individual difference features: in SDT the main concern is not about how individuals differ from each other in the strength of their actual or long term needs. Instead, the question is – in SDT terms – how social environments are different from each other in providing these basic needs for the individuals. Empirical studies demonstrated that personal experience of higher satisfaction of BPNs, autonomy, competence and relatedness was connected to higher well-being and better psychological health in everyday settings (REIS et al. 2000; RYAN et al. 2010) and close relationships (PATRICK 2007). 4. One corollary of the above described concepts concerns the relationship between values, psychologically healthy goal striving, need satisfaction and well-being. Several studies demonstrated that intrapersonal experience of autonomy and ownership in one’s strivings and life goals supports the realisation of need satisfaction (in terms of BPN) and thus it may lead to better functioning and well-being (RYAN et al. 1996; SHELDON 2014; SHELDON & HOUSERMARKO 2001). 5. Since its inception, SDT has been deeply concerned with specific forms of autonomy support and control strivings in different kinds of human relationships. Specifically, much attention was paid to the questions how autonomy and control processes work in different interpersonal settings and what their consequences are. A great part of SDT-inspired research is aimed at how people who have impact on others (e.g. parents, health professionals, teachers, coaches and supervisors) facilitate behavioural change (e.g. smoking cessation, acquiring new skills) and/or attitude change (e.g. value internalisation) and support persistence. As a general principle, controlling (non-autonomy-supporting) relationship acts and the subjective interpretation of being controlled in a relationship are regarded as detrimental for growth, healthy functioning and good quality of relationships (for supporting data see DECI & RYAN 2008; GUAY et al. 2013; HAERENS et al. 2015; RATELLE & DUCHESNE 2014; ROTH & WEINSTOCK 2013). Even more generally, several studies demonstrated that need supporting

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 78

T. MARTOS & V. SALLAY

attitude and behaviour (in terms of BPN satisfaction) are in fact necessary prerequisites for these desirable outcomes in several settings. Although the above outlined core topics capture only the rough structure of the many aspects of SDT, it has probably become salient so far that SDT has a lot to say about several life domains and several questions of the functioning of the human personality and relationships. Recently, two edited book were released that demonstrate the plasticity of the theory; both summarise an enormous amount of empirical research and present applications of the basic theory for two – partly overlapping – domains of human experience, that is, close relationships and work. (Just recall again the words attributed to Freud.) First we give a short overview of the two volumes then we will look for similarities and common features in the theoretical and practical advancements. Finally, from a more distal perspective, we pinpoint some questions and potential theoretical approaches that are underdeveloped in SDT in general and in these volumes in particular but that may enrich and extend the original theory. 4. Self-determination Theory, relationships and work motivation The book Human Motivation and Interpersonal Relationships: Theory, Research, and Application edited by Netta WEINSTEIN (2014) focuses on the relational side of human motivation. It explicitly formulates and relies on the sixth ‘mini-theory’ of SDT, the Relationship Motivation Theory (DECI & RYAN 2014). Most of the articles are reviews with many references to previous empirical studies and only a few of them present original data and analysis. The book organises these contributions around three main topics. The first couple of chapters deal with broad theoretical aspects of interpersonal relationships from an SDT perspective. Not surprisingly, one of the most detailed questions throughout the three chapters is the fundamental role of autonomy in human functioning and particularly in human relationships. Autonomy is a centrepiece of the theoretical construction of SDT: need for autonomy, subjective experience of autonomy, providing support in ways that support the need for autonomy as well, dispositional vs situational determinants of autonomy – these are well discussed topics both in SDT literature and in the chapters. Given its central role in the theory, it is worth shortly presenting what autonomy is and what it is not from an SDT point of view. The latter is probably the easier question: theorists of SDT often claim that autonomy is not individualism, egocentrism, or disconnection from others. Rather, as CHIRKOV (2014) points out, psychological autonomy refers to the inner capacity of self-direction, either in general, in the individual’s life as a whole (personal autonomy) or in a specific domain (motivational autonomy, e.g., in health behaviour, in relational decisions, etc.). Psychological autonomy refers to: 1) a set of self-generated and meaningful life-goals and values where inner capacity for self-direction refers to the ability of choosing and pursuing such goals; 2) awareness and reflections on bodily, sensual and affective impulses where autonomy lies also in using appropriate skills for dealing

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 79

SELF-DETERMINATION THEORY

with these impulses; and 3) the awareness and understanding of cultural and social norms and expectations along with an inner capacity to freely decide whether to follow or reject them. Cultures and social settings may greatly differ in the endorsement of an autonomous personal position but the dilemmas are similar. DECI and RYAN (2014) describe Relationship Motivation Theory as one of the so called ‘mini-theories’ within SDT, positing that the feeling of relatedness alone is not enough to build and maintain satisfactory relationships. Mutual support of autonomy and competence are also vital ingredients of every well functioning relationship. The authors refer for example to the possibility of conflict between autonomy and relatedness: although they may be often experienced as contradictory demands, they are not necessarily antitheses of each other. In fact, the theory of basic psychological needs posits that both are prerequisites for healthy human functioning. In contrast, conditional regard and the resulting relationship-contingent self esteem (see also the chapter of ASSOR et al. 2014) represent the darker side of the relationships: these ways of relationships offer relatedness at the cost of autonomy, that is, they build on interpersonal control. After this introduction the next part unfolds several theoretical aspects of the basic principles for a series of relevant domains. These chapters deal with the importance of need support in different types of social experiences; the different forms of the automatic us-them divide and the accompanying defensiveness; the role of an authentic self-concept in relationships; conflict processes in romantic relationships; the role of autonomy in intergroup process and the role of autonomous self-disclosure in developing a healthy LGBT identity. It is very compelling how the relatively simple basic principles and theoretical propositions of SDT can be connected to other scientific conceptions. We would like to cite two examples more in detail: the automatic usthem divide and conflict resolution processes in relationship with autonomy support. The automatic us-them divide refers to the well-known social psychological phenomenon of differentiation between in-group and out-group members. This is a basic social cognitive process that can be very easily activated. However, the authors question the view that this differentiation should inevitably lead to defensive inner processes (motivated downward evaluation of out-group and upward evaluation of in-group members that can reduce anxiety in persons) and the resulting social distinction. They argue that experiences of intrinsic motivation and autonomy relate to lower self-defensiveness and lead to more positive and non-defensive social experiences like pro-social behaviour, gratitude to others, taking interpersonal responsibility and joint creativity. More interestingly, the authors make linkages between the autonomous self-functioning and the Buddhist perspective of Self; especially the praxis of mindful meditation. Mindful acceptance of inner states and experiences is also a more and more investigated therapeutic praxis even in Western behavioural and psychological sciences that may contribute to decoupling the first automatic link between us-them cognitions and the resulting defensive reactions. Autonomy as well as mindfulness creates an extra symbolic ‘space’ both in the mind and in the relationships that in turn makes more relaxed and non-judgemental relationships possible.

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 80

T. MARTOS & V. SALLAY

This interpretation may be further strengthened by the thoughts of KNEE and colleagues (2014) who explore the relationship between conflict regulation and different aspects of self-determined way of living. According to the authors, SDT may be linked and at the same time can be contrasted to other well-established theories of romantic relationship dynamics, for example self-expansion theory (ARON & ARON 1996), attachment theory (BOWLBY 1969) and interdependence theory (KELLEY et al. 2003). KNEE and colleagues (2014) analyse the basic propositions and assumptions of these approaches and compare those with SDT which seems unique with its focus on need for autonomy and the assumed importance of autonomy support. However, while the authors acknowledge these features and build on them, they still have to admit that SDT’s basic premises refer to the relationship of the individual and her larger social environment and thus largely lack the dyadic aspect of relationships. At the same time, this may shed light on a promising future research direction – a conclusion that is much in line with ours as we present below. The third part of the volume presents applied domains and special applications, mostly connected to several aspects of health and physical activity. The chapters cover many important topics on different forms of supporting relationships: sport educators, health practitioners, counsellors and other actors of the social environment. The evidence presented here is a good summary and support for the basic SDT tenets: regardless of the actual type of the relationship, more support for autonomy, competence and relatedness is associated with better outcomes, adherence to treatment regimes and better therapeutic relationships. While these associations are important to be emphasised again and again, there is also a less worked-out point. We find the proposition of LA GUARDIA and PATRICK (2014) especially promising in this regard. They mention that relationships often function as if romantic partners had a specific ‘relational contract’ between them (LA GUARDIA & PATRICK 2008). Relational contracts are created about the expectations each romantic partner has for themselves and for the other and they are constructed of a hierarchical system of basic as well as elaborate functions that let the relationship work in a stable way. This idea is close to an early formulation of relationship contracts, named marriage contract by SAGER (1976) and may show again toward a potential approach between SDT and relationship science. Unfortunately, the idea of ‘relational contracts’ is not detailed further in the chapter although an SDT based framework would be very interesting in this domain. The other volume of our special concern, Oxford Handbook of Work Engagement, Motivation, and Self-Determination Theory (GAGNÉ 2014) addresses work experiences and work contexts in the light of SDT. The basic structure of the volume is similar to the above mentioned book. After the first chapters that cover the general theoretical foundations, middle level connections are explored between the basic principles and several mid-range characteristics, for example the role of leadership in promoting healthy motivation, different types of passion for work, thriving and flow in work and the causes and processes of workplace violence; all these and other topics through the lens of SDT. The various chapters map both individual aspects

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 81

SELF-DETERMINATION THEORY

(e.g. the role of attachment experiences in the maintenance of autonomous motivation) and organisational and contextual considerations (e.g., the role of compensation as well as the possibility of providing training and development in the sense of SDT). The final chapters provide insight into certain domains of practical application: teacher motivation, health promotion at the workplace, and the pursuit of various values and goals at the workplace. While the chapters of the book as a whole balance well between positive and negative phenomena (e.g., thriving and violence), there is still a positive overall message that can be clearly read from the studies. Workplaces can and should be constructed in a way that may lead to positive motivation, authentic passion and long term commitment for self-determined goals. However, the main line of research in SDT (as applied for workplace motivation and close relationships) imply a mostly linear view of effects that focuses on the role of the stronger and broader actors in the system, i.e. those with more power and potential to influence others. In the world of organisations these agents are bosses, leaders (and more generally the organisational culture) and it follows that change can be effectively facilitated through them. One excellent example of this basic approach is the overview of PELLETIER and AITKEN (2014). They summarise those ways how leaders and social context in an organisation may promote positive change towards environmentally responsible actions in employees. It was shown previously that pro-environmental behaviour (PEB) of individual employees can have a distinctive effect on the environment therefore it is of utmost importance to support PEB in workplaces. Since several activities that are associated with PEB are not intrinsically enjoyable, identification with and integration of these actions, that is, autonomous motivation for PEB is a key factor in achieving sustainable change. Correspondingly and in line with SDT principles, the main route to this change is an organisational culture and practice that satisfy the basic psychological needs of employees. The study gives a broad overview of several pathways from information provision through overt pro-environmental organisational policies to the supervisorâ&#x20AC;&#x2122;s interpersonal behaviour towards the employees. To summarise our overview shortly, Self-determination Theory provides a wellfounded account of many aspects of human specific motivation and as a main contribution to psychology and behavioural sciences it clearly emphasises the role of specific social contexts and relationships in development of motivated states and processes. One aspect, according to our view, is underdeveloped in SDT. It is a basic assumption in SDT that human beings are active, growth oriented organisms. However, when it comes to the role division between the person and their social context, we find that there is much more emphasis on those effects that the context may have on the person (context to person effects) than the effects in the opposite direction (person to context effects). Below we refer to two broad theoretical frames, Relationship Science and Niche Construction Theory, that may enrich SDT by their specific concern with a mutual and circular account of this relationship.

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 82

T. MARTOS & V. SALLAY

5. Self-determination Theory and Relationship Science Relationship science (RS) is an emerging interdisciplinary field of research and partly of praxis as well that places the functioning of human connections and relationships in the focus of scientific scrutiny. This shift in focus from the individual characteristics to the relational ones is not a haphazard change but a logical corollary of many experiences that humans, human behaviours and human phenomena can be better explained when considering individuals together with their connectedness to specific others. RS can be followed back to such broad theories like attachment theory, interdependence theory or evolutionary psychology (FINKEL & SIMPSON 2015). As we could see, SDT too places a definite accent on the ways how persons relate to each other; how they satisfy each other’s basic psychological needs; how they experience themselves and others in connection. Therefore, we deeply agree with the basic message of the above presented works saying that SDT has not only been a motivational theory but also a fundamental theory of human relationships, even since the beginning of its formulation (LA GUARDIA & PATRICK 2008). Systemic relationships are present throughout the theoretical formulations of SDT in two ways. First, and more evidently, there is an interpersonal circle of self-regulation and relationship behaviour. Earlier approaches in SDT emphasised mostly linear relationship dynamics, concentrating on the effects that the basic need supporting behaviour of one agent (e.g. parent, teacher or healthcare provider) may have on the behaviour, motivation, and well-being of the other agent (adolescent, student or patient). In contrast to this rather one-sided approach to the relationship between persons and their ‘social contexts’, newer formulations include more interdependent and circular models of interpersonal processes. For example, in their theoretical overview, WEINSTEIN and DEHAAN (2014) present a tentative model where autonomous motivation in the individual and need supporting behaviour of relational figures are mutually interrelated and continuously support each other in a positive way. Or, in contrast, negative feedback may deteriorate this healthy functioning both from the relational and the individual side of the process. We see this as a very promising extension of the original SDT principles since it gives a more complex description of how individuals themselves are active agents in the formation of their relationships. At this point, SDT is also in accordance with the system theoretical approaches of Relationship Science: in many ways individual self-regulation is a function of relationships (FINKEL & FITZSIMONS 2011) and also serves as a motivational basis for specific relational perceptions and acts (FITZSIMONS & FINKEL 2011). For example, Transactive Goal Dynamics (TGD) Theory (FITZSIMONS et al. 2015), a newly developed theoretical approach in RS is concerned with interpersonal processes of self-regulation. TGD is based on the assumption that individual self-regulation processes may only be understood as parts of a broader interpersonal and interdependent system of self-regulation. These propositions are at present rather theoretical in nature but they are open to empirical investigation and also they suggest that SDT and Relationship Science can move along similar pathways to gain a deeper understanding of human relationships.

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 83

SELF-DETERMINATION THEORY

The second aspect of a systemic approach to relationships that is inherently present in SDT concerns the relationship of the person with their inner Self. SDT driven research on mindfulness (DECI et al. 2015) as well as theoretical considerations on autonomy (CHIRKOV 2014) authenticity (RYAN et al. 2005) and the nature of self-esteem (RYAN & BROWN 2003) present this line of investigation. We think that this aspect may be best represented in a second circular model of inner self-regulation processes and this way it could be added to the interpersonal circular model of WEINSTEIN and DEHAAN (2014). Intra- and interpersonal levels of self-regulation are interdependent circular processes, however, both levels have their own autonomy and may have mutual effect on each other. Since human systems are open systems, we think that SDT could profit from research on circular relationship processes. 6. Self-determination Theory and Niche Construction Theory We considered the aspects of Relationship Science in order to reflect on the SDT approach to close relationships (the ‘love’ side of the ‘love and work’ dichotomy). Now we turn to another scientific innovation, that is, the evolutionary theory of Niche Construction, because we think that it may give a broader outlook on the often cited examples of the SDT approach to work and work motivation. To summarise it shortly, Niche Construction Theory (NCT; ODLING-SMEE et al. 2003) describes evolutionary processes as constant and cyclical transactions between the organisms, their socio-physical environment and their genetic heritage. The core assumption behind NCT is that the changes organisms perform in their environments become evolutionary forces themselves. Therefore, adaptation is not a unidirectional process that leads only from environment and environmental pressures to gene selection but there is an opposite direction as well. Organisms are to some extent co-authors of their (and also others’) evolution. For the best and the worst, human beings are among the most successful niche constructors on the Earth: our intelligence and culture gives us enormous tools to modify our social and physical environment in a way that may support the fitness of the species Homo Sapiens. In turn, these modifications exert new selective pressures that have effects both on the biological and on the cultural level (e.g., values, preferred and rewarded traits). In recent years, many applications of NCT arose outside of evolutionary theorising. Principles of niche construction have been applied to cultural differences and heritage (KENDAL 2011; LALAND, & O’BRIEN 2011; YAMAGISHI, & HASHIMOTO 2016), to modern economy (DEW & SARASVATHY 2016), to individual developmental processes and its social context (FLYNN et al. 2013), and on the psychological level to interpersonal relationships, for example friendships (BAHNS et al. 2016; PAPADOPOULOU 2016). Niche construction seems to prevail as a universal phenomenon in every domain and at every level of the human-environment socio-ecological systems: both on the micro and the macro level, both on a life-span and on an evolutionary time scale.

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 84

T. MARTOS & V. SALLAY

If we come back to our main focus, we might ask whether the basic tenets of NCT may add new aspects to SDT (and especially to its application to work domain)? NCT emphasises the potential of lower level systems (e.g., organisms) being active agents towards higher level systems (the environment) in a way that would affect (benefit) the functioning of the lower level systems. As we pointed out earlier with reference to the interpersonal relationships, this circular effect largely lacks in the basic conceptualisations of SDT: social environment is assumed to be need satisfying or need thwarting to a certain extent but there is no theoretical feedback loop from the individual to its environment. However, if we look at work environments as constructed niches, we may hypothesise that they are partly dependent on the constructing processes of the subordinate system levels, that is, the employees and workgroups. Obviously, not all individuals have the same potential to influence their work environment: individual characteristics (e.g., dispositional autonomy, assertive competencies) and status capacities may help one to have more impact on the organisational processes than others. There is still a missing link and we believe that a niche construction approach could broaden the horizon of motivational and self-regulation processes at the workplace, just as a systemic view of interpersonal relationships adds to the understanding of close relationships and SDT. To give an example, GREGURAS and colleagues (2014) review several approaches to different forms of person-environment fits and misfits: person-organisation fit, person-job fit and person-group fit, among others. They argue that these fit experiences are important ingredients of the well-being and positive work functioning of the employees on the one side and they may be results of a need supporting environment on the other. While these processes are fundamental to the self-determination theoretical description of a work environment, the reader still asks whether there are alternative routes for employees to reach a congruence between their self and their work conditions, job demands or the functioning of their team. The authors themselves do not confront this question explicitly; however, they still identify social network theory as a guiding principle that helps to understand how employees and their relationships contribute to the different fits. Individuals are not alone, they are embedded in a network of strong ties and this gives them a certain amount of freedom in shaping their conditions. This way, social networks are vehicles of a niche construction process â&#x20AC;&#x201C; and they are themselves niches as well. It is important to note that besides profiting from the above outlined aspects of NCT, SDT may also offer a lot for the future models of psychological niche construction. If we accept the notion that basic psychological needs are universal then search for and support for need satisfaction can serve as basic interpersonal rules that make some social niche construction processes successful or else they can provide explanations for failures of others.

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 85

SELF-DETERMINATION THEORY

7. Self-determination Theory: conclusions While our special concern was to give an overview on two recently issued edited books on Self-determination Theory, we also wished to put this living and developing branch of theories into a broader context. Both basic assumptions of Relationship science and Niche Construction Theory are supportive of SDT when they emphasise the importance of a supporting environment in individual functioning; however, both approaches provide also an alternative route where individuals actively contribute to their own environmental conditions by selecting and/or altering them. Researchers and theorists in the SDT tradition did excellent job in investigating several aspects of self-regulation and its social contexts. However, it is a good opportunity for the next generation that there are still a lot of things both about love and work that have to be understood. References ARON, E.N. & A. ARON (1996) ‘Love and the Expansion of the Self: The State of the Model’, Personal Relationships 3, 45–58 (DOI: 10.1111/j.1475-6811.1996.tb00103.x). ASSOR, A., Y. KANAT-MAYMON & G. ROTH (2014) ‘Parental Conditional Regard: Psychological Costs and Antecedents’ in N. WEINSTEIN, ed. (2014) 215–37. BAHNS, A.J., C.S. CRANDALL, O. GILLATH, & K.J. PREACHER (2016) ‘Similarity in Relationships as Niche Construction: Choice, Stability and Influence within Dyads in a Free Choice Environment’, Journal of Personality and Social Psychology, n.p. (DOI: 10.1037/pspp0000088). BOWLBY, J. (1969) Attachment (New York: Basic Books). CHIRKOV, V. (2014) ‘The Universality of Psychological Autonomy across Cultures: Arguments from Developmental and Social Psychology’ in N. WEINSTEIN, ed. (2014) 27–51. CSÍKSZENTMIHÁLYI, M. (1991) Flow: The Psychology of Optimal Experience (New York: Harper). DECI, E.L. & R.M. RYAN (1985) ‘The General Causality Orientations Scale: Self-Determination in Personality’, Journal of Research in Personality 19, 109–34. DECI, E.L. & R.M. RYAN (2008) ‘Facilitating Optimal Motivation and Psychological Well-Being across Life’s Domains’, Canadian Psychology/Psychologie canadienne 49, 14–23. DECI, E.L. & R.M. RYAN (2014) ‘Autonomy and Need Satisfaction in Close Relationships: Relationships Motivation Theory’ in N. WEINSTEIN, ed. (2014) 53–73. DECI, E.L., R.M. RYAN, P.P. SCHULTZ & C.P. NIEMIEC (2015) ‘Being Aware and Functioning Fully: Mindfulness and Interest-Taking within Self-Determination Theory’ in K.W. BROWN, J.D. CRESWELL & R.M. RYAN, Handbook of Mindfulness: Theory, Research, and Practice (New York: Guilford) 112–29. DEW, N. & S.D. SARASVATHY (2016) ‘Exaptation and Niche Construction: Behavioural Insights for an Evolutionary Theory’, Industrial and Corporate Change 25, 167–79. FINKEL, E.J. & G.M. FITZSIMONS (2011) ‘The Effects of Social Relationships on Self-Regulation’ in K.D. VOHS & R.F. BAUMEISTER, eds. Handbook of Self-Regulation: Research, Theory, and Applications (New York: Guilford) 390–406. FINKEL, E.J. & J.A. SIMPSON (2015) ‘Editorial Overview: Relationship Science’, Current Opinion in Psychology 1, 5–9. FITZSIMONS, G.M. & E.J. FINKEL (2011) ‘The Effects of Self-Regulation on Social Relationships’ in K.D. VOHS & R.F. BAUMEISTER, eds. Handbook of Self-Regulation: Research, Theory, and Applications (New York: Guilford) 407–21.

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 86

T. MARTOS & V. SALLAY

FITZSIMONS, G.M., E.J. FINKEL & DELLEN, M.R. van (2015) ‘Transactive Goal Dynamics’, Psychological Review, 122, 648–73. FLYNN, E.G., K.N. LALAND, R.L. KENDAL & J.R. KENDAL (2013) ‘Target Article with Commentaries: Developmental Niche Construction’, Developmental Science 16, 296–313. GAGNÉ, M., ed. (2014) Oxford Handbook of Work Engagement, Motivation, and Self-Determination Theory (Oxford: Oxford UP). GREGURAS, G.J., J.M. DIEFENDORFF, J. CARPENTER & C. TRÖSTER (2014) ‘Person-Environment Fit and Self-Determination Theory’ in M. GAGNÉ, ed. (2014) 143–61. GUAY, F., C.F. RATELLE, S. LAROSE, R.J. VALLERAND & F. VITARO (2013) The Number of Autonomy-Supportive Relationships: Are More Relationships Better for Motivation, Perceived Competence, and Achievement?’ Contemporary Educational Psychology 38, 375–82 (DOI: 10.1016/j.cedpsych. 2013.07.005). HAERENS, L., N. AELTERMAN, M. VANSTEENKISTE, B. SOENENS & S. Van PETEGEM (2015) ‘Do Perceived Autonomy-Supportive and Controlling Teaching Relate to Physical Education Students’ Motivational Experience Through Unique Pathways? Distinguishing between the Bright and Dark Side of Motivation’, Psychology of Sport and Exercise 16, 26–36 (DOI: 10.1016/j.psychsport.2014.08.013). KELLEY, H.H., J.G. HOLMES, N.L. KERR, H.T. REIS, C.E. RUSBULT & P.A.M. Van LANGE (2003) An Atlas of Interpersonal Situations (New York: Cambridge UP). KENDAL, J.R. (2011) ‘Cultural Niche Construction and Human Learning Environments: Investigating Sociocultural Perspectives’, Biological Theory 6, 241–50. KNEE, C.R., B. PORTER & L.M. RODRIGUEZ (2014) ‘Self-Determination and the Regulation of Conflict in Romantic Relationships’ in N. WEINSTEIN, ed. (2014) 139–58. LA GUARDIA, J.G. & H. PATRICK (2008) ‘Self-Determination Theory as a Fundamental Theory of Close Relationship’, Canadian Psychology/Psychologie canadienne 49, 201–09. LA GUARDIA, J.G. & H. PATRICK (2014) ‘The Influence of the Social Environment on Health Behavior’ in N. WEINSTEIN, ed. (2014) 299–316. LALAND, K.N. & M.J. O’BRIEN (2011) ‘Cultural Niche Construction: An Introduction’, Biological Theory 6, 191–202. MARTOS, T. & M. KOPP (2012) ‘Life Goals and Well-Being: Does Financial Status Matter?’ Social Indicators Research 105, 561–68. ODLING-SMEE, F.J., K.N. LALAND & M.W. FELDMAN (2003) Niche Construction: The Neglected Process in Evolution (Princeton: Princeton UP). PAPADOPOULOU, M. (2016) ‘The “Space” of Friendship: Young Children’s Understandings and Expressions of Friendship in a Reception Class’, Early Child Development and Care 186, 1544–58 (DOI: 10.1080/03004430.2015.1111879). PATRICK, H., C.R. KNEE, A. CANEVELLO & C. LONSBARY (2007) ‘The Role of Need Fulfillment in Relationship Functioning and Well-Being: A Self-Determination Theory Perspective’, Journal of Personality and Social Psychology 92, 434–57. PELLETIER, L.G. & N.M. AITKEN (2014) ‘Encouraging Environmental Actions in Employees and in the Working Environment: A Self-Determination Theory Perspective’ in M. GAGNÉ, ed. (2014) 314–34. PRIVETTE, G. (1983) ‘Peak Experience, Peak Performance, and Flow: A Comparative Analysis of Positive Human Experiences’, Journal of Personality and Social Psychology 45, 1361–68. RATELLE, C.F. & S. DUCHESNE (2014) ‘Trajectories of Psychological Need Satisfaction from Early to Late Adolescence as a Predictor of Adjustment in School’, Contemporary Educational Psychology 39, 388–400 (DOI: 10.1016/j.cedpsych.2014.09.003).

EJMH 12:1, June 2017

05_SDT_review_Junius 2017.05.23. 9:13 Page 87

SELF-DETERMINATION THEORY

REIS, H.T., K.M. SHELDON, S.L. GABLE, J. ROSCOE & R.M. RYAN (2000) ‘Daily Well-Being: The Role of Autonomy, Competence, and Relatedness’, Personality and Social Psychology Bulletin 26, 419–35. ROTH, G. & M. WEINSTOCK (2013) ‘Teachers’ Epistemological Beliefs as an Antecedent of Autonomy-Supportive Teachin’, Motivation and Emotion 37, 402–12 (DOI: 10.1007/s11031-0129338-x) RYAN, R.M. & K.W. BROWN (2003) ‘Why we don’t Need Self-Esteem: On Fundamental Needs, Contingent Love, and Mindfulness’, Psychological Inquiry 14, 71–76. RYAN, R M. & E.L. DECI (2000a) ‘Self-Determination Theory and the Facilitation of Intrinsic Motivation, Social Development, and Well-Being’, American Psychologist 55, 68–78. RYAN, R M. & E.L. DECI (2000b) ‘The Darker and Righter Sides of Human Existence: Basic Psychological Needs as a Unifying Concept’. Psychological Inquiry 11, 319–38. RYAN, R.M., J.H. BERNSTEIN & K.W. BROWN (2010) ‘Weekends, Work, and Well-Being: Psychological Need Satisfactions and Day of the Week Effects on Mood, Vitality, and Physical Symptoms’, Journal of Social and Clinical Psychology 29, 95–122. RYAN, R.M., J.G. LA GUARDIA & L.J. RAWSTHORNE (2005) ‘Self-Complexity and the Authenticity of Self-Aspects: Effects on Well Being and Resilience to Stressful Events’, North American Journal of Psychology 7, 431–48. RYAN, R.M., K.M. SHELDON, T. KASSER & E.L. DECI (1996) ‘All Goals are not Created Equal: An Organismic Perspective on the Nature of Goals and their Regulation’ in P.M. GOLLWITZER & J.A. BARGH eds., The Psychology of Action: Linking Cognition and Motivation to Behavior (New York: Guilford) 7–26). SAGER, J. (1976) Marriage Contracts and Couple Therapy (New York: Brunner/Mazel). SHELDON, K.M. (2014) ‘Becoming Oneself: The Central Role of Self-Concordant Goal Selection’, Personality and Social Psychology Review 18, 349–65. SHELDON, K.M., & L. HOUSER-MARKO (2001) ‘Self-Concordance, Goal-Attainment, and the Pursuit of Happiness: Can there be an Upward Spiral?’ Journal of Personality and Social Psychology 80, 152–65. WEINSTEIN, N., ed. (2014) Human Motivation and Interpersonal Relationships: Theory, Research, and Applications (Dordrecht etc.: Springer). WEINSTEIN, N. & C.R. DEHAAN (2014) ‘On the Mutuality of Human Motivation and Relationships’ in N. WEINSTEIN, ed. (2014) 7–26. WEINSTEIN, N., A.K. PRZYBYLSKI & R.M. RYAN (2012) ‘The Index of Autonomous Functioning: Development of a Scale of Human Autonomy’, Journal of Research in Personality 46, 397– 413. WONG, M.M. (2000) ‘The Relations among Causality Orientations, Academic Experience, Academic Performance, and Academic Commitment’, Personality and Social Psychology Bulletin 36, 315–26. YAMAGISHI, T. & H. HASHIMOTO (2016) ‘Social Niche Construction’, Current Opinion in Psychology 8, 119–24.

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 88

European Journal of Mental Health 12 (2017) 88–103 DOI: 10.5708/EJMH.12.2017.1.6

EVA MOROVICSOVÁ*, ANTON HERETIK SR., ANTON HERETIK JR. & IGOR ŠKODÁČEK

HISTORY OF PSYCHOTHERAPY IN SLOVAKIA (Received: 22 August 2016; accepted: 10 December 2016)

Authors present the history of psychotherapy in Slovakia. The first section refers to the social requirements for psychology and psychotherapy development. The history of psychotherapy alone is analysed in three stages of development. The first stage includes the years 1918–1945, where, related to the activities of the Clinic of Psychiatry and Neurology of the Faculty of Medicine of Comenius University in Bratislava, we come across the first attempts at applying psychotherapeutic approaches in medical practice and in the training of physicians. The second developmental stage (1945–1989) introduces individuals that significantly influenced the development of psychotherapeutic theories and their application in individual fields of clinical practice. They simultaneously show the contribution of the training school SUR to the development of psychotherapy in Slovakia. The most significant changes in the aspect of domestication and development of psychotherapy in Slovakia happened in the last characterised stage, in the period following the Velvet Revolution in 1989. The previously almost unavailable psychotherapeutic literature became available and psychotherapy was gradually introduced into the undergraduate and postgraduate education of physicians and other professionals. The first Slovak Society of Psychotherapy was founded and became a common ground for professionals in this field. In the final section of this paper, the authors present current questions and problems of the development, research and application of psychotherapy in Slovakia and briefly characterise the influence of legislation changes and reforms in healthcare on the position of psychotherapy. Keywords: history, 20–21th century, psychotherapy, psychology, psychiatry, communism, dictatorship, helping profession, Slovakia Geschichte der Psychotherapie in der Slowakei: Die Verfasser stellen die Geschichte der Psychotherapie in der Slowakei dar. Im ersten Teil geht es um die gesellschaftlichen Voraussetzungen nach den drei Phasen ihrer Entwicklung behandelt. Die erste Phase umfasst den Zeitraum von 1918 bis 1945. Damals fanden im Zusammenhang mit den Aktivitäten der Klinik für Psychiatrie und

Corresponding author: Eva Morovicsová, Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava and University Hospital Bratislava – Old Town, Mickiewiczova 13, SK 813 69 Bratislava, Slovakia; eva.morovicsova@fmed.uniba.sk.

06_History_PST_Junius 2017.05.23. 9:22 Page 89

HISTORY OF PSYCHOTHERAPY IN SLOVAKIA

Neurologie der Medizinischen Fakultät der Comenius-Universität in Bratislava die ersten Versuche der Anwendung psychotherapeutischer Ansätze in der medizinischen Praxis und bei der Ausbildung von Ärzten statt. In der zweiten Entwicklungsphase (1945–1989) traten Persönlichkeiten auf, die die Entwicklung psychotherapeutischer Theorien und ihrer Anwendung in den einzelnen Bereichen der klinischen Praxis erheblich beeinflusst haben. Sie zeigen zugleich den Beitrag der Ausbildungsstätte SUR zur Entwicklung der Psychotherapie in der Slowakei. Die bedeutendsten Veränderungen hinsichtlich der Etablierung und der Entwicklung der Psychotherapie in der Slowakei erfolgten in der letzten der drei Phasen, in der Zeit nach der Samtenen Revolution im Jahr 1989. Zuvor beinahe unzugängliche psychotherapeutische Literatur wurde zugänglich, und die Psychotherapie wurde schrittweise in die postgraduale Ausbildung von Ärzten und anderen Fachleuten integriert. Die erste Slowakische Gesellschaft für Psychotherapie wurde gegründet und wurde zur gemeinsamen Basis der in diesem Bereich tätigen Fachleute. Im abschließenden Teil des Beitrags zeigen die Verfasser aktuelle Fragen und Probleme der Entwicklung der Psychotherapie in der Slowakei, der Forschung in diesem Bereich und der Anwendung der Psychotherapie in der Slowakei. Außerdem gehen sie kurz auf die Auswirkungen von Gesetzesänderungen und Reformen im Gesundheitswesen auf die Stellung der Psychotherapie ein. Schlüsselbegriffe: Geschichte, 20–21. Jahrhundert, Psychotherapie, Psychologie, Psychiatrie, Kommunismus, Diktatur, helfende Berufe, Slowakei

1. Social requirements for the development of psychology, psychiatry and psychotherapy in Slovakia Since the end of the 10th century until 1918, Slovakia was a part of the Hungarian Kingdom, and since 1526 of the Habsburg Monarchy that was formed by uniting the Austrian countries, the Czech Kingdom, and Hungary into one state under the rule of the Habsburg dynasty. The first universities in Hungary (Pécs 1367, Óbuda 1395, Pozsony/Pressburg/Bratislava 1465) survived only for a few years, thus higher education and culture was influenced by students returning from universities abroad, mainly from neighbouring countries, where universities existed continually since the second half of the 14th century (Prague, Cracow, Vienna). However, there is also evidence of students attending more distant universities in Italy or Western Europe. These graduates could be the first to introduce a certain segment of psychologically focused knowledge, although it is impossible to speak about specialised education in psychology at medieval universities. The study of the psyche received, however, more space within the study of philosophy and theology at newer Jesuit universities, including the university in Trnava (Nagyszombat, Tyrnau) founded by Cardinal Peter Pázmány in 1635. The first two faculties of the university were the Faculty of Arts and the Faculty of Theology. The Faculty of Law was added in 1667 and later the Faculty of Medicine in 1769 (ŠIMONČIČ & HOLOŠOVÁ 2010; BOKESOVÁ-UHEROVÁ 1962). Philosophical thinking and, thus, psychological knowledge was influenced mainly by the Neo-Scholastic version of the teachings of Aristotle, catholic theology, and later, especially following the enlightened reforms of Maria Theresa, by the eclectic reception of the elements of modern philosophy and natural sciences. Among

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 90

E. MOROVICSOVÁ, A. HERETIK SR., A. HERETIK JR. & I. ŠKODÁČEK

the Trnava University professors, psychological knowledge is found in the works of the Jesuit polymath Martin Szentiványi in the 17th century and then mainly in the works of the representatives of the mentioned Enlightenment movement, professors of philosophy and natural sciences (A. Reviczky, A. Jaszlinszky, J. Ivanchich, J. B. Horváth and others) (MARCINKECH 1986). In 1777, Trnava University was relocated to Buda and the only college in the territory of today's Slovakia was the Mining Academy in Banská Štiavnica (Schemnitz), founded in 1762. As this school was a technical type of college, we cannot expect lectures or research in psychology. The Elizabeth University was founded in Bratislava in 1912, but the organisational procedures lasted years and were heavily restricted by World War I. Lectures at the Faculty of Arts started in the summer semester of 1917/1918, and at the Faculty of Medicine even later, in the academic year 1918/1919, and only in the clinical study programs. Although it was an institution with the potential to focus also on modern trends in psychiatry, after unsuccessful negotiations with the new Czechoslovak government the school was relocated to Hungary in 1919. At medieval and Jesuit universities classes were in Latin. The use of national languages in university classes and science was introduced by the Enlightenment movement, which was also shown in the rise of national academies and other scientific or cultural institutions, especially in the 19th century. In regard to the Slovak language, this trend was applied only marginally due to the lack of national institutions, e.g., academies. Although attempts to nurture sciences, including psychology, existed within the national cultural society, Matica slovenská, and in the Slovak national movement, due to the strong Magyarisation in the country in the last decades of the 19th century and a fragmented national movement, these initiatives were never brought to fruition (HOLLÝ 2013). From the national point of view, more favourable conditions for Slovaks arose only after the foundation of the Czechoslovak Republic in 1918. Nevertheless, a whole group of experts with Slovak origins found success before that at research centres in Budapest, Vienna, or other foreign scientific centres. Foundation of the Czechoslovak Republic in 1918 brought free usage of the national language on the one hand, and, on the other hand, caused rupture of old ties in the economic and cultural fields and it became necessary to create new relationships in these areas. In place of the Hungarian Elizabeth University, Czechoslovak national university was founded in 1919, which bore the name of J.A. Comenius since November 1919. The Faculty of Medicine was the first out of the four faculties founded (FALISOVÁ 2010). Shortly thereafter the Faculties of Arts, of Law, and of Theology were founded, however, the Faculty of Natural Sciences established by law was not de facto founded until 1940. Comenius University was established by Czech professors who gradually educated their Slovak successors. The fate of the university, and of the whole republic, was influenced by politics, even on an international level. In October 1938, the Slovak autonomy was announced, and in March 1939, heavily assisted by Nazi Germany, the Slovak State was established – the Slovak Republic, according to the later adopted constitution. Hitler’s army occupied Bohemia and Moravia and, by announcing the protectorate Böhmen und Mähren, finished the dis-

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 91

HISTORY OF PSYCHOTHERAPY IN SLOVAKIA

integration of Czechoslovakia. Due to these events there were other changes in the system of education, science and also healthcare. Especially in 1938–1939, the majority of Czech government officials had to leave Slovakia, including teachers and doctors. They were replaced by Slovak experts, in some cases ensuring continuity, in others, however, discontinuity of a promising development. Even crueller was the fate of those removed by violence due to the anti-Jewish laws, which is one of the darkest chapters in Slovak history. Naturally, this ideology had a negative influence on the approach to some modern schools in psychiatry. After World War II the existence of the Czechoslovak Republic was renewed, however, after a short period of repairing war damages, the political establishment entered the road towards Stalinist dictatorship. This was the result of a communist coup d'état in February 1948 that led to the Sovietisation of the country and to the establishment of a totalitarian power represented by the Communist Party. This period of history ended with the Velvet Revolution in November 1989, while attempts to weaken this hegemony during the events of the so called Prague Spring were brutally suppressed when the armies of the Soviet Union and the Warsaw Pact occupied Czechoslovakia in August 1968. In regard to the development of psychology, psychiatry and especially psychotherapy, the worst damage was caused by the Communist Party ideology that adamantly rejected all alternative methods and brought the country to economic and also substantial scientific isolation. Western scientific literature was difficult to obtain, travelling to and scientific contact with western countries was restricted, and often attempts to apply alternative methods had to be carried out in secret or semi-legally. Substantial change was brought by the non-violent revolution in November 1989 which ended the period of communist totalitarianism and steered Czechoslovakia ‘back to Europe’, back to parliamentary democracy. On January 1, 1993, two republics, the Czech and the Slovak, embarked on their independent journeys, but their similar political systems, their membership in the EU and especially their refusal of any violent ideologies fully opened the gate for the application of psychotherapy and other progressive movements in schooling, research and the application sphere (ČAPLOVIČ et al. 2000). 2. Psychotherapy in Slovakia in the years 1918–1945 The beginnings of psychotherapy in Slovakia are closely related to the activities of the Clinic of Psychiatry and Neurology at the Faculty of Medicine UK in Bratislava. This clinic provided psychiatry classes, at first only as lectures, but later practical classes were also added. The Czech professor Zdeněk Mysliveček was named head of the clinic on 29/9/1919 and he remained in this function until 1930. He wrote the first university textbooks of general and specialised psychiatry and was interested also in forensic psychiatry. He emphasised the importance of supportive psychotherapy in addition to increasing the effect of current treatment (MOROVICSOVÁ 2013).

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 92

E. MOROVICSOVÁ, A. HERETIK SR., A. HERETIK JR. & I. ŠKODÁČEK

A step in the right direction for the domestication of psychotherapy in Slovakia was that in the academic year 1921/1922 the syllabus of general medicine included the subject ‘Vybrané kapitoly z pathologickej psychologie s demonstraciami’ (Selected chapters from pathological psychiatry with demonstrations) (Soznam prednášok UK 1921/22, 6). Classes comprised demonstrations of interesting cases and case studies, supplemented by analyses and explanations of significant causes of mental disorders in specific patients. In the following years, this subject was again absent from the syllabus (MOROVICSOVÁ 2012, 158). When prof. Z. Mysliveček left for the Faculty of Medicine of Charles University in Prague, other Czech professors took over the clinic, Miroslav Křivý in 1930–1937 and Stanislav Krákora in 1937–1939, who was one of those Czech employees dismissed due to Slovakisation. The aforementioned Czech professors raised the first generation of Slovak psychiatrists during their time at the clinic and these gradually entered the process of classes, primarily practical classes. Among them were, e.g., physicians Antonín Pekelský, Karol Hlava, Ľudmila Radimská-Jandová, Ignác Matis, František Gašpar, Ján Prokop, Karol Matulay and others. The merit of the Czech professors in raising Slovak psychiatrists, but also physicians and intelligentsia in general, is really significant (MOROVICSOVÁ 2012). The first Slovak professor of psychiatry was Karol Matulay (1906–2002) (MATULAY, K., Osobný spis, Archív UK). After graduating from the Faculty of Medicine of Comenius University in Bratislava he worked as an assistant at the Clinic of Psychiatry and following the mentioned dismissal of Czech professors he took over as the head of the clinic. As the head of the clinic in 1939–1945 he made some radical changes in the treatment of mental patients. He removed cells, introduced routine treatment, active work and sports therapy, art therapy, and he founded the children’s ward. He gradually introduced active mental therapy also in the psychiatric hospital in Pezinok (TICHÝ & SEDLÁČKOVÁ 1996). The hospital was founded on the initiative of Professor Z. Mysliveček in the old spa compound in 1925 and was managed under the clinic. It served the treatment of chronic mental patients (BENIAK et al. 1989). The outcome of his research work in regard to psychotherapy are the works Liečenie duševných chorôb zamestnaním (Work therapy in the treatment of mental disorders), Chronická schizofrénia a možnosti jej rehabilitácie (Chronic schizophrenia and possibilities of rehabilitation), Sociálne problémy zamestnania dospelých epileptikov (Social problems of employing adults suffering from epilepsy), Cvičná terapia nervových porúch (Training therapy of neural disorders), Liečebná telesná výchova a rehabilitácia v psychiatrii (Healing physical education and rehabilitation in psychiatry), Mentálna retardácia (Mental retardation), and others (TICHÝ & SEDLÁČKOVÁ 1996). Without any obvious reasons he was dismissed from the position of Head of the Clinic of Psychiatry of the Slovak University in May 1945 and was completely made redundant in 1946 (MATULAY, K., Osobný spis, Archív UK). Following his dismissal from the Clinic of Psychiatry of the Faculty of Medicine of Comenius University in Bratislava he worked at the psychiatric hospital in Pezinok. In ergotherapy, which was an essential part of treatment, he was striving for activity with a concrete and practically applicable outcome. The patients treated with ergotherapy wove and sewed carpets among other things. He

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 93

HISTORY OF PSYCHOTHERAPY IN SLOVAKIA

also encouraged the founding of a psychiatric hospital for chronic mental patients in Veľké Leváre, where he also used psychotherapy in the treatment of mental disorders. He was one of the first to use the autogenous training of J. H. Schulze in the treatment of neurotic patients. When the Jessenius Faculty of Medicine in Martin was founded, he participated in establishing the faculty’s Clinic of Psychiatry (CIFFRA & HULÍN 1982). Attempts to use psychotherapy in clinical practice are already present in the inter-war period in the treatment of chronic alcohol abusers in the detoxification centres in Tuchlov and in Istebné nad Oravou, being the first institutions of this kind. The preferred methods were work therapy, bibliotherapy and music therapy. Work therapy focused on activities keeping the centres running. In the winter it was mainly workshop activities. There were daily physical trainings, walks or even day trips (KOŇAŘÍK 1924). Bibliotherapy and music therapy took place usually in the evenings. According to the director of the detoxification centre in Istebné (KRAUS 1965), treatment consisted of individual and group therapy. The essence of individual psychotherapy was a personal interview by the director and the centre physician with the patient and their family, and group therapy comprised a set of lectures. As opposed to Hungary, psychoanalysis was introduced slowly to Slovakia. The Society for Psychoanalysis had already been founded by S. Ferenczi in Budapest in 1913. And Bratislava, former Pozsony/Pressburg, lies only 50 km away from Vienna, the city were Sigmund Freud, the founder of psychoanalysis, lived and worked. He even spent some holidays in the Slovak mountains. He regularly visited the High Tatras, however, he went there for picking mushrooms and not introducing psychoanalysis. Psychoanalysis pioneers in Bohemia were Russian expats B. Dosužkov and N. J. Osipov. The Czechoslovak Society for the Study of Psychoanalysis was accepted only after the arrival of O. Fenichel in Prague in 1935. However, the most well-known Czech psychoanalyst Jaroslav Stuchlík (1890–1967) was active in Slovakia (in Košice and Bratislava) in the inter-war period. He published first works on psychoanalysis; moreover, he was also interested in hypnosis, the principles of mental hygiene, and the application of projection methods (the Rorschach test of associations) in clinical psychodiagnostics. As a private assistant professor, he gave lectures in general psychopathology and psychotherapy (Zoznam prednášok UK 1946/47–1947/48) at the Faculty of Medicine of Comenius University in Bratislava in the after war period (in the academic years 1946/47–1947/48). Psychoanalysis became politically undesirable during the Slovak State (1939–1945), when not only the Czech, but, due to adopted racial laws, the Jewish physicians were also forced to leave the country. 3. History of psychotherapy in the years 1945–1989 The rise of the Communist regime in 1948 and the ideological dictate of the Soviet Union resulted in radical changes on the psychotherapeutic scene in Slovakia in the 1950s. Psychology was denounced as a ‘bourgeois pseudoscience’ and replaced by I. P. Pavlov’s teachings on higher neural activity. Only those psychotherapeutic methods

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 94

E. MOROVICSOVÁ, A. HERETIK SR., A. HERETIK JR. & I. ŠKODÁČEK

were accepted that could be explained by reflexology theory, e.g., hypnosis (as partial sleep) or aversive therapy for alcohol abusers, where the effective mechanism was interpreted as conditioned conditioning. Psychoanalysis was written about in critical nature, emphasising its reductionism and pansexualism. Psychotherapy alone during the communist regime did not have almost any support and its regional development encountered many obstacles. Fear because of the communists was too large, sometimes larger than the real danger was. Several academics and other professionals were well-informed and they had a wealth of knowledge in this field, but they were afraid of openly disseminating the theory and practice of psychotherapy, as well as other knowledge coming from the west. Some professionals addressed this problem of being devoted to western theories by using other names or by using different modifications of these theories. For example, Ernest Guensberger in his textbook of psychiatry and medical psychology, while writing about the ego-defense mechanisms, termed them generally as ‘mechanisms of personality’ (‘mechanizmy osobnosti’) (GUENSBERGER et al. 1963). Ondrej Kondáš labelled his methodology as discent psychotherapy, although he was devoted to the cognitive and, respectively, the cognitive-behavioral directions (KONDÁŠ 1973). The softening of the ideological oppression in the 1960s gave new life to the psychotherapy scene. Prof. Ernest Guensberger (1912–1987) was then the head of the Clinic of Psychiatry at the Faculty of Medicine of Comenius University in Bratislava, and he supported the interest in psychotherapy. In addition to clinical hypnosis and narcoanalysis, he also pioneered the use of behavioural psychotherapy methods. He focused on the theoretical questions of psychotherapy; however, his primary focus was on rational psychotherapy and treatment by conditioning. He had no deeper interest in group psychotherapy (FLEISCHER 1997). His experience with psychotherapy in treatment of mental disorders was published in co-authorship with his successor, Ján Molčan (MOLČAN & GUENSBERGER 1979) and other colleagues (J. Pogády, T. Čaplová, J. Fleischer). Professor J. Molčan focused primarily on psychofarmacology. However, he published also works on psychotherapy, mainly on music therapy and work therapy (MOLČAN 1954; 1955; 1957). He gave a lecture on relaxation psychotherapeutic methods within the psychotherapy workshop on 6/5/1965 in Bratislava (MOLČAN, Osobný spis, Archív UK). Credit for the development of behavioural psychotherapy is given to Professor Ivan Žucha (1935–2009). He developed the method of systematic desensitisation in thiopental subnarcosis (BÁRDOŠ, HERETIK & ŽUCHA 1976). Žucha authored several great essays and philosophic reflections on important questions of psychiatry, society and his own experience in psychotherapy (ŽUCHA 1991; 1997; 1999a; 1999b; 2000). Other university textbooks, scientific papers and studies focusing on psychotherapy were written together with doc. Tatiana Čaplová (ŽUCHA & ČAPLOVÁ 1999; 2003; 2006; 2007). Psychologists have contributed significantly to the rise and development of psychotherapy. Professor Ondrej Kondáš (1930–2002) is considered as the founder of psychotherapy in Slovakia. He elaborated a complex behavioural approach in psychotherapy, later labelled as discent psychotherapy (with the name originating in the

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 95

HISTORY OF PSYCHOTHERAPY IN SLOVAKIA

Latin term disco, discere – to learn) (KONDÁŠ 1973). Professor Kondáš obtained basic clinical experience while working at the Psychiatric hospital in Veľké Leváre and at the Clinic of Psychiatry at the Faculty of Medicine of Comenius University in Bratislava. His theory of discent psychotherapy was fully developed at the Department of Psychological Sciences at the Faculty of Arts of Comenius University in Bratislava. He taught special classes of the Basics of Re-education, Psychotherapy and Rehabilitation since the academic year 1960/61, which later became a compulsory class (Zoznam prednášok na FF UK 1961/62–1968/69). Discent psychotherapy is based on the theory of learning and relies also on critically re-evaluated findings of behavioural therapy in regard to cognitive processes (KONDÁŠ et al. 1989). His specific approach to the psychotherapy of neuroses, stage fright, and stammering was miles ahead of the development of cognitive-behavioural psychotherapy (KONDÁŠ 1983). In addition to behaviour modification methods he also emphasised the analysis of life history and work with intervening variables – attitudes and irrational beliefs (KONDÁŠ & KORDAČOVÁ 2000). A significant role in the development of psychotherapy in Slovakia was played by an excellent – even in Bohemia – training school. Stanislav Kratochvíl (*1932) founded a ward for the treatment of neuroses 18B in the Psychiatric hospital in Kroměříž. The unique model of neurosis treatment by means of group and community psychotherapy is used to this day. The ward simultaneously became an unofficial training base for group psychotherapy. Moreover, Kratochvíl also organised hypnosis, relaxation methods, and functional sexual neurosis treatment classes that were attended by many physicians and psychologists even from Slovakia (KRATOCHVÍL 2012). Psychotherapy was the main interest not only on academic grounds within the undergraduate training of physicians, psychologists, and in the postgraduate training of healthcare professionals but also directly in clinical practice. Psychiatrists in cooperation with clinical psychologists attempted more and more to apply psychotherapy in the treatment of patients in psychiatric hospitals and in several areas of somatic medicine. The form and content of psychotherapy were given by the nature of the mental disorder and somatic disease. Psychiatrists and psychologists in various fields of clinical practice for children and adults used group therapy. In the Daycare psychiatric sanatorium in Bratislava, group therapy was used since 1976. Credit for its implementation and development is given to Z. Gešová, M. Odehnalová, N. Križková, L. Klenovský and others. The principles of group therapy were also applied to the work with dissocial and pre-delinquent youths in the Research Institute for Child Psychology and Pathopsychology in Bratislava. Active in this area were J. Kožnar, J. Štúrová, S. Martínková, Š. Matula, K. Lukáčová and others. Several institutions use adult group psychotherapy in the treatment of addictions, e.g., the psychiatric hospitals in Veľké Zálužie, Hronovce, Pezinok and other facilities. At the rehabilitation ward in Veľké Zálužie, individual groups for psychotics and alcohol abusers were introduced, and practical application of group psychotherapy can be attributed to M. Kabátová and A. Imrišková. In the psychiatric hospital in Pezinok, the modelling of psychotherapeutic processes was the focus of

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 96

E. MOROVICSOVÁ, A. HERETIK SR., A. HERETIK JR. & I. ŠKODÁČEK

J. Pogády, and the rehabilitation of psychoses was the focus of C. Škoda and K. Matulay. Matulay elaborated his experience in this area further as the head of the Clinic of Psychiatry of Jessenius Faculty of Medicine of Comenius University in Martin. Together with H. Nagyová a M. Skaličanová they obtained positive results with hypnosis in the treatment of dermatologic patients. Positive effects of psychotherapy in the treatment of addictions were also achieved by doctors at the Psychiatry ward in Nitra, where it had been a long-term focus of P. Csáder and J. Stempelová, in the treatment of psychosomatic disorders by S. Heřmánek, E. Borzová and M. Arpáš. Psychotherapy was used in neurosis treatment also in Hronovce, where the therapy group for neurotics was led by P. Molnár. With time, psychotherapy became more common in other institutions as well. J. Lehotský and M. Šlepecký introduced psychotherapeutic procedures to the Psychiatry ward in Liptovský Mikuláš, J. Hašto did it in Trenčín and R. Máthé in Nové Zámky. Gradually, psychotherapy began to flourish also at the newly founded Faculty of Medicine at the Pavol Jozef Šafárik University in Košice, especially thanks to such names as J. Medvecký, J. Kafka, A. Stančák and others. There were supporters of psychotherapy also in the psychiatric hospital in Prešov and in other facilities. In addition to the treatment of mental disorders, psychotherapy found its field of application in the treatment of psychosomatic disorders. For example, V. Zikmund used hypnosis in the treatment of psychosomatic disorders at the Institute of Normal Physiology of Slovak Academy of Sciences and at the Faculty of Medicine of Comenius University. L. Ličko applied psychotherapy in the treatment of ulcerous diseases and enuresis in children, and L. Kamenčík and V. Wohlandová did so in working with children at the psychological-educational clinic. Psychotherapy gradually found its place also in surgical and internal medicine, where it became an important element of pre-op preparation of patients before surgery. M. Verner elaborated its use in orthopedics, D. Brucháč and A. Marišová in the psychoprophylactic preparation for child delivery. V. Zikmund and E. Borzová focused on the use of psychotherapy in internal medicine, and S. Heřmánek in rheumatology (KONDÁŠ et al. 1989). Moreover, V. Zikmund was also involved in education. At the Faculty of Medicine of Comenius University in Bratislava he gave lectures on psychophysiology and psychosomatics within elective classes for Psychophysiology of Mental Health since 1971 (Zápisnica z Kolégia dekana, Archív UK). In the late 1960s, a semi-legal initiative, the SUR training school, arose, completely outside of the official academic structures. It was founded by psychiatrists Jaroslav Skála (1916–2007), Jaromír Rubeš (1918–2000) and psychologist Eduard Urban (1928–2001). They were devoted to group psychotherapy. The substance of the SUR educational model was to gain experience with self-awareness in a large group (training community) and in a small group as part of the community. The educational model was divided into four to five years. During the training year the whole community met for weekly stays, which were followed by four weekend meetings of small groups (KALINA et al. 2008). Young psychotherapists from Slovakia were joining into this long-term community trainings. For example, in 1982, a five-year train-

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 97

HISTORY OF PSYCHOTHERAPY IN SLOVAKIA

ing under the leadership of J. Rubeš and P. Příhoda included about 15 psychiatrists and psychologists. J. Štúrová, J. Kožnar and J. Hašto also followed the model ‘SUR’ led groups focused on self-awareness. It was also in the years 1980–1987 that the so called ‘federal community F1’ active. Its leader was J. Skála and his systematic nature made him maintain an equal ratio of physicians and psychologists, men and women, Czechs and Slovaks in the group. Thus, SUR played a decisive role not only in resolving fights for competence in psychotherapy among psychiatrists and psychologists, but also in popularising the eclectically focused group psychotherapy in Slovakia. Almost all Slovak psychotherapists of the middle and older generation are SUR graduates. Analogical trainings for psychiatric nurses in Slovakia were led by Peter Breier. Trained nurses had to participate as co-therapists, particularly in psychiatric wards and psychiatric sanatoriums. P. Breier, in the 80s of the last century, also initiated the introduction of the Balint supervisory groups in Slovakia. The so-called F group (F – as in Freud) was also active in Slovakia. Its members, Jozef Hašto, Jana Štúrová, Peter Breier, and others, held regular ‘apartment classes’. These focused on education in theories and methods of psychoanalysis (BŽOCH 2007). In the years 1977–1978 there was another group in Slovakia, led by J. Štúrová, which focused on self-awareness in the so-called ‘psycho-gymnastics’ for psychiatrists and psychologists working in the psychiatric hospital in Pezinok. The method was similar to concentrative movement therapy, developed by H. Junová and F. Knobloch in Prague. In the late ‘80s of the last century, P. Breier and J. Hašto tried to establish a section for group psychotherapy within the Psychiatric Association , which was to provide training seminars for psychiatrists, psychologists and psychotherapists. The then management of the Psychiatric Association did not support this effort. In the 1970s and ‘80s, psychodynamic literature was distributed only in the form of samizdats, which were secretly translated and distributed works (VYBÍRAL & ROUBAL 2010). This was also the way texts for training in psychotherapy as well as some scientific publications were published. For example, the psychological counselling centre in Bratislava, led by J. Gabura, published a monograph of J. KOŽNAR (1992) Skupinová dynamika (Group dynamics). J. Hašto at the psychiatric department in Trenčín even published an edition Otázky duševného zdravia (Mental health issues), in which several monographs in the field of depth psychology were published. 4. Psychotherapy after the Velvet Revolution in 1989 Sociopolitical changes after 1989 brought a radical turn within the field of psychotherapy in four different aspects (HERETIK & HERETIK jr. 2004, HERETIK 2007): Availability of psychotherapeutic literature. Already in the first decade after the revolution classic works of psychotherapy by S. Freud, C.G. Jung, V. Frankl, C. Rogers and others were swiftly published, for up till then only 30-50 year-old works had been available. Synthesising works on current integrative psychotherapy were also published

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 98

E. MOROVICSOVÁ, A. HERETIK SR., A. HERETIK JR. & I. ŠKODÁČEK

(PROCHASKA & NORCROSS 1999). Czech publishing houses like Portál, Grada, Triton and the Slovak publishing house Vydavateľstvo F, founded by J. Hašto, have published up-to-date books on all significant directions in psychotherapy. Undergraduate study. The elimination of ideological restrictions significantly widened the horizons of future psychotherapists. In addition to the compulsory psychotherapy class, students of psychology can participate in many elective classes on all significant schools and methods. At the Department of Psychology at the Faculty of Arts of Comenius University in Bratislava, these include, e.g., introduction to psychoanalysis, person centred approach (PCA), short-term dynamic psychotherapy, family and systemic therapy, Gestalt therapy, art therapy, imaginative methods in psychotherapy, and cognitive-behavioural psychotherapy. These classes are taught experientially and, hopefully, personal experience will help in choosing the appropriate training form after receiving the Master’s degree. Elective classes in psychotherapy are also in the curriculum of faculties of medicine or in the study of social work and nursing care. Postgraduate study. Already before the Velvet revolution in 1989, foreign psychotherapeutic institutions started coming to Slovakia and offer experience workshops of their approaches. The first to come was the PCA institute under Rogers’ student CH. Devonshire. Many other foreign institutes and lecturers started pouring to Slovakia after 1990 and were opening long-term trainings. In addition to PCA, these included trainings in Gestalt therapy, Process oriented psychotherapy, Short-term psychoanalytic oriented psychotherapy, Concentrative movement psychotherapy, Family and systemic psychotherapy, Kathatym imaginative psychotherapy, Logotherapy, Adlerian Individual psychotherapy and others. In all of these and many other psychotherapeutic schools, Slovak training centres were created that organise trainings and provide lecturers with theoretical classes, self-experience, supervision, and individual training therapy. At present, education of psychotherapists is under the patronage of the Slovak Institute for Education in Psychotherapy (SIVP), currently under the leadership of Pavol Černák (*1949), director of Pinel’s hospital in Pezinok. SIVP is the only institution accredited by the Ministry of Health SR to license certified psychotherapists. Slovak Psychotherapist Society (SPS). It was founded as an individual expert society already in 1990, independent of medical and psychological institutions. The first president, and one of the founders, was Jozef Hašto (*1949), at that time holding the position of senior consultant of the Clinic of Psychiatry of the Trenčín University in Trenčín. His long-term interest has been psychodynamic psychotherapy, hypnosis, autogenic training and lately even the problems of attachment and mentalisationbased treatment. Other presidents of the society were Anton Heretik, Jana Vránová, Pavol Černák and Zita Michlerová. SPS fills the role of expert society and organises common biannual Czecho-Slovak psychotherapeutic conferences, the venue being alternately in the Czech Republic or Moravia and the Slovak Republic. Simultaneously, it performs the function of a professional organisation as the appointment of an individual Chamber of Psychotherapists was not ratified in the parliament (prob-

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 99

HISTORY OF PSYCHOTHERAPY IN SLOVAKIA

ably due to political reasons). The SPS committee prepared a draft of the Act on Psychotherapy and later the Accreditation paper for education in psychotherapy as a certified activity. SPS is a collective member of the European Association of Psychotherapy (EAP) and has adopted its Ethical codex. Individual members can receive a European certificate in psychotherapy after meeting the given criteria. 5. Current scene and trends in psychotherapy in Slovakia The latest survey of the Slovak psychotherapy environment was conducted in 2003 (HERETIK & HERETIK jr. 2004). The survey in the SPS bulletin was answered by 110 respondents, approximately a fifth of the members. Psychotherapists in Slovakia are unevenly distributed in regard to gender, undergraduate education, years of practice and region of employment. The sample comprised 77.3% women and 23.7% men. 60% of the respondents were psychologists, 25.4% were physicians, and 24.6% were experts with other undergraduate education. Distribution of years of practice was uneven with two peaks around 5 and 25 years of practice after graduation. Almost a half of all psychotherapists work in the Bratislava region, around 10% in the KoĹĄice region, and the other six regions of Slovakia are represented by around 5% of the psychotherapists. Up to 47.1% of respondents practice psychotherapy in a non-state medical facility or private practice. 81.8% of the participants had attended long-term trainings in psychotherapy: 40% in dynamic psychotherapy, 18.2% in cognitive-behavioural therapy; and other methods were represented by less than 10%. Short-term trainings focused mainly on such methods as hypnosis, relaxation techniques, individual methods of cognitive-behavioural, systemic psychotherapy, and non-verbal techniques. Regarding theoretical focus, 57.3% of the respondents listed dynamic psychotherapy, 33.0% cognitive-behavioural therapy, 25.2% suggestive methods, 19.4% Katathym imaginative psychotherapy, 14.6% systemic psychotherapy, and 9.7% Rogersian therapy. Results are in many aspects comparable to the findings of Prochaska and Norcross (1999) in the USA, including the differences between psychologists and psychiatrists. However, there are also schools, e.g., classic psychoanalysis and interpersonal psychotherapy, which are practically non-existent in our region. The current representation of different schools of psychotherapy is best reflected in the list of institutions providing education and training in psychotherapy, under the patronage of SPS (SPS 2016). They are listed in Appendix I. 6. Discussion and Conclusion Psychotherapy as a scientific discipline and psychotherapy as a practically applied form of treatment has undergone a very dramatic development, especially in the last 25 years. In many aspects it has narrowed the gap that the unfavourable ideological

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 100

100 E. MOROVICSOVÁ, A. HERETIK SR., A. HERETIK JR. & I. ŠKODÁČEK and socio-economic situation in the country had created in psychiatry. Nevertheless, the following topics remain open or problematic: Low intensity of research in psychotherapy. The Slovak Republic still lacks an institution that would focus systematically on the study of the effect or process of psychotherapy. Moreover, this research is probably the most methodologically complex among applied sciences on man. Published papers have the form of reviews or case studies and that is too little in the current, evidence-based science. Striking exceptions are the few dissertation theses, in which the problem of psychotherapy is well processed and approached, e.g., by high-quality methodology. In addition, several synthesising works of Slovak authors on the research in psychotherapy have been published (e.g., TIMUĽÁK 2003, TIMUĽÁK 2008). Legislative issues. Repeated attempts to implement the act on the Chamber of Psychotherapists SR and psychotherapeutic activity failed due to various reasons. Thus, the SPS focused on legalising psychotherapy as an activity certified by the Ministry of Health SR. This process was concluded in 2008. However, the patronage of the Ministry of Health SR over psychotherapy also has its drawbacks. There is too much paperwork involved in order to organise trainings and education in psychotherapy. Psychotherapy cannot be practised by educated and trained psychotherapists who are not registered as healthcare professionals but as social workers or remedial teachers due to their undergraduate major. Impact of socio-economic conditions and the healthcare reform. Experience with a permanent healthcare reform shows that cost-saving measures endanger mental health care primarily. The opinion, that psychotherapy is not a natural part of complex healthcare but a ‘luxury’ to be financed by the patients themselves, is steadily circulating in our society. Besides, the uneven regional availability of psychotherapy, concerning especially the economically less developed regions of Slovakia, is obvious from the above cited review. References BÁRDOŠ, M., A. HERETIK & I. ŽUCHA (1976) ‘K možnostiam terapeutického použitia systematickej desenzitizácie a jej modifikácií’, Bratislavské lekárske listy 66, 421–25. BENIAK, M., L. KAPUSTA, M. REMIŠOVÁ & M. TICHÝ (1989) Fakultná nemocnica Bratislava 1864– 1989 (Bratislava: Alfa). BOKESOVÁ-UHEROVÁ, M. (1962) Lekárska fakulta Trnavskej univerzity (1770–1777) (Bratislava: VEDA). BŽOCH, A. (2007) Psychoanalýza na periférii; K dejinám psychoanalýzy na Slovensku (Bratislava: Kaligram). ČAPLOVÁ, T. (1999) Propedeutiku medicínskej psychoterapie (Bratislava: Univerzita Komenského). ČAPLOVIČ, D., V. ČIČAJ, D. KOVÁČ, Ľ. LIPTÁK & J. LUKAČKA (2000) Dejiny Slovenska (Bratislava: Academic Electronic Press). CIFFRA, J. & I. HULÍN (1982) Lekárska fakulta Univerzity Komenského v Bratislave 1919–1979 (Bratislava: Alfa).

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 101

HISTORY OF PSYCHOTHERAPY IN SLOVAKIA

101

FALISOVÁ, A. (2010) Lekári na Slovensku do roku 2000 (Bratislava: VEDA). FLEISCHER, J. (1997) Klinicko-psychopatologické problémy (Bratislava: Psychiatrická klinika LFUK a FN, Lundbeck). GUENSBERGER, E. et al. (1963) Všeobecná psychiatria a základy medicínskej psychológie (Bratislava: SPN). HERETIK, A. & A. HERETIK jr. (2004) ‘Súčasná psychoterapeutická scéna v SR (výsledky ankety členov SPS)’, Psychiatria 11, 32–37. HERETIK, A. (2007) ‘História klinickej psychológie’ in A. HERETIK & A. HERETIK jr., eds., Klinická psychológia (Nové Zámky: Psychoprof) 23–38. HOLLÝ, K. (2013) Veda a slovenské národné hnutie: Snahy o organizovanie a inštitucionalizovanie vedy v slovenskom národnom hnutí v dokumentoch 1863–1898 (Bratislava: Historický ústav SAV). KALINA, K., I. DOUDA, H. KLÍMOVÁ, J. KROMBHOLZ, P. POPOV, J. RŮŽIČKA & J. VODŇANSKÁ (2008) ‘Spravedlivý jako palma kvést bude: Jaroslav Skála – zakladatel české adiktologie’, Zaostřeno na drogy 6, 1–12. KOŇAŘÍK, B. (1924) ‘O Tuchlově’, Vyšší národ 5, 4, 28–30. KONDÁŠ, O. & J. KORDAČOVÁ (2000) Iracionalita a jej hodnotenie (Bratislava: Stimul). KONDÁŠ, O., S. KRATOCHVÍL & E. SYŘIŠŤOVÁ (1989) Psychoterapia a reedukácia (Martin: Osveta). KONDÁŠ, O. (1973) Discentná psychoterapia, 2. vyd. (Bratislava: SAV). KONDÁŠ, O. (1983) Zajakavosť. Psychologický rozbor a terapia (Bratislava: SPN). KOŽNAR, J. (1992) Skupinová dynamika: Teorie a výzkum (Praha: Karolinum). KRATOCHVÍL, S. (2012) Základy psychoterapie (6th ed., Praha: Portál). KRAUS, E. (1965) ‘Liečenie alkoholizmu v Abstinentnej liečebni v Istebnom nad Oravou’, Protialkoholický obzor 1, 14–16. MARCINKECH, A.J. (1986) ‘K psychologickému mysleniu na Trnavskej univerzite’ in M. NOVACKÁ ed., Trnavská univerzita v dejinách školstva a vzdelanosti (Bratislava: Slovenská pedagogická knižnica). MATULAY, K. Osobný spis. Archív UK v Bratislave. Fond RUK – Personálne oddelenie. Osobné spisy pedagogických pracovníkov, spis č. 63. MOLČAN, J. Osobný spis. Archív UK v Bratislave. Fond RUK – Personálne oddelenie. Osobné spisy pedagogických pracovníkov, spis č. 132. MOLČAN, J. (1954) Muzikoterapia pre ošetrovateľov [Pezinské ošetrovateľské príručky] (Pezinok). MOLČAN, J. (1955) ‘Muzikoterapia v psychiatrickom zariadení’, Neurologie a psychiatrie Československá 18, 220. MOLČAN, J. (1957) ‘Liečenie zamestnávaním’ in E. GUENSBERGER, E. O. BORODIN, G. DOBROTKA, G. HORKOVIČ, A. JANÍK, J. MASÁRIK, J. MOLČAN, J. POGÁDY, O. TESAŘOVÁ, M. TURČEK & V. ZIKMUND, eds., Všeobecná psychiatria, 2. vyd. (Bratislava: SPN) 384–92. MOLČAN, J. & GUENSBERGER, E. (1979) ‘Verhältniss der Pharmakotherapie und Psychotherapie bei Psychosen’, Agressologie, 20, 283–85. MOROVICSOVÁ, E. (2012) ‘Začiatky výučby psychiatrie na Lekárskej fakulte Univerzity Komenského v Bratislave’ in I. VOJTEKOVÁ, V. OZOROVSKÝ, E. DOBIÁŠOVÁ & R. KNEZOVIĆ, eds., Fragmenty z dejín medicíny, farmácie a veterinárnej medicíny: zborník vedeckých prác (Bratislava: Kancelária WHO na Slovensku) 157–59. MOROVICSOVÁ, E. (2013) ‘Pôsobenie českých lekárov na Psychiatrickej klinike LF UK v Bratislave’ in R. SLABOTINSKÝ & P. STÖHROVÁ, eds., Po stopách zdraví a nemoci člověka a zvířat, II: K historii a současnosti medicíny, farmacie a veterinárního lékařství (Brno: Technické muzeum v Brně) 98–105.

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 102

102 E. MOROVICSOVÁ, A. HERETIK SR., A. HERETIK JR. & I. ŠKODÁČEK MOROVICSOVÁ, E. & KOŘÍNKOVÁ, V. (2015) ‘Činnosť Psychiatrickej kliniky Lekárskej fakulty Univerzity Komenského v Univerzitnej nemocnici Bratislava – Staré Mesto v rokoch 1864– 2014’, Česká a slovenská psychiatrie, 111, 314–23. PROCHASKA, J.O. & NORCROSS, J.C. (1999) Psychoterapeutické systémy (Praha: Grada). SOZNAM prednášok a soznam osôb a ústavov UK v Bratislave, 1921/22, 6. Archív UK v Bratislave. ŠIMONČIČ, J. & A. HOLOŠOVÁ (2010) Dejiny Trnavskej univerzity 1635–1777. 1992–2010. (Trnava: TU v Trnave). TICHÝ, M. & E. SEDLÁČKOVÁ (1996) Prof. MUDr. K. Matulay. Nestor slovenskej psychiatrie a neurológie. (Bratislava: JUGA). TIMUĽÁK, L. (2003) ‘Súčasné trendy vo výskume psychoterapie II. Výskum procesu psychoterapie’, Česká a slovenská psychiatrie 99, 4, 194–202. TIMUĽÁK, L. (2008) Research in Psychotherapyand Counseling (London: Sage). VYBÍRAL, Z. & J. ROUBAL (2010) Současná psychoterapie (Praha: Portál). ZÁPISNICA z Kolégia dekana LF UK zo dňa 4. novembra 1971, 5. Archív UK v Bratislave. Fond LF UK. ZOZNAM osôb, ústavov a prednášok v školských rokoch 1946/47–1947/48. Bratislava: Akademický senát Slovenskej univerzity v Bratislave. Archív UK v Bratislave. ZOZNAM prednášok na Filozofickej fakulte v študijných rokoch 1961/62–1968/69. Bratislava: Filozofická fakulta UK. Archív UK v Bratislave. ŽUCHA, I. (1991) ‘Psychoterapia’ in F. KLIMO, J. BUCHVALD, I. BURAN, J. FLEISCHER, V. GALANDA, I. HUDEC, E. KIŠŠKOVÁ, Ľ. LISÝ, F. MAKAI, J. MIHALE, V. MOKRÁŇ, J. MOLČAN, Z. OLÁH, D. OROLIN, P. PEKAROVIČ, A. PEKAROVIČOVÁ, K. PORADOVSKÝ, V. SEDLÁK, J. STRELKA, P. ŠPALEK, K. TRÁVNIK, M. VALENT, D. ŽITŇAN & I. ŽUCHA, eds., Všeobecné lekárstvo 4 (Martin: Osveta) 419–40. ŽUCHA, I. (1997) Zápisník psychiatra Ivana Žuchu (Bratislava: Slovak Academic Press). ŽUCHA, I. (1999a) ‘O filozofovaní v psychiatrii’, Psychiatria, 6, 132–33. ŽUCHA, I. (1999b) ‘Veľmi inteligentný pacient – problém pre psychoterapeuta’, Bratislavské lekárske listy, 100, 525. ŽUCHA, I. (2000) ‘Filozofia a psychoterapia, psychoterapia a filozofia’, Psychiatria 7, 172–73. ŽUCHA, I. & T. ČAPLOVÁ (1999) Propedeutika medicínskej psychoterapie (Bratislava: Univerzita Komenského). ŽUCHA, I. & T. ČAPLOVÁ (2003) ‘K problémom psychoterapeutickej praxi na Slovensku’, Medicínsky monitor 9, 36. ŽUCHA, I. & T. ČAPLOVÁ (2006) ‘Frustrácia: Medicínsko-psychologická úvaha’, Psychiatria 13, 1–2, 3–5. ŽUCHA, I. & T. ČAPLOVÁ (2007) ‘Stigma: Medicínsko-psychologická úvaha’, Psychiatria – Psychoterapia – Psychosomatika 14, 3–4.

EJMH 12:1, June 2017

06_History_PST_Junius 2017.05.23. 9:22 Page 103

HISTORY OF PSYCHOTHERAPY IN SLOVAKIA

103

APPENDIX List of institutions offering psychotherapeutic training in SR ABC Slovenský inštitút pre výcvik v KBT Dialóg Slovenský inštitút pre výcvik v Gestalt psychoterapii Inštitút krátkodobej psychoanalytickej psychoterapie Inštitút Virginie Satirovej v Slovenskej republike Košický inštitút pre systemickú skúsenosť ISZ KEPCA Inštitút PCA ISTER POPI Slovensko – Inštitút proces orientovanej psychológie SIPP Slovenský inštitút psychodynamickej psychoterapie Slovenská spoločnosť pre katatýmne-imaginatívnu psychoterapiu Slovenská spoločnosť pre koncentratívnu pohybovú terapiu Slovenský inštitút pre supervíziu /SIPS/ Slovenský inštitút pre psychotraumatológiu a EMDR (SIPE) Slovenský inštitút logoterapie (SILOE) Inštitút pre výcvik v relaxačnej a symbolickej psychoterapii

EJMH 12:1, June 2017

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 104

European Journal of Mental Health 12 (2017) 104–115 DOI: 10.5708/EJMH.12.2017.1.7

MAHDI ABDOLAHZADEH RAFI, NARGES ADIBSERESHKI* & MARYAM HASANZADEH AVAL

THE MEDIATING ROLE OF EARLY MALADAPTIVE SCHEMAS IN RELATIONSHIPS OF EMOTIONAL MALTREATMENT AND EMOTIONAL DISORDERS** (Received: 13 September 2016; accepted: 2 April 2017)

Although the consequences of emotional maltreatment have not been extensively investigated, experiences of emotional maltreatment or abuse have been associated with powerful and enduring psychological problems. The purpose of this study was to explore the extent to which emotional maltreatment contributed to emotional disorders, and the role of Early Maladaptive Schemas (EMS) in relationships of emotional maltreatment and emotional disorders in pre-adolescents. This study used the correlation-modelling design. A total of 492 junior high students participated in the study. The emotional abuse or maltreatment questionnaire made by NOROUZI (2012), the Achenbach self-report emotional disorders questionnaire preadolescence form (ACHENBACH & RESCORLA 2001), and the Early Maladaptive Schemas questionnaire (RIJKEBOER& DE BOO 2010) were used to measure and analyse emotional maltreatment and EMS in the students. The findings indicated that emotional maltreatment can directly lead to emotional disorders (anxiety, affective disorder) and schemas such as loneliness, submission and vulnerability. Emotional maltreatment was a significant predictor of emotional disorders. Findings of this study can inform parents and those who treat children in negative ways (maltreatment) of their impact on children’s emotions and of the negative outcomes. Keywords: emotional maltreatment or abuse, early maladaptive schemas, emotional disorders, anxiety, affective disorder

Corresponding author: Narges Adibsereshki, Faculty of University of Social Welfare and Rehabilitation Sciences & Pediatric Neurorehabilitation Research Center, Evin, Daneshjoo BLV. Kodakyar Street, Tehran, Iran; n.adib@hotmail.com. Acknowledgment: Thanks to University of AllamehTabatabai, Education administration, students, personnel and teachers of schools who helped us in this study.

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 105

THE MEDIATING ROLE OF EARLY MALADAPTIVE SCHEMAS

105

Die Mittlerrolle früher maladaptiver Schemata in Beziehungen mit emotionalem Missbrauch und bei emotionalen Störungen: Obwohl die Folgen emotionaler Misshandlung noch nicht eingehend untersucht wurden, konnten Zusammenhänge zwischen dem Erleben emotionaler Misshandlung oder emotionalen Missbrauchs und ausgeprägten und andauernden psychischen Problemen hergestellt werden. Mit der Studie sollte das Ausmaß ermittelt werden, in dem emotionale Misshandlungen zur Entstehung emotionaler Störungen beigetragen haben, und festgestellt werden, welche Rolle frühe maladaptive Schemata (EMS) hinsichtlich der Beziehung zwischen emotionaler Misshandlung und emotionalen Störungen in der Vorpubertät spielen. Für die Studie wurde ein Korrelationsmodell verwendet. Insgesamt nahmen 492 Schüler im Alter von 12bis 15 Jahren an der Studie teil. Zur Ermittlung und Analyse von emotionaler Misshandlung und EMS bei den Schülern wurden der Fragebogen zu emotionalem Missbrauch oder emotionaler Misshandlung von NOROUZI (2012), Achenbachs Selbstbeurteilungsfragebogen zu emotionalen Störungen in der Vorpubertät (ACHENBACH& RESCORLA2001) und der Fragebogen zu den Early Maladaptive Schemas (RIJKEBOER & DE BOO 2010) eingesetzt. Die Ergebnisse legen nahe, dass emotionale Misshandlung unmittelbar zu emotionalen Störungen (Angststörungen, affektiven Störungen) sowie Schemata wie Einsamkeit, Unterwerfung und Verletzlichkeit führen kann. Emotionale Misshandlung war ein wichtiger Prädiktor für emotionale Störungen. Die Ergebnisse dieser Studie können Eltern und anderen, die Kinder schlecht behandeln (Misshandlung), bewusst machen, was für einen Einfluss sie auf die Emotionen und die negative Entwicklung der Kinder haben. Schlüsselbegriffe: emotionale Misshandlung oder emotionaler Missbrauch, frühe maladaptive Schemata, emotionale Störungen, Angst, affektive Störung

1. Introduction Literature in the area of emotional disorders indicates that about one in every three to four children suffer from a mental disorder and that about one in ten has a Serious Emotional Disturbance (BRAUNER & STEPHENS2006, COSTELLO, EGGER, ANGOLD 2005; MERIKANGAS et al. 2010). This also extends to adolescents, where data suggest that 20 percent of adolescents have a diagnosable mental disorder (SCHWARZ 2009). GLASER (2002, 697) states, ‘Emotional abuse and neglect are defined as a carerchild relationship that is characterised by patterns of harmful interactions, requiring no physical contact with the child’. Studies about the cause and development of emotional disorders reveal that the role of families could be very important in this matter (SKUS et al. 1998; SHAFFER, YATES & EGELAND 2009; SHENK, NOLL & CASSARLY 2010; WEKERLE et al. 2009). There are different parent-child relationships, ranging from good to maladaptive, damaging and abusive ones. Emotional abuse/maltreatment describes a relationship between the parents and the child which is harmful causing impairment to the child’s psychological/emotional health and development (GLASER 2002). It might be the most prevalent form of child maltreatment, and also the most hidden, under-reported, and least studied form of abuse (BARNET et al. 2005). Emotional maltreatment/abuse could have negative impacts on the development and functionality of children and cause problems such as unsafe attachment, low self-control and self-esteem, aggression, rejection by peers, depression, educational problems, and

EJMH 12:1, June 2017

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 106

106

M. ABDOLAHZADEH RAFI, N. ADIBSERESHKI & M. HASANZADEH AVAL

physical illnesses like headaches, digestive and heart difficulties (TIETJEN et al. 2010, 2007; RAMIRO et al. 2010; KLEIN, et al. 2007; HUND & ESPELAGE 2006; ZANARINI 2000; CULLERTON-SEN et al. 2008; HAMARMAN 2000; ROGOSCH & CICCHETTI 2004; VARIA et al. 1996; DUNCAN 2000; HART et al. 1998; HERRENKOHL & HERRENKOHL 2007; POWERS et al. 2009; GIBB et al. 2007). Emotional disorders in adolescents could be caused by emotional maltreatment/abuse (SHAFFER et al. 2009; SHENK et al. 2010; WEKERLE et al. 2009). Emotional maltreatment has a strong link with self-depression and self-anxiety associations (VAN HARMELEN et al. 2010). Young’s theory about the formation of personal and psychological problems in individuals (YOUNG et al. 2003) indicates five emotional needs of a human being and explains how unmet needs could result in forming maladaptive schemas and then psychological problems: 1) secure attachments (includes safety, stability, nurturance, and acceptance), 2) autonomy, competence, and sense of identity, 3) freedom to express valid needs and emotions, 4) spontaneity and play, 5) realistic limitations and self-control. Of course, fulfilling all needs of individuals would be important, but because of the cognitive, physical and social changes that occur during the adolescent years, meeting all these emotional needs seems impossible. Emotional maltreatment might be an obstacle for indulging the emotional needs. For example, a child forms representational models of attachment figures of the self, and of self-in-relation to others based on his or her relationship with primary caregivers (BOWLBY 1982). If within a child’s mind, the maladaptive models of the self develops as unworthy, incompetent, powerless or bad instead of the self as worthy of love and attention, he/she could be at risk for psychological distress (LIEM & BOUDEWYN 1999; PERRY et al. 2007; WRIGHT 2009). Findings reveal that the perceptions of childhood emotional abuse and neglect each influence later symptoms of anxiety and depression. This relationship is mediated by some schemas (HORNOR 2012). Schemas are individuals’ prior experiences that influence current perceptions, thinking, and behaviour. WRIGHT and colleagues (2009) state that the way a person evaluates and internalises experiences is even more important than the events themselves in determining their long-term impact. Limited work has been done to examine the mediating mechanism in the link between childhood maltreatment and later adaptations. However, the link has been found between early child maltreatment and subsequent internalising symptoms of depression and anxiety with self-criticism (SACHS-ERICSSON et al. 2006). This means self-criticism has been found to mediate the relationship between maltreatment and subsequent mental illness symptoms. SACHS-ERICSSON and colleagues (2006) stated that selfcriticism mediates the relationship between childhood verbal abuse perpetrated by parents and symptoms of anxiety or depression. WRIGHT and colleagues (2009) also support Sach-Ericsson’s findings, mentioning that childhood emotional abuse is significantly associated with a negative cognitive attribution style (GIBB 2002) and negative self-schemas mediate the relationship between emotional abuse and internalising disorders (GIBB et al. 2001; HANKIN 2005). HANKIN (2005) studied childhood maltreatment as a risk factor for depression through three mechanisms as mediators. He

EJMH 12:1, June 2017

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 107

THE MEDIATING ROLE OF EARLY MALADAPTIVE SCHEMAS

107

showed that a childhood history of maltreatment predicted an elevation of depressive symptoms and that a negative cognitive style, attachment style, and negative events accounted for the link between child maltreatment and later depressive symptoms. GIBB and colleagues (2001) indicated that levels of childhood emotional maltreatment related to the level of depression and that cognitive risks fully mediated the relation between childhood emotional maltreatment and major depression. Unfortunately, the number of incidents of maltreatment are high and sometimes the consequences are irreparable. The role of schemas as mediators in this process is not clear enough; that is why giving some attention to this area and extending such studies seems necessary. This study aims to investigate the mediating role of early maladaptive schemas in the link of adolescence emotional maltreatment and emotional disorders. 2. Methods 2.1. Participants There were 600 students recruited from middle schools (7th and 8th grades). 35 students who had some kind of learning disabilities or intellectual disabilities, and those who had not filled out the questionnaires completely were not included in the study. The participants were 492 students: 183 boys (37.2%) and 309 girls (62.8%). In terms of grades, 264 students (53.7%) were in 7th grade and 228 (46.3%) in 8th grade. The mean for students’ age was 13.61± 0.682 for boys and 13.60± 0.572 for girls. 2.2. Instruments The emotional abuse or maltreatment: This questionnaire made by NOROUZI (2012) was used, which is based on HART and his colleagues’ (1998) definition of maltreatment, and GARBARINO and colleagues’ (1986), and ESTEBAN’s (2006) works. The formal and content validity is high, and internal consistency is reported as 0.96. The validity was also evaluated by ABDOLAHZADEH RAFI (2014) and MOHAMADKHANI and colleagues (2003; r = 0.720, p < 0.001). The reliability was measured by Cronbach’s alpha reported as 0.96. The Achenbach System of Empirically Based Assessment (ASEBA): This questionnaire was for the assessment of adolescence emotional disorders. MINAEy (2005) standardised this form of assessment (ACHENBACH & RESCORLA 2001) in Persian. There were three forms in which the adolescence self-reported form was used in this study. An internal correlation coefficient of 0.74 to 0.88 was reported. The emotional disorders: anxiety and depression (affective disorder) scales of this questionnaire were used. The Early Maladaptive Schemas questionnaire: This utilised scale was made based on Young’s work and designed by RIJKEBOER and DE BOO (2010). There were

EJMH 12:1, June 2017

EJMH 12:1, June 2017 0.468** 0.369** 0.275** 0.343** 0.039

0.533** 0.459** 0.376** 0.401**

Vulnerability 0.388**

0.365**

Defectiveness 0.430**

0.376**

0.399** 0.434**

0.453**

0.343**

Failure

Submission 0.324**

0.295**

0.426**

0.387**

Self-control

0.385**

0.334**

0.167**

Self-sacrifice 0.137**

0.344**

0.064

0.195**

0.363**

Enmeshment

Unrelent Standards p < 0.05

0.008

0.090*

0.035

Entitlement

Mistrust

Loneliness

0.550**

0.652**

0.665**

0.500**

0.683**

0.674**

0.577**

0.272**

0.104*

0.133**

0.641**

0.545**

0.647**

0.586**

0.635**

0.511**

0.560**

0.377**

0.015

0.475**

0.559**

0.454**

0.471**

0.419**

0.017

0.199**

0.465**

0.501** 0.206**

0.529**

0.369**

0.574**

0.581**

0.469**

0.234**

0.073

0.131**

0.298**

0.187**

0.006

0.171**

0.298**

0.186**

0.052

0.001

0.137**

0.022

0.076

0.364**

0.329**

0.199**

0.280**

0.462**

0.611**

0.514**

0.364**

0.586**

0.484****

108

Anxiety.DSM 0.411**

Emotional Abuse Affective.dis DSM

Table 1 Correlations between the variables

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 108

M. ABDOLAHZADEH RAFI, N. ADIBSERESHKI & M. HASANZADEH AVAL

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 109

THE MEDIATING ROLE OF EARLY MALADAPTIVE SCHEMAS

109

40 questions about childhood maladaptive schemas (Loneliness, Vulnerability to Harm or Illness, Mistrust/Abuse, Defectiveness/Shame, Unrelenting Standards, Enmeshment, Entitlement/Grandiosity, Insufficient Control, Failure, Submission, and Self-sacrifice) which were answered by students. Cronbach’s alpha was between 0.53 to 0.79. MONTEZERI and his colleague (2012) reported a = 0.73. For this study the agreement was obtained from the education administration office and its research committee. The assigned schools were introduced for the study. The schools invited the mothers to a meeting and the researcher informed them about the study and the secrecy of the results, except for those who engage with the study to learn more, and, in case of a problem, to get some help. Those who consented to the participation of their children and themselves signed a consent form. 3. Results This study used a correlation-modelling design. The relationships or links between the variables were found by correlation and a model that consisted of these links was made. Table 1 shows that there were significant positive relationships between emotional maltreatment and emotional disorders (anxiety and affective disorder) (p < 0.05). There was a positive correlation between emotional abuse and early maladaptive schemas (loneliness, vulnerability, mistrust, defectiveness, entitlement, enmeshment, self-sacrifice, self-control, submission, unrelenting standards; p < 0.05), and a positive link between maladaptive schemas and emotional problems (anxiety and affective disorder; p < 0.05). To evaluate the fit of each model, several subjective indices of goodness-of-fit were used. Table 2 shows that they were not appropriate for the suggested research model. Thus, the paths that were not statistically significant have been deleted and the model was tested again. Table 2 Fit indexes in models of relationships of parenting styles, anxiety disorders, and maladaptive schemas

X2=

Index

Statistic

p-value

Admissibility

Results

1933.26

> 0,001

> 0.05

Model isn’t fit

GFI

0.412

–

> 0.9

Model isn’t fit

RMSEA

0.359

–

< 0.08

Model isn’t fit

NFI

0.411

–

> 0.95

Model isn’t fit

chi-square statistic; CFI = Comparative Fit Index; GFI = Goodness Fit Index; RMSEA = Root Mean Square Error of Approximation; NFI = Normal Fit Index

EJMH 12:1, June 2017

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 110

110

M. ABDOLAHZADEH RAFI, N. ADIBSERESHKI & M. HASANZADEH AVAL

Changes were implemented in the model as demonstrated in Index Table 3. Fit indices were excellent for this model, X2 = 2.31, p < 0.05; RMSEA = 0.052, NNFI = 0.997, CFI = 0.998. Table 3 Corrected model of fitting indicators

X2=

Index

Statistic

p-value

Admissibility

Results

2.31

0.099

> 0,05

Model fits

GFI

0.998

–

> 0.9

Model fits

RMSEA

0.052

–

< 0.08

Model fits

NFI

0.997

–

> 0.95

Model fits

2.31, p < 0.05; RMSEA = 0.052, NNFI = 0.997, CFI = 0.998

Table 4 The direct and indirect impact of variables in fitted model Estimate

Standard Estimate

S.E.

C.R.

Submission

<---

Emotional. Abuse

0.044

0.343

0.005

8.080

***

Vulnerability

<---

Emotional. Abuse

0.064

0.388

0.007

9.335

***

Loneliness

<---

Emotional. Abuse

0.075

0.550

0.005

14.593

***

Anxiety.DSM

<--- Submission

0.070

0.149

0.024

2.921

0.003

Affective.DSM <--- Submission

0.151

0.168

0.036

4.215

***

Affective.DSM <--- Vulnerability

0.083

0.116

0.0026

3.127

0.002

<--- Loneliness

0.095

0.212

0.023

4.039

***

Affective.DSM <---

Emotional. Abuse

0.066

0.564

0.004

16.253

***

Anxiety.DSM

Emotional. Abuse

0.015

0.246

0.003

5.388

***

Anxiety.DSM

EJMH 12:1, June 2017

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 111

THE MEDIATING ROLE OF EARLY MALADAPTIVE SCHEMAS

111

Submission 0.168 0.149

0.343

Affective. DSM

0.564

Emotional Abuse

0.116 0.388

Vulnerability

0.246 0.550 0.212

Anxiety. DSM

Loneliness

Figure 1 Model: The direct and indirect (through schemas) impacts of emotional abuse on emotional disorders

The fitted model represents that emotional maltreatment impacts anxiety directly and through loneliness and submission schemas. It also has a direct impact on affective disorders and an indirect effect through vulnerability and submission schemas. 4. Discussion The results of this study indicate that emotional maltreatment influences emotional disorders directly and through some schemas as mediators which support past research by many authors (SHAFFER et al. 2009; SHENK et al. 2010; GIBB & ABELA 2008; LUMLEY & HARKNESS 2009; ABDOLAHZADEH RAFI 2014; LESSON & NIXON 2011)1. The mediation analysis suggested that early maladaptive schemas such as 1

There was a research project for University of Social Welfare and Rehabilitation Sciences, Tehran (2014), N. Adibsereshki: The mediating role of maladaptive schemas in mothersâ&#x20AC;&#x2122; parenting style and child anxiety disorders.

EJMH 12:1, June 2017

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 112

112

M. ABDOLAHZADEH RAFI, N. ADIBSERESHKI & M. HASANZADEH AVAL

loneliness, vulnerability to harm, and submission have an effective role on the relationship of emotional maltreatment and emotional disorders such as anxiety and affective disorders, which is consistent with WRIGHT and colleagues (2009) and CALVET 2014). WRIGHT and her colleagues (2009) focused on the extent to which experiencing emotional abuse by parents contributed to Young’s adult maladaptive outcomes in terms of anxiety, depression, and dissociation. The findings revealed that emotional abuse continued to exert an influence on later symptoms of anxiety and depression. This relationship was mediated by vulnerability to harm, shame, and self-sacrifice. CALVET (2014) assessed whether the influence of emotional abuse in depression and social anxiety is mediated by EMSs and the mechanisms that contribute to developing depression and social anxiety. The results for the case of depression indicated that mediation occurred through disconnection/rejection, and for social anxiety it occurred through other domains (CALVETE et al. 2013a; EBERHART et al. 2011; LUMLEY & HARKNESS 2007; ROELOFS et al. 2011; CALVETE et al. 2013b; HINRICHSEN et al. 2004). Emotional maltreatment may result in global, negative beliefs about the self (WRIGHT et al. 2009). When the parents have negative ways of interaction with their children, such as threatening, blaming, not loving/boycotting, rejecting, and put downs which are known as emotional maltreatments, the emotional needs of children cannot be met. These adolescents, not having the needed love and support, have beliefs they cannot do anything by themselves, and disappointment and hopelessness might dominate their minds and feelings. Since they feel incompetent and worthless, some maladaptive schemas may be formed, which then lead to emotional disorders such as anxiety and affective disorders. Limitations and future studies: The findings of this study were based on participants’ self-reported recalls of the incidences of their childhood maltreatment, rating of schemas, and psychological well-being. Longitudinal studies related to this area could have clearer results. Another limitation was that the sample was recruited from an almost homogeneous community and the results may not be generalised to all. Also, this study did not consider gender effects; future studies can look at this factor and emotional maltreatment, the severity of abuse on forming different schemas in boys and girls, and their impacts on their emotional disorders. References ABDOLAHZADEH RAFI, M. (2014) The Mediating Role of Individual, Social, and Family Support in the Relationships of Emotional Maltreatment and Emotional, Behavioural Disorders of Adolescence (PhD Dissertation, University of Allameh Tabatabai, Tehran). ACHENBACH, T.M. & L.A. RESCORLA (2001) Manual for the ASEBA School-Age Forms & Profiles (Burlington, VT: ASEBA). BARNET, O., C.L. MILLER-PERRIN & R.D. PERRIN (2005) ‘Child Psychological Maltreatment’ in O. BARNET, C.L. MILLER-PERRIN & R.D. PERRIN, eds., Family Violence across the Lifespan: An Introduction (2nd ed., Thousand Oaks, CA: Sage Publications) 151–78. BOWLBY, J. (1982) Attachment (2nd ed., London: Hogarth; New York: Basic Books).

EJMH 12:1, June 2017

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 113

THE MEDIATING ROLE OF EARLY MALADAPTIVE SCHEMAS

113

BRAUNER, C.B & C.B. STEPHENS (2006) ‘Estimating the Prevalence of Early Childhood Serious EmotionalBehavioural Disorders: Challenges and Recommendations’, Public Health Reports 121, 303–10. CALVET, E. (2014) ‘Emotional Abuse as a Predictor of Early Maladaptive Schemas in Adolescents: Contributions to the Development of Depressive and Social Anxiety Symptoms’, Child Abuse & Neglect 38, 735–46. CALVETE, E., I. ORUE & B.L. HANKIN (2013a) ‘Transactional Relationships among Cognitive Vulnerabilities, Stressors, and Depressive Symptoms in Adolescence’, Journal of Abnormal Child Psychology 41, 399–410 (DOI: 10.1007/s10802-012-9691-y). CALVETE, E., I. ORUE & B.L. HANKIN (2013b) ‘Early Maladaptive Schemas and Social Anxiety in Adolescents: The Mediating Role of Anxious Automatic Thought’, Journal of Anxiety Disorders 27, 278–88 (DOI: 10.1016/j.janxdis.2013.02.011). COSTELLO, E.J., H. EGGER & A. ANGOLD (2005) ‘10-Year Research Update Review: The Epidemiology of Child and Adolescent Psychiatric Disorders: I. Methods and Public Health Burden’, Journal American Academy Child Adolescent Psychiatry 44, 972–86. CULLERTON-SEN, C., A.R. CASSIDY, D. MURRAY-CLOSE, D. CICCHETTI, N.R. CRICK & F.A. ROGOSCH (2008) ‘Childhood Maltreatment and the Development of Relational and Physical Aggression: The Importance of a Gender-Informed Approach’, Child Development 6, 1736–51. DUNCAN, R.D. (2000) ‘Childhood Maltreatment and College Drop-Out Rates: Implication for Child Abuse Researcher’, Journal of Interpersonal Violence 9, 987–95. EBERHART, N.K., R.P. AUERBACH, J. BIGDA-PEYTON & J.R.Z. ABELA (2011) ‘Maladaptive Schemas and Depression: Tests of Stress Generation and Diathesis-Stress Models’, Journal of Social & Clinical Psychology 30, 75–104 (DOI: 10.1521/jscp.2011.30.1.75). ESTEBAN, E. (2006) ‘Parental Verbal Abuse: Culture-Apecific Coping Behavior of College Students in the Philippines’, Child Psychiatry & Human Development 36, 243–59 (DOI:10.1007/s10578-0050001-6). GARBARINO, J., E. GUTTMAN & J. SEELEY (1986) The Psychologically Battered Child: Strategies for Identification, Assessment, and Intervention (San Francisco, CA: Jossey-Bass). GIBB, B.E. &J.R.Z. ABELA (2008) ‘Emotional Abuse, Verbal Victimization, and the Development of Children’s Negative Inferential Styles and Depressive Symptoms’, Cognitive Therapy and Research 32, 161–76. GIBB, B.E., L. CHELMINSKI & M. ZIMMERMAN (2007) ‘Childhood Emotional, Physical, and Sexual Abuse, and Diagnoses of Depressive and Anxiety Disorders in Adult Psychiatric Outpatients’, Depression and Anxiety 24, 256–63 (DOI: 10.1007/s10608-006-9106-x). GIBB, B.E. (2002) ‘Childhood Maltreatment and Negative Cognitive Styles: A Quantitative and Qualitative Review’, Clinical Psychology Review 22, 223–46. GIBB, B.E., L.B. ALLOY, L.Y. ABRAMSON, D.T. ROSE, W.G. WHITEHOUSE, P. DONOVAN, M.E. HOGAN, J. CRONHOLM & S. TIERNEY (2001) ‘History of Childhood Maltreatment, Negative Cognitive Styles, and Episodes of Depression in Adulthood’, Cognitive Therapy and Research 25, 425–46. GLASER, D. (2002) ‘Emotional Abuse and Neglect (Psychological Maltreatment): A Conceptual Framework’, Child Abuse & Neglect 26, 697–714. HAMARMAN, S. & W. BERNET (2000) ‘Evaluating and Reporting Emotional Abuse in Children: ParentBased, Action Based Focus Aids in Clinical Decision-Making’, Journal of American Academy Child Adolescent Psychiatry 39, 928-30 (DOI: 10.1097/00004583-200007000-00023). HANKIN, B.L. (2005) ‘Childhood Maltreatment and Psychopathology: Prospective Tests of Attachment, Cognitive Vulnerability, and Stress as Mediating Processes’, Cognitive Therapy and Research 29,645–71. HART S., N. BINGGELI & M. BRASSARD (1998) ‘Evidence of the Effects of Psychological Maltreatment’, Journal of Emotional Abuse 1, 27–58. HORNOR, G. (2012) ‘Emotional Maltreatment’, Journal of Pediatric Health Care 26, 436–42.

EJMH 12:1, June 2017

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 114

114

M. ABDOLAHZADEH RAFI, N. ADIBSERESHKI & M. HASANZADEH AVAL

HERRENKOHL, T.I. &R.C. HERRENKOHL (2007) ‘Examining the Overlap and Prediction of Muliple Forms of Child Maltreatment, Stressors, and Socioeconomic Status: A Longitudinal Analysis of Youth Outcomes’, Journal of Family Violence 22, 553–62. HINRICHSEN, H., G. WALLER & F. EMANUELLI (2004) ‘Social Anxiety and Agoraphobia in the Eating Disorders: Associations with Core Beliefs’, Journal of Nervous and Mental Disease 192, 784–87. HUND, A.R. & D.L. ESPELAGE (2006) ‘Childhood Emotional Abuse and Disordered Eating among Undergraduate Females: Mediating Influence of Alexithymia and Distress’, Child Abuse & Neglect 30, 393–407. KLEIN, H., K.W. ELIFSON & C.E. STERK (2007) ‘Childhood Neglect and Adulthood Involvement in HIVRelated Risk Behaviours’, Child Abuse & Neglect 31, 39–53. LEESON, F.J. & R.D.V. NIXON (2011) ‘The Role of Children’s Appraisals on Adjustment Following Psychological Maltreatment: A Pilot Study’, Journal of Abnormal Child Psychology 39, 759–71 DOI: 10.1007/s10802-011-9507-5). LIEM J.H. & A.C. BOUDEWYN (1999) ‘Contextualizing the Effects of Childhood Sexual Abuse on Adult Self- and Social Functioning: An Attachment Theory Perspective’, Child Abuse & Neglect 23, 1141–57. LUMLEY, M.L. & K.L. HARKNESS (2009) ‘Childhood Maltreatment and Depressotypic Cognitive Organization’, Cognitive Therapy and Research33, 511–22 (DOI: 10.1007/s10608-009-9257-7). LUMLEY, M.N. & K.L. HARKNESS (2007) ‘Specificity in the Relations among Childhood Adversity, Early Maladaptive Schemas, and Symptom Profiles in Adolescent Depression’, Cognitive Therapy and Research 31, 639–57 (DOI: 10.1007/s10608-006-9100-3). MERIKANGAS, K.R., J.P. HE, D. BRODY, P.W. FISHER, K. BOURDON & D.S. KORETZ (2010) ‘Prevalence and Treatment of Mental Disorders among US Children in the 2001–2004 NHANES’, Pediatrics 125, 75–81 (DOI: 10.1542/peds.2008-2598). MINAEY, A. (2005) Manual Forms of School-Age Measurement System Based on the Experience Achenbach (ASEBA) (Tehran: Center for Exceptional Children). MOHAMMADKHANI, P., M.R. MOHAMMADI, M.A. NAZARI, M. SALAVATI & O.M. RAZZAGHI (2003) ‘Development, Validation and Reliability of Child Abuse Self Report Scale (Casrs) In Iranian Students’, Medical Journal of The Islamic Republic of Iran (MJIRI) 17, 51–58. MONTEZERI, M.S., Z. FARSANI, H. MEHRABI & A. SHAKIBA (2012) ‘The Relationships between Early Maladaptive Schemas and Depression in Male Students’, Journal of Mazandaran Medical University 97, 179–88. NOROUZI, P. (2012) ‘The Comparison of Neuropsychological Function of Emotional Abused and Nonabused Female Students Master’s Thesis of Exceptional Children Psychology, Tehran: Allame Tabatabae’i University. PERRY, A.R., D. DILILLO & J. PEUGH (2007) ‘Childhood Psychological Maltreatment and Quality of Marriage: The Mediating Role of Psychological Distress’, Journal of Emotional Abuse 7, 117−42. POWERS, A., K.J. RESSLER & R.G. BRADLEY (2009) ‘The Protective Role of Friendship on the Effects of Childhood Abuse and Depression’, Depression and Anxiety 26, 46–53 (DOI: 10.1002/da.20534). RAMIRO, L.S., B.J. MADRID & D.W. BROWN (2010) ‘Adverse Childhood Experiences (ACE) and HealthRisk Behaviours among Adults in a Developing Country Setting’, Child Abuse & Neglect 34, 842–55 (DOI: 10.1016/j.chiabu.2010.02.012). RIJKEBOER, M.M. & G.M. DE BOO (2010) ‘Early Maladaptive Schemas in Children: Development and Validation of the Schema Inventory for Children’, Journal of Behavior Therapy and Experimental Psychiatry 41, 102–09 (DOI: 10.1016/j.jbtep.2009.11.001). ROELOFS, J., C. LEE, T. RUIJTEN & J. LOBBESTAEL (2011) ‘The Mediating Role of Early Maladaptive Schemas in the Relation between Quality of Attachment Relation-Ships and Symptoms of Depression in Adolescents’, Behavioural and Cognitive Psychotherapy 39, 471–79 (DOI: 10.1017/S1352465811000117).

EJMH 12:1, June 2017

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 115

THE MEDIATING ROLE OF EARLY MALADAPTIVE SCHEMAS

115

ROGOSCH, F.A. & D. CICCHETTI (2004) ‘Child Maltreatment and Emergent Personality Organization: Perspective from the Five-Factor Model’, Journal of Abnormal Child Psychology 32, 123–45. SACHS-ERICSSON, N., E. VERONA, T. JOINER & K.J. PREACHER (2006) ‘Parental Verbal Abuse and the Mediating Role of Self-Criticism in Adult Internalizing Disorders’, Journal of Affective Disorders 93, 71–78. SCHWARZ, S.W. (2009) Adolescent Mental Health in the United States: Facts for Policy-makers, retrieved 21Apr 2017 from http://nccp.org/publications/pdf/text_878.pdf. SHAFFER, A., T.M. YATES & B.R. EGELAND (2009) ‘The Relation of Emotional Maltreatment to Early Adolescent Competence: Developmental Processes in a Prospective Study’, Child Abuse & Neglect 33, 36–44. SHENK, C.E., J.G. NOLL & J.A. CASSARLY (2010) ‘A Multiple Mediational Test of the Relationship between Childhood Maltreatment and Non-suicidal Self-Injury’, Journal of Youth and Adolescence 39, 335–42. SKUSE, D., A. BENTOVIM, J. HODGES, J. STEVENSON, C. ANDREOU, M. LANYAD, M. NEW, B. WILLIAMS & D. MCMILLAN (1998) Risk Factors for the Development of Sexually Abusive Behaviour in Sexually Victimized Adolescent Males: Cross Sectional Study’, British Medical Journal 317, 175–79. TIETJEN, G.E., J.L. BRANDES, K.B. DIGRE, S. BAGGALEY, V.T. MARTIN, A. RECOBER, L.O. GEWEKE, F. HAFEEZ, S.K. AURORA, N.A. HERIAL, C. UTLEY & S.A. KHUDER (2007) ‘History of Childhood Maltreatment is Associated with Co-Morbid Depression in Women with Migraine’, Neurology 69, 959–68. TIETJEN, G.E, J.L. BRANDES, B.L. PETERLIN, A. ELOFF, R.M. DAFER, M.R. STEIN, E. DREXLER, V.T. MARTIN, S. HUTCHINSON, S.K. AURORA, A. RECOBER, N.A. HERIAL, C. UTLEY, L. WHITE & S.A. KHUDER (2010) ‘Childhood Maltreatment and Migraine (Part II): Emotional Abuse as a Risk Factor for Headache Chronificationhead’, Headache 50, 32–41 (DOI: 10.1111/j.1526-4610. 2009.01557.x). VAN HARMELEN, A.L., P.J. DE JONG, K.A. GLASHOUWER, P. SPINHOVEN, B.W. PENNINX & B.M. ELZINGA (2010) ‘Child Abuse and Negative Explicit and Automatic Self-Associations: The Cognitive Scars of Emotional Maltreatment’, Behavior Research and Therapy 48, 486–94. VARIA, R., R.R. ABIDING & P. DASS (1996) ‘Perceptions of Abuse: Effects on Adult Psychological and Social Adjustment’, Child Abuse & Neglect 6, 511–26. WEKERLE, C., E. LEUNG, A.M. WALL, H. MACMILLAN, M. BOYLE., N. TROCME & R. WAECHTER (2009) ‘The Contribution of Childhood Emotional Abuse to Teen Dating Violence among Child Protective Services-Involved Youth’, Child Abuse & Neglect 33, 45–58. WRIGHT, M.O., E. CRAWFORD & D. DEL CASTILLO (2009) ‘Childhood Emotional Maltreatment and Later Psychological Distress among College Students: The Mediating Role of Maladaptive Schemas’, Child Abuse & Neglect 33, 59–68. YOUNG, J.E., J.S. KLOSKO & M.E. WEISHAAR (2003) Schema Therapy: A Practitioner’s Guide (New York, NY: Guilford Press). ZANARINI, M.C. (2000) ‘Childhood Experiences Associated with the Development of Borderline Personality Disorder’, Psychiatric Clinics of North America 23, 89–101. ZANARINI, M.C., A.A. WILLIAMS, R.E. LEWIS, R.B. REICH, C. SOLEDAD, A. VERA & F.R. FRANKENBURG (1997) ‘Reported Pathological Childhood Experiences Associated with the Development of Borderline Personality Disorder’, American Journal of Psychiatry 154, 1101–06 (DOI: 10.1176/ ajp.154.8.1101).

EJMH 12:1, June 2017

07_Early_Maladaptive_Junius 2017.05.24. 11:32 Page 116

08_Book_Rev_Junius 2017.05.23. 9:50 Page 117

117

BOOK REVIEWS / REZENSIONEN

BOOK REVEIWS / REZENSIONEN

EJMH 12:1, June 2017

08_Book_Rev_Junius 2017.05.23. 9:50 Page 118

118

EJMH 12:1, June 2017

BOOK REVIEWS / REZENSIONEN

08_Book_Rev_Junius 2017.05.23. 9:50 Page 119

European Journal of Mental Health 12 (2017) 119–123 DOI: 10.5708/EJMH.12.2017.1.Rev.1

ILDIKÓ ERDEI

CHRISTIAN SCHOLARS’ UNDERSTANDING OF THE SOUL AND THE SPIRIT SIMON-SZÉKELY, A., ed. (2015), Lélekenciklopédia: A lélek szerepe az emberiség szellemi fejlődésében, Vol. 1: Világvallások lélekképzetei (Budapest: Károli Gáspár University of the Reformed Church in Hungary & L’Harmattan) 23 cm, 540 pp., ISBN 978 963 414 001 6, 5990 Ft. The first volume of Lélekenciklopédia (‘Encyclopaedia of the Soul’) is the opening piece of an ambitious enterprise. The project was supported by the Hungarian Academy of Sciences (MTA) with the expectation that a decade of creative work would result in a unique knowledge about the soul and the spirit. The subtitle, in English translation, is ‘The role of the soul in the intellectual evolution of humanity’, and the series is designed to describe the most important notions of the soul in a multi-disciplinary manner. The undertaking enriches the encyclopaedic literature while allowing insight into the great religions of the world, and exploring myths, philosophies and scholarship concerning concepts of the soul. The aim of the series is to explain not only concepts of the soul but also closely related notions such as spirit, breath, psyche, consciousness, self-awareness, unconsciousness, subconscious mind, body, heart, life, death, rebirth, immortality, ghost, demon, devil, afterlife, heavenly world, and underworld. These are described from the perspectives of ethnography, anthropology, psychiatry, psychology, theology and philosophy. Emőke Bagdy offers a laurel wreath to the editor-in-chief in her preface, and Attila Simon-Székely himself, not so modestly, considers the work an unparalleled and unique achievement. At the same time, although there are many studies in the volume, its reading may be difficult because of some editing problems I will mention in detail below. The first volume discusses ideas about the soul and the spirit in five world religions (Christianity, Judaism, Islam, Hinduism and Buddhism). Each study follows the same editorial principles, namely, the first part explains the history and key beliefs of the given religion, and then comes a discussion of the concept of the soul. However, this uniform structure upsets the internal balance of the papers. Too much emphasis is put on the introduction of religious traditions, and although attention is later given to theories of the soul, their proportions do not correspond to the title of the volume and its stated goal. Moreover, the reader initially gets a balanced picture of the history and fundamental beliefs of each religion, yet the issues that arise concerning the soul are not always mainstream. Thus the studies do not so much represent the orthodox view of the given religion about the soul and the spirit as they reflect the difficulty of the soul-spirit concept by incorporating

08_Book_Rev_Junius 2017.05.23. 9:50 Page 120

120

BOOK REVIEWS / REZENSIONEN

marginal ideas. This is most clear in the section on Christianity, which is much larger in scope than the rest. The section on Christianity amounts to a third of the whole book and describes the history and teachings of nine denominations, including Roman Catholicism, Orthodox Christianity, the World Communion of Reformed Churches, Lutheranism, Unitarian Church, Seventh-Day Adventist Church, Baptist Church, United Methodist Church and the Pentecostal and Charismatic movement.1 With respect to the scope of this book, it is too much, but considering the entire Christian world, it covers too little. It is perfectly understandable that an interreligious encyclopaedia does not undertake to present all denominations. However, the selection of nine denominations would definitely require explanation, because there are many more Christian denominations in Hungary, even under the recently introduced restrictive legislation on religious communities. So I am very interested in what the criteria for the selection were. As it stands, without editorial justification, the selection seems arbitrary, and a similar arbitrariness characterises the whole book. Legitimate questions may arise about Judaism, Islam and Hinduism, which also have several varieties: why were their branches not given an opportunity to express their characteristic vision, and why were Christianity and Buddhism, by contrast, treated more generously? Similarities between Christian interpretations inevitably arise because of the well-established meanings of terms soul and spirit. Most authors introduce their topic by Hebrew (ruah, nephesh) and Greek (pneuma, psyche) equivalents of the words spirit and soul. Despite the rich semantic fields of the terms, authors agree and claim that ruah/pneuma means ‘wind’, ‘breath’ and, on this basis, ‘spirit’, while nephesh/psyche means ‘life’, ‘life force’, and hence, ‘soul’. Sometimes there is an overlap between the soul and the spirit. Only the Unitarian author argues strongly that the Bible makes a clear distinction: the spirit is immaterial and independent of the body (substantia), and the soul is immaterial, but it is always linked to the body. A Protestant author draws attention to the fact that serious conceptual confusion reigns in Protestant literature about the religious use of the terms soul and spirit, but the disorder is not worse than in other Christian traditions. The debate takes place around the translation of Szentlélek and Szent Szellem (roughly, Holy Spirit and Holy Ghost), due to the fact that the words soul and spirit are also used for other concepts in the Hungarian language. In this case, István Perczel’s excellent study must be mentioned, who reviews the history of early Christian interpretations of the soul. However, he writes not as a theologian but as a philosopher. His article, as the first substantial paper in the volume, constitutes a strong opening. In the light of his study, subsequent questions that arose during two millennia of Christian thought become much more understandable. Fortunately, there is no great difference between the Christian authors’ basic concepts of the soul. Differences appear when they locate their theories of the soul 1

The authors use the terms pentecostal and charismatic interchangeably.

EJMH 12:1, June 2017

08_Book_Rev_Junius 2017.05.23. 9:50 Page 121

BOOK REVIEWS / REZENSIONEN

121

within their own systematic theology. For instance, some denominations do not treat the doctrine of the soul within Christian pneumatology as could be expected. Only the Roman Catholic theologian, Liviu Jitianu says that ‘in Catholic theology the primary place of dealing with the concept of the soul is Pneumatology’,2 and Calvinist Tamás Juhász places the notions of the soul and spirit within the doctrine of the Trinity (p. 108). Surprisingly, Unitarian author Csilla Lakatos still deals more with the Holy Spirit (of course, in order to be able to say that they consider the Holy Spirit the power of God, not a person) (p. 156) than the Pentecostal authors,3 who do not discuss the third person of the Trinity despite the fact that this topic is one of the most fundamental features of Pentecostal theology. Instead of Pneumatology, Mátyás Komesz and Lajos Simonfalvi place the topic within anthropology (p. 222). Further, these two authors do not represent the main line of their denomination with regard to anthropological trichotomy.4 They criticise the trichotomy theory of Greek philosophy, even if many Christians have adopted this view. According to them, the Bible does not fully support either trichotomy or dichotomy but talks about the human person holistically instead (p. 224). This viewpoint gains importance in the context of Pentecostal and Charismatic literature that typically has reference to trichotomy. Gergely András Nacsinák, an Orthodox priest, also discusses the concept of the soul within the framework of anthropology, stressing that the analysis of human personality plays an important role in most ascetic-mystic tracts, and monastic practices focus on the most creative elements of the soul such as purity of heart and mental temptation (p. 92). Most Christian denominations situate the discussion of spirit and soul within eschatology, and mainly deal with the survival of the soul through death. This seems to be the point where the different dominations are able to deliver their spirit concept in the most individual way, while from the perspective of pneumatology, Christology, and anthropology there are a lot of similarities. The Seventh-Day Adventist Church stresses, for example, that the soul is not immortal after death, but is in an unconscious sleep, and will resurrect only at the resurrection (p. 176). In connection with the immortality of the soul, opinions are divided as well. The Catholic Church had decided in favour of the immortality of the soul at the Fifth Lateran Council (1513), but on the Protestant side there is no full consensus on the subject because some consider it to be the product of Aristotelian philosophy. Tamás Béres only tangentially mentions the doctrine of soul sleep that is often attributed to Luther. However, Béres puts an emphasis on the denial of the immortality of the soul (p. 142), trying to avoid the arising contradictions in this case. Not looking for a his2 3

The original text: ‘A katolikus teológia lélekfogalmának elsődleges helye a pneumatológia’ (p. 61). There are two authors of the Pentecostal study, although only one of them appears on the contents page. Similar editorial errors occur in several places throughout the volume. I.e. the notion that humans possess a physical body, a soul, and a spirit. The model of trichotomy deals primarily with how the three aspects of humanity combine to form human nature. This model makes a distinction between the human soul and the human spirit.

EJMH 12:1, June 2017

08_Book_Rev_Junius 2017.05.23. 9:50 Page 122

122

BOOK REVIEWS / REZENSIONEN

torical explanation for the anomalies, he prefers to interpret Luther’s opinion in the light of Paul Tillich’s theology, which obscures the contradictions rather than resolves them (p. 143). So heaven and hell are just symbols for Lutheran theology, which is likely to be far from Luther’s intention but reflects modern trends in academic theology. In contrast to soul sleep, the soul remains in a conscious state after death, according to Baptists and Pentecostals, and instantly enjoys being in heaven. The Unitarians’ position is based on science rather than the Bible, so they deny the bodily resurrection. Eternal life has only a spiritual meaning for them. Authors typically rather articulate their criticism of their own dominations than present the main lines of their churchs’ teaching on the topic. This approach keeps returning in the studies. Although it is undoubtedly a great advantage of the volume that the studies are written by expert religious practitioners, and thus every religious movement is described from within, it is inherent in academic thinking that not every article of faith is slavishly repeated but they are sometimes questioned. While the reader would expect that the writers faithfully represent the vision of their church, in reality authors do not shy away from presenting alternative viewpoints in the light of recent research. In this sense the studies do not always reflect the mainstream view. By incorporating marginal ideas, the volume manages to present difficulties of the soul-spirit concept. The authors sometimes question or challenge other religions in an honourable way, but their searching thoughts and reflections are mostly directed at their own denominations. It can thus happen that a Catholic professor finishes his study, after an exposition of the real spatial and temporal vision of afterlife, with the Protestant Rudolf Bultmann’s existential explanation (p. 76). As the author himself does not opt for either of those statements, and they are not evaluated, his academic thinking rather than a Catholic apologist’s presentation prevails in the study. Tamás Juhász’s opinion is more apparent when he divides the Protestant theologians and believers into ‘majority’ and ‘another group’ and attributes to the former the conviction that hell is not a real place and the devil is not a real person, so they deny the reality of hell and the devil (p. 105). To the latter group he attributes a literal interpretation of those concepts. In this case, many might disagree with Juhász’s view. As we can read in the editor-in-chief’s preface, the encyclopaedia is a collection of studies, reference materials, textbooks and also an educational work not only for experts but also for laymen. But this time, the sum of its parts is more than the total. The essays are easy to understand and accessible to lay people. They are very informative and neat in their descriptions of the denominations, and the historical overviews of individual religions are accurate. The work can also be used as an encyclopedia, but the reconstructions of religious traditions’ positions on the soul must be treated with more caution. They often reflect the individual views of the authors rather than the official teachings. This should not be a disadvantage except that the volume is called an encyclopaedia. It is true that the reader gets a clear picture about the evolution of individual religions, but he or she does not get an accurate picture of their concept of the soul. One gets the impression from reading the volume that the concept

EJMH 12:1, June 2017

08_Book_Rev_Junius 2017.05.23. 9:50 Page 123

BOOK REVIEWS / REZENSIONEN

123

of the soul is so huge a subject that it is impossible to make substantive statements about it. One should presuppose that religions have systematically developed doctrines about the soul, but the emerging picture suggests that they have not. Ultimately, the idea of an encyclopaedia and its realisation work at cross-purposes. In this volume, we can read excellent studies on the soul without an ultimate systematic picture emerging from the work.

EJMH 12:1, June 2017

08_Book_Rev_Junius 2017.05.23. 9:50 Page 124

European Journal of Mental Health 12 (2017) 124–128 DOI: 10.5708/EJMH.12.2017.1.Rev.2

KINGA BAKOS

HAPPY WORKPLACE? ROBERTSON, I. & C. COOPER (2011) Well-Being: Productivity and Happiness at Work (Hampshire: Palgrave Macmillan) 224 pp., 15 x 25,5 cm, ISBN 978-0-23024995-0, $ 50.

Robertson and Cooper’s work is a book which fills a gap. Although many articles and books are preoccupied with psychological well-being, very few place focus specifically on well-being at the workplace. The book tells us about the new findings and knowledge about this topic in a clear, transparent, plain style, but at the same time with scientific standards. The authors seek to define the concept of well-being from the perspective of the workplace and the staff, its influencing factors, benefits and possibilities of improvement. A very positive aspect of the book is that the authors are aware of both the individual and organisational benefits of psychological wellbeing (PWB). Although they give us some specific examples, the whole book is about workplace-well-being in general, without focusing on a specific profession. The book contains five parts, each one focusing on a question related to wellbeing. Part 1 talks about ‘why well-being matters’ for individuals and for organisations, and about the links between well-being and employee engagement. The importance of well-being at the workplace is emphasised by the authors already in the first sentence: ‘Work can make you sick and work can make you happy. Which one happens depends on who you are, what you do and how you are treated at work’ (p. 3). Here the ‘who you are’ refers to the personality-traits, which are considered to be one of the most important factors of PWB. The ‘what you do’ is about thriving, resilience and one’s engagement with the work, in other words the individual’s contribution to PWB. The ‘how you are treated at work’ concept covers the contextual factors existing at the workplace which influence the employee’s PWB. In this first part of the book Robertson and Cooper emphasise the delimitation and clarification of some concepts used in the area of well-being, like ‘PWB’, ‘job satisfaction’, ‘motivation’, ‘engagement’, ‘happiness’. For example, ‘job satisfaction’ and PWB at the workplace are not the same, because it is possible that an individual is satisfied with their job, but unhappy with the relationships they have with the members of the staff. The authors present the relations between these concepts carefully, and treat the findings referring to the links between PWB and biochemical responses (for example the secretion of cortisol and interleukin) with caution, due to small sample sizes and the lack of representativity of population. The authors use a complex approach when analysing the factors that have implications in PWB: they establish a hedonic factor

08_Book_Rev_Junius 2017.05.23. 9:50 Page 125

BOOK REVIEWS / REZENSIONEN

125

(money and material goods) and an eudaimonic factor (the purpose and meaning of life and work). The well-known relation between wealth and well-being is reinforced: in a survey, where people were asked to rank their sense of well-being, the American millionaires’ average score was 5.8 and that of the slum dwellers was 4.6, which means that after reaching a point, well-being is independent of the existence of material goods, and it possibly depends more on meaning and purpose that people have in their life or work. Regarding the benefits that PWB of employees give to organisations, the concept of productivity is most analysed, which shows a linear positive correlation with PWB. The ideal work-pressure is analysed as well, which is not too weak and not too strong, avoiding both rust-out and burnout. The ideal quantity of pressure is related both to positive PWB and good performance. The authors draw attention to the fact that with the improvement of the employees’ well-being, simultaneously is improved the organisation itself through the increase of productivity, the decrease of absenteeism and the quality of work. Talking about employee engagement and its relation to PWB, the authors try to define the concept of engagement in a clear manner. They report this topic from the very business-focused view of Robinson et al., where engagement is a ‘positive attitude held by the employee towards the organisation and its values. An engaged employee is aware of business context, and works with colleagues to improve performance within the job for the benefit of the organisation’ (p.28). In the conceptualisation of Csíkszentmihályi, the engagement of workers is characterised by positive emotions. Engagement is replaced by an emotional state during work, which is ideal when the state of ‘flow’ arises. Although authors make a clear delimitation of different views on this topic, maybe it would be useful to detach the concept of engagement to the profession from the concept of engagement to the organisation, because it is possible that someone is engaged to their job due to pragmatic motivations, but the profession itself isn’t the profession which makes them happy and in which they would like to engage, independent of contextual factors. Part 2 is about the concept of well-being. The title of this part is ‘What is Wellbeing?’, but here it really refers to psychological well-being. Robertson and Cooper talk about PWB from the perspective of the typical dichotomy in this field: dividing the PWB into the hedonic and eudaimonic aspects. The hedonic part of well-being contains positive emotions, the eudaimonic aspect covers the meaningfulness of life or of work. Part 2 also contains a chapter focusing on the very important topic of the measurement of well-being. The authors, with a policy-focused view, argue this way: ‘In fact, being able to measure is important, not just for understanding what might change after an intervention but, in the case of PWB, accurate measurement is even more important in deciding what needs to happen to improve things’ (p.51). Robertson and Cooper suggest that researchers should use self-report questionnaires in the assessment of psychological well-being. It remains a question for us whether the other methods and techniques could be mentioned as ‘additional information’-gathering methods, and if it could be stated that ‘The self-report questionnaire approach is the only realistic method for collecting reliable information about levels of PWB

EJMH 12:1, June 2017

08_Book_Rev_Junius 2017.05.23. 9:50 Page 126

126

BOOK REVIEWS / REZENSIONEN

within organisation’ (p.62). It seems to ignore the validity of the qualitative approach, which, in many cases, can yield deep and psychologically relevant information about one’s well-being, which isn’t possible by using the questionnaires. We should take into consideration that quantitative methods aren’t absolutely realistic in every situation. Every research is conducted by a researcher or a group of researchers, who have their perspectives, norms, (in the worst cases, also interests) and hypothetical arguments which could influence their research, merely due to the questions of research and goal-settings, thus also influencing the results. Maybe the question is not which is the ‘only realistic’ method, but in which cases, in which steps of the research should we use the self-report questionnaires and when should we use the interviews or narratives, for example. I agree with the authors’ making a distinction between the hedonic and the eudaimonic approach and that this should be the starting point for thinking about the measurement of PWB. It seems to be a very useful approach, when they say ‘a comprehensive assessment of PWB at work would need to focus on both hedonic and eudaimonic aspects of PWB’ (p. 54), and I find it good that they use the ASSET model (A Shortened Stress Evaluation Tool, an organisationwide audit tool) ‘for measuring and understanding the role of PWB in the workplace’ (p. 54). The original questionnaire focused on psychological ill-health, and Robertson and Cooper have enhanced the tool so positive emotional experiences, purpose and meaning can also be measured this way to be more useful in measuring PWB at the workplace. Part 3 is about the influencing factors of well-being, like personality traits and working conditions or work context. In this part Robertson and Cooper report several very interesting research findings which show that inherited personality traits explain variations in PWB at the workplace, evidently in interaction with situational and contextual factors. For example, the tendency to experience positive emotions is an inherited personality trait. Being likely to experience positive feelings makes it more likely to be satisfied with one’s job. This could be explained by Arvey’s research (ARVEY et al. 1991) which had concluded that job satisfaction is inherited. The very important role of personality could be explained by the fact that underlying personality traits determine people’s reactions to events and workplace stressors. In regard to this relationship, it seems to be a very important question whether personality traits or working conditions have the main influence on PWB. It is clearly stated by the authors that there are two personality traits which are most strongly related to PWB: neuroticism (negative correlation) and extraversion (positive correlation). They also use the concept of ‘set point’ for PWB that is relatively stable for each person and it is influenced by personality. Contextual factors and working conditions are taken into consideration, as they could increase or decrease PWB, but it has the tendency to return to the set point. In conclusion, authors sustain that PWB is not directly influenced by genetic factors, only the personality traits are inherited, and these personality traits, mostly neuroticism and extraversion have an impact on PWB, and the interaction between inherited and contextual factors ‘has the biggest part to play’ (p. 71). There are four main factors that have the biggest influence on PWB at the

EJMH 12:1, June 2017

08_Book_Rev_Junius 2017.05.23. 9:50 Page 127

BOOK REVIEWS / REZENSIONEN

127

workplace: work and its context (work demands, access to resources and equipment, effectiveness of communication in the organisation), relationships at work and workhome interface (relationship with colleagues and social support), purpose and meaning (clarity about work-goals, feeling that work-goals are worthwhile) and leadership, management and supervision (the impact that the manager has on the workgroup; leadership commitment to employeesâ&#x20AC;&#x2122; PWB). The authors also clarify the impact of social and personal life on PWB and emphasise the importance of balance between personal and working life, as well as between working periods and resting periods. Part 4 also contains the dichotomy of the individual and the organisational view: one chapter talks about the possibilities of the individualâ&#x20AC;&#x2122;s development of well-being and resilience, and the second chapter talks about the organisational benefits of this. Robertson and Cooper have previously divided the workplace factors which influence the PWB into four main clusters: work and its context, relationships at work and the work-home interface, purpose and meaning, leadership, management and supervision. They show us in a systematic style the possibilities of improving well-being at the workplace, the levels of intervention, and establishing a strategic approach for building a healthy workplace. As far as the development of individual factors (for example, resilience) is concerned, the authors find it possible, because while personality traits are stable and could be very hard to change, our ways of thinking and behaviour can be developed. The best example for this is the development of attributional style, presented by the authors in a well-displayed figure: a positive attitude both in successes and failures results in positive thinking and resilience, a negative attitude has the opposite effect not only in case of failures but in successes too. The attributional or explanatory style can be developed and can result in a better PWB. The authors also present the three levels of PWB interventions: on the primary level the aim is to enhance work situation factors, the secondary level is about the development of individual skills and resilience, as well as the augmentation of management, and the tertiary level provides support or treatment for individuals experiencing low levels of PWB without making changes in the organisation. Part 5 contains nine case studies analysing different aspects of well-being at the workplace and at different workplaces. One case describes an intervention program that includes the use of a well-being audit and follow-up management development activity, three of the cases report the implementation of some well-being programs in specific organisations, two chapters offer general guidance on the introduction of health and well-being initiatives, one case study describes the introduction of a comprehensive well-being program developed after a well-being audit, and the last case describes the introduction of a well-being theme into a leadership development program. Each case study is well structured, with an initial overview, a background of the case, and after this, the approach of the well-being-building intervention and its outcomes. Every case study is concluded with the summarised evaluation of the intervention. The most important contribution of Robertson and Cooperâ&#x20AC;&#x2122;s book to the scientific analysis of the psychological well-being is that they summarise the findings and

EJMH 12:1, June 2017

08_Book_Rev_Junius 2017.05.23. 9:50 Page 128

128

BOOK REVIEWS / REZENSIONEN

relationships of PWB from the perspective of workplace factors in one book. It is a systematic and elaborated work on the topic of workplace PWB. This book could also be a starting point for many researches in this field. For example, the evolution of engagement should be investigated with qualitative methods (e.g. focused interviews) and the steps which could be determined through work careers and the contextual factors determining these steps. Parts 4 and 5 contain many suggestions for organisations to ameliorate their employees’ well-being, and at the same time their own productivity too. References ARVEY, R.D., G.W. CARTER & D.K. BUERKLEY (1991) ‘Job satisfaction’ in C.L. COOPER & I.T. ROBERTSON, eds., International Review of Industrial and Organizational Psychology (Chichester, UK: Wiley) 372-76.

EJMH 12:1, June 2017

09_Contributors_Junius 2017.05.23. 9:53 Page 129

129

THE MEDIATING ROLE...

CONTRIBUTORS TO THIS ISSUE/ AUTOREN DIESES HEFTES Mahdi ABDOLAHZADEH RAFI Farhangian University Iran/Iran Mehdi.Rafi@gmail.com Narges ADIBSERESHKI University of Welfare and Rehabilitation Sciences Neurorehabilitation Research Center Evin, Daneshjoo BLV.Kodakyar street Tehran Iran/Iran n.adib@hotmail.com Anson AU LSE Health and Social Care Cowdray House London School of Economics and Political Science Department of Social Policy 2nd Floor, Old Building London School of Economics and Political Science Houghton Street WC2A 2AE London United Kingdom/Großbritannien anson.au@mail.utoronto.ca BAKOS Kinga Debreceni Egyetem Humán Tudományok Doktori Iskola Szociológia és Társadalompolitika Doktori Program H-4032 Debrecen Egyetem tér 1. Hungary/Ungarn b.kinguci76@gmail.com

BÁLITY Csaba Semmelweis Egyetem Egészségügyi Közszolgálati Kar Egészségügyi Menedzserképző Központ H-1125 Budapest Kútvölgyi út 2. Hungary/Ungarn bality@emk.sote.hu BÉRES Orsolya Semmelweis Egyetem Egészségügyi Közszolgálati Kar Mentálhigiéné Intézet H-1089 Budapest Nagyvárad tér 4., 19. em. Hungary/Ungarn beresorsi2@gmail.com Prof. Eleanor BRADLEY Institute of Health & Society University of Worcester Henwick Grove, Worcester WR2 6AJ United Kingdom/Großbritannien e.bradley@worc.ac.uk DURÁCZKY Bálint Károli Gáspár Református Egyetem Bölcsészettudományi Kar Társadalom- és Kommunikációtudományi Intézet H-1091 Budapest Kálvin tér 9. Hungary/Ungarn duraczky.balint@gmail.com ERDEI Ildikó Pünkösdi Teológiai Főiskola H-1183 Budapest Gyömrői út 89. Hungary/Ungarn erdei.ildiko@vipmail.hu

EJMH 12:1, June 2017

09_Contributors_Junius 2017.05.23. 9:53 Page 130

130

CONTRIBUTORS TO THIS ISSUE / AUTOREN DIESES HEFTES

Maryam HASANZADEH AVAL School teacher Iran/Iran Hassanzadeh.maryam@gmail.com Dr. Anton HERETIK jr. Katedra psychológie Filozofickej fakulty Univerzity Komenského Gondova 2 P.O. Box 32 SK-81499 Bratislava Slovakia/Slowakei anton.heretik2@uniba.sk Prof. Anton HERETIK sr. Katedra psychológie Filozofickej fakulty Univerzity Komenského Gondova 2 P.O. Box 32 SK-81499 Bratislava Slovakia/Slowakei anton.heretik@uniba.sk Dr. ITTZÉS Gábor Károli Gáspár Református Egyetem Hungary/Ungarn mental@ittzes.eu Dr. Tim JONES Institute of Health & Society University of Worcester Henwick Grove, Worcester WR2 6AJ United Kingdom/Großbritannien ac2745@coventry.ac.uk

EJMH 12:1, June 2017

Dr. habil. MARTOS Tamás Semmelweis Egyetem Egészségügyi Közszolgálati Kar Mentálhigiéné Intézet H-1089 Budapest Nagyvárad tér 4., 19. em. Szegedi Tudományegyetem Bölcsészettudományi Kar Pszichológiai Intézet Egyetem tér 2. H-6722 Szeged Hungary/Ungarn martos.m.tamas@gmail.com Dr. Eva MOROVICSOVÁ Psychiatrická klinika Lekárskej fakulty Univerzity Komenského a Univerzitná nemocnica Staré Mesto Miczkiewiczova 13 SK-813 69 Bratislava Slovakia/Slowakei eva.morovicsova@fmed.uniba.sk Dr. PILINSZKI Attila Semmelweis Egyetem Egészségügyi Közszolgálati Kar Mentálhigiéné Intézet H-1089 Budapest Nagyvárad tér 4., 19. em. Hungary/Ungarn pilinszki.attila@public.semmelweis-univ.hu Dr. SALLAY Viola Semmelweis Egyetem Egészségügyi Közszolgálati Kar Mentálhigiéné Intézet H-1089 Budapest Nagyvárad tér 4., 19. em. Szegedi Tudományegyetem Bölcsészettudományi Kar Pszichológiai Intézet Egyetem tér 2. H-6722 Szeged Hungary/Ungarn sallay.viola@gmail.com

09_Contributors_Junius 2017.05.23. 9:53 Page 131

CONTRIBUTORS TO THIS ISSUE / AUTOREN DIESES HEFTES Laura SIMMONS Institute of Health & Society University of Worcester Henwick Grove, Worcester WR2 6AJ United Kingdom/Großbritannien siml2_11@uni.worc.ac.uk Dr. SIPOS-BIELOCHRADSZKY Bernadett Semmelweis Egyetem Egészségügyi Közszolgálati Kar Mentálhigiéné Intézet H-1089 Budapest Nagyvárad tér 4., 19. em. Hungary/Ungarn sb.bernadett@gmail.com

131

Dr. habil. Igor ŠKODÁČEK Klinika detskej psychiatrie Lekárskej fakulty Univerzity Komenského a Detská fakultná nemocnica s poliklinikou Limbová 1 SK-83340 Bratislava Slovakia/Slowakei skodacek@dfnsp.sk

EJMH 12:1, June 2017

09_Contributors_Junius 2017.05.23. 9:53 Page 132