Unit 4.1 Discussion: Treating Addiction with Methadone

To add to her confusion, Eric Kim, whom she has been dating for three years and who is two years older than she, proposed to her a week ago. He wants to get married in a year or two.

At first, Shannon was flattered by the proposal and accepted the ring. But now she is having second thoughts, as she does not know if she wants to be in a committed relationship with Eric for the rest of her life. Shannon realizes that the decisions she makes in young adulthood will have a major impact on the rest of her life-including her health, well-being, and happiness.

Shannon’s parents, Patrick and Laura Bailey, are in the middle adulthood phase of their lives. They have been married for 23 years and have had relatively few serious conflicts. Shannon is their only living child; another child died of sudden infant death syndrome when he was 8 months old. This was very traumatic for them for several years.

More recently, Patrick’s father died from a heart attack. Although their three other parents are still living, they are worried about Patrick’s mother living alone, their parents declining health, and what the future will look like with aging parents. Patrick, who is 50, has been employed as a construction worker most of his adult life. Due to a recession that impacted the housing industry, he was unemployed from 2009 to 2011, creating a heavy financial burden on his family. Luckily, Laura, age 48, has been a carrier for Federal Express for the past 13 years and had more stability in her income. They feel they are just getting back on their feet and are grateful there home was not foreclosed on, as had happened to several of their friends and family members during this time. However, they do still have some outstanding debts, mainly credit cards, and are resuming contributions to their retirement accounts.

They are active in church activities and enjoy taking walks, gardening, playing softball, and bowling. For the past five summers, they have been spending their vacations traveling to various places in the United States in their Buick Enclave SUV.

A Perspective

Young adulthood is both an exciting and a challenging time of life. Growth and decline go on throughout life, in a balance that differs for each individual. In young adulthood, human beings build a foundation for much of their later development. This is when young people typically leave their parents’ homes, start careers, get married, start to raise children, and begin to contribute to their communities.

Middle adulthood has been referred to as the prime time of life. Patrick and Laura Bailey illustrate this. Most people at this age are in fairly good health, both physically and psychologically. They are also apt to be earning more money than at any other age and have acquired considerable wisdom through experiences in a variety of areas. However, middle adulthood also has developmental tasks and life crises. This chapter will examine human biological subsystems in young and middle adulthood and discuss how they affect people’s lives.

10-1Recognize the Contributions of Physical Development, Health Status, and Other Factors to Health during Young Adulthood

10-1aYoung Adulthood

It is difficult to pinpoint the exact time of life we are referring to when we talk about young adulthood. The transition into adulthood is not a clear-cut dividing line. People become voting adults by age 18. However, in most states, they are not considered adult enough to drink alcoholic beverages until 21. A person cannot become a U.S. senator until age 30 or president until age 35. All this presents a confusing picture of what we mean by adulthood.

Various theorists have tried to define young adulthood. Buhler (1933) clustered adolescence and young adulthood together to include the ages from 15 to 25. During this time, people focus on establishing their identities and on idealistically trying to make their dreams come true. Buhler saw the next phase as young and middle adulthood. This period lasts from approximately age 23 to age 45 or 50. This group focuses on attaining realistic, concrete goals and on setting up a work and family structure for life.

Levinson, Darrow, Klein, Levinson, and McKee (1974) broke up young adulthood into smaller slices. They believed that in the process of developing a life structure, people go through stable periods separated by shorter transitional periods. The stage from ages 17 to 22 is characterized by leaving the family and becoming independent. This is followed by a transitional phase from ages 22 to 28, which involves entering the adult world. The age-30 transition focuses on making a decision about how to structure the remainder of life. A settling-down period then occurs from about ages 32 to 40.

The current generation of young adults is called the millennials, compared to past generations who held the titles of baby boomers, Generation X, and upcoming (Generation Z). Currently there are 50 million millennials who grew up in the twenty-first century and the digital age. These young adults have learned to navigate the ever-changing world of technology and have faced traumas such as the terrorist attacks of September 11, 2001, and the recession of 2008–2009 (Tanenhaus, 2014).

Ethical Question 10.1

10-1bPhysical Development

Young adults are in their physical prime. Maximum muscular strength is attained between the ages of 25 and 30, and generally begins a gradual decline after that. After age 30, decreases in strength occur mostly in the leg and back muscles. Some weakening also occurs in the arm muscles.

Top performance speed in terms of how fast tasks can be accomplished is reached at about age 30. Young adulthood is also characterized by the highest levels of manual agility. Hand and finger dexterity decrease after the mid-30s.

Sight, hearing, and the other senses are their keenest during young adulthood. Eyesight is the sharpest at about age 20. A decline in visual acuity isn’t significant until age 40 or 45, when there is some tendency toward presbyopia (farsightedness). At that point, you start to see people read their newspapers by holding them 3 feet in front of them.

Hearing is also sharpest at age 20. After this, there is a gradual decline in auditory acuity, especially in sensitivity to higher tones. This deficiency is referred to as  presbycusis. Most of the other senses—touch, smell, and taste—tend to remain stable until approximately age 45 or 50.

10-1cHealth Status

Young adulthood can be considered the healthiest time of life. Young adults are generally healthier than when they were children, and they have not yet begun to suffer the illnesses and health declines that develop in middle age. (Papalia & Martorell, 2015)

Most young adults report they are in good to excellent health (Papalia & Martorell, 2015). However, rates of injury, homicide, and substance abuse peak at this time (Papalia & Martorell, 2015). In the past, this age group has lacked access to health care, often aging out if they did not go to college or if there were age limits on their parents’ insurance, but with the Affordable Care Act of 2010, most young adults can stay on their parents’ insurance plan until the age of 26. This change has resulted in 5.7 million young adults having health care coverage (The White House, 2015) and allowing young adults the health care they require to prevent or address health concerns. However, the Trump administration has indicated it plans to repeal/replace the Affordable Care Act, which could impact the health care of young adults.

Many people in all socioeconomic classes show a significant interest in measures that promote health. For example, running and other forms of exercising, health foods, and weight control have become very popular.

It has also been found that adults in the United States are using more complementary medicine approaches, including dietary supplements, yoga, chiropractors, meditation, acupuncture, massage therapy, and/or osteopathic manipulation. In 2012, in the National Health Interview Survey, it was found that 33.2 percent of adults used complementary health approaches (NCCIH, 2016).

Even though young adulthood is generally a healthy time of life, health differences can be seen between men and women. For example, women of all ages tend to report more illnesses than do men (Lefrancois, 1999). However, these health issues may be related to gender (such as contraception, pregnancy, or an annual Pap test), rather than more general health problems. Perhaps women are also more conscientious about preventive health care in general.

Of all the acute or temporary pressing health problems occurring during young adulthood, approximately half are caused by respiratory problems. An additional 20 percent are due to injuries. The most frequent chronic health problems of young adulthood are spinal or back difficulties, hearing problems, arthritis, and hypertension. These chronic problems occur even more frequently in families of lower socioeconomic status. For example, young African Americans experience hypertension more frequently than their white counterparts (Papalia & Martorell, 2015).

Other health concerns are also on the rise for young adults. Alarmingly, people ages 15–24 account for half of the 20 million newly diagnosed sexually transmitted infections yearly in the United States (CDC, 2015). Obesity rates are of concern with young adults, along with increases in stress levels, lack of sleep, smoking, and alcohol use (Papalia & Martorell, 2015).

A 21-year-old male, who has been healthy his entire life, has a pain in his groin area. As he is a student athlete, he assumes it is a pulled muscle and ignores it. Despite the continued discomfort it causes, he believes it is not healing properly due to his continued training. By the time he seeks care, it is too late. He has untreatable prostate cancer. The following year, his family accepts his college diploma on his behalf as he died several months prior to graduation.

This case highlights the need for males to seek medical care. In 2014, 83.2 percent of adults visited a physician; however, the majority of these visits were made by females (CDC, 2015b). Despite recommendations that men visit their primary physician once every two years. (However, it is recommended they go more routinely if they smoke, have high blood pressure, or have high cholesterol.) Between the ages of 18 and 39, men do not visit the physician as often as women, especially for preventive care (CDC, 2015b). The leading causes of death for men are heart disease, cancer, and accidents (CDC, 2015c). Of cancer, the most frequent diagnoses are prostrate, lung, and colorectal; however, lung cancer causes the most deaths (CDC, 2015a). Many of the health issues faced only by men, such as prostate cancer or low testosterone, can be prevented or treated successfully if caught early (NIH, 2016b). It is critical that young males be encouraged to seek routine, preventive health care in order to live to their fullest potential.

Women and Health

Although women do tend to visit the physician more than men, as indicated above, women have unique needs, such as pregnancy, conditions of female organs, and breast health that need to be routinely monitored. Women also have a higher incidence than men of certain health risks; for example, women are more likely to die following a heart attack than men, are more likely to show signs of depression, are affected more often by osteoarthritis, and are more likely to have urinary tract problems (NIH, 2016c). The leading causes of death for women are heart disease, cancer, and chronic lower respiratory disease (CDC, 2016b).

10-1dBreast Cancer

Within the context of health status, an extremely important issue confronting women is the incidence of breast cancer. According to the American Cancer Society (ACS, 2016b), breast cancer is the most common form of cancer among women, except for skin cancer. Approximately 1 out of 8 women will get breast cancer during their lifetime, and about 40,450 women will die from it in every year (ACS, 2016b). It is the second leading cause of cancer death in women, second only to lung cancer (ACS, 2016b). Although men can get breast cancer, the numbers are significantly lower than those of women, with 2,600 cases diagnosed in men each year and 440 reported deaths (ACS, 2016d).

Although older adult women are much more likely to get breast cancer than their younger counterparts, because of its general prevalence it will be discussed here.

Being knowledgeable about the issue of breast cancer is especially important in helping your female clients become aware of risks, prevention, and treatment. If you are a woman, it’s important for your own health. If you are a man, it’s important for the women who are close to you.

Benign Lumps

To begin with, it’s important to note that 80 percent of all breast lumps are benign (not cancerous) (Hyde & DeLamater, 2017). These usually take one of two forms (Crooks & Baur, 2014). First, there are  cysts, which are pouches of fluid. The other form of lump is a  fibroadenoma, which is a more solid, rounded growth of cells resembling scar tissue (Crooks & Baur, 2014, p. 81).

Symptoms

A number of symptoms other than identification of a lump or tumor can indicate malignancy. Tumors can assume a number of shapes and forms. Generally, any change in the external appearance of the breasts should make one suspicious. For instance, one breast becoming significantly larger or hanging significantly lower than the other is a potential warning sign. Discharges from the nipple or nipple discoloration are additional indications, as is any pain in the breast. Dimpling or puckering of the nipple or skin of the breast should be noted. Nipple retraction (where the nipple turns inward) is also a potential sign of cancer. Finally, any swelling of the upper arm or lymph nodes under the arm should be investigated.

Risk Factors

Between 5 and 10 percent of breast cancers are related to genetic mutations, most frequently in the genes labeled BRCA1 and BRCA2 (ASC, 2016e). Women with mutations in these specific genes may increase their likelihood of breast cancer by as much as 80 percent. Note that mutations in other genes may also be linked to increased risk.

Genetic testing can be done to determine if a female has BRCA1 or BRCA2 mutations, but women are encouraged to talk to a genetic counselor or doctor to explain the results (ACS, 2016e).

Family history is another relevant variable in assessing breast cancer risk. Having close female relatives on either side of the family with breast cancer increases a woman’s chances. Risk doubles for women who have a mother, sister, or daughter who has breast cancer and triples for women with two such relatives. (However, note that over 85 percent of all women with breast cancer do not have it in their family history.) Having a prior history of breast cancer increases the chances of developing a new cancer in the same or the other breast.

Race affects risk. “White women are slightly more likely to get breast cancer than are African American women but African American women are more likely to die of this cancer. However, in women under 45 years of age, breast cancer is more common in African American women. Asian, Hispanic, and American Indian women have a lower risk of developing and dying from breast cancer” (ACS, 2016).

Women who have been exposed to radiation treatment in the chest area at some earlier time have greater risk. Risk may also be related to menstruation. It increases a bit for women who started menstruating before age 12 or who went through  menopause (the normal change of life occurring in middle age when a woman stops menstruating and can no longer bear children) after age 55. Having dense breast tissue (the fatty, fibrous, and glandular tissue making up breasts) increases the risk of developing breast cancer. Additionally, having been diagnosed with certain benign breast conditions (e.g., certain benign breast tumors) also increases breast cancer risk, although the level of risk varies with the particular condition.

Some risk factors for breast cancer are linked to lifestyle and life choices. Risk increases slightly for childless women and for women having their first child after age 30. Conversely, having numerous pregnancies and bearing children at a young age reduces a woman’s chance of getting breast cancer. The risk posed by taking oral contraception (birth control pills) is not yet understood. Studies have found that women now using birth control pills have a slightly greater risk of breast cancer than women who have never used them. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk. Women should address issues such as this with a physician. Long-term use of  combined hormone therapy (HT) with estrogen and progesterone to diminish the negative symptoms of menopause increases the risk of breast cancer and of dying from the disease. The use and effects of hormone therapy are complex and should be carefully discussed with a physician. Since combined HT also “appears to increase the risk of heart disease, blood clots, and strokes,” “there appear to be few strong reasons to use post-menopausal hormone therapy” (ACS, 2016c). Alcohol consumption, especially in greater quantities on a regular basis, increases risk, as does being overweight.

Several other factors that may contribute to the risk of breast cancer are under investigation. However, research results aren’t clear at this time. These factors include high-fat diets, chemicals in the environment, tobacco smoke, and working at night. In contrast, exercise appears to reduce risk, as does having breast-fed a child, especially if the practice lasted for one-and-a-half to two years.

Remember that the factors discussed here do not condemn a woman to getting breast cancer. Such discussion should only alert women to be careful and aware.

Suspicion of Breast Cancer

Second,  magnetic resonance imaging (MRI) scans “use radio waves and strong magnets instead of x-rays” (ACS, 2016a). A dye is injected into the bloodstream to accentuate effects. Healthy and diseased bodily tissues absorb the energy in different ways so that a computer can interpret results and discover abnormalities. Some research has found that MRIs can discover more and smaller cancers than can mammograms. However, MRIs are more expensive, may take up to an hour, and involve being confined in a tube (which makes some people quite uncomfortable). In current practice, MRIs are usually used along with mammograms to screen women in high-risk groups, to investigate suspicious tissue, to determine the mass of a cancer that has already been detected, or to check for the existence of cancer in the opposite breast. New imaging tests are also being studied.

Third, an  ultrasound (picture of an internal area by the use of sound waves) may also be employed. Ultrasound has become a valuable tool to use along with mammography because it is widely available and less expensive than other options such as MRI. The use of ultrasound instead of mammograms for breast cancer screening is not recommended. Usually, breast ultrasound is used to target a specific area of concern found on the mammogram. Ultrasound helps distinguish between cysts (fluid-filled sacs) and solid masses and sometimes can help tell the difference between benign and cancerous tumors.

Ultrasounds can be beneficial in assessing breasts with exceptionally dense tissue, as tumors may be more difficult to see in mammograms. Research is currently being done to determine the value, pros, and cons “of adding breast ultrasound to screening mammograms in women with dense breasts and a higher risk of breast cancer” (ACS, 2013c).

Fourth, for women with nipple discharge, a  ductogram (or  galactogram) can be performed. This involves inserting “a very thin plastic tube into the opening of the duct in the nipple” producing the discharge and injecting a very small quantity of a liquid into the duct (ACS, 2016a). This provides a contrast between the injected liquid and breast tissue, thus delineating the structure of the duct. An X-ray can then determine if a mass exists within the duct.

Fifth, a  biopsy involves extracting some amount of tissue to examine for cancerous cells. In a  fine needle aspiration biopsy (FNAB), an extremely fine needle extracts fluid from the lump for evaluation. In a  core needle biopsy, a larger needle is used to remove several cores of tissue from a potentially problematic area discovered during an ultrasound or mammogram. “Because it removes larger pieces of tissue, a core needle biopsy is more likely than an FNAB to provide a clear diagnosis, although it may still miss some cancers” (ACS, 2016c).  Vacuum-assisted biopsies such as Mammotome® or ATEC® (Automated Tissue Excision and Collection) (trade names) are outpatient procedures that involve the suctioning of tissue using a hollow probe through a small incision. A  surgical biopsy entails a removal by incision of a larger section of the identified mass or abnormal area in addition to some of the surrounding tissue. This more complex procedure, used because of the tissue’s location or because the results of a core biopsy are unclear, is usually performed in a hospital’s outpatient unit and requires anesthesia. The type of biopsy selected depends on a woman’s specific circumstances. “Some of the factors your doctor will consider include how suspicious the lesion appears, how large it is, where in the breast it is located, how many lesions are present, other medical problems you may have, and your personal preferences” (ACS, 2016c).

Treatment of Breast Cancer

If it is established that the lesion is cancerous, several treatment options are available (National Cancer Institute [NCI], 2016a). The type of treatment depends on the complexity, severity/progression of the cancer. Women with breast cancer need to explore all of the options with their doctor to determine their best course of action based on their individual situation. The standard treatment options used are listed below.

1. Surgery: Surgery removes the cancer. During surgery lymph nodes may be removed because they are the first structures to receive drainage from the tumor (NCI, 2016c). The sentinel lymph node is the lymph node to receive the drainage first. This lymph node is evaluated for cancer cells and if no cancer cells are found, removal of more lymph nodes may be unnecessary. Different types of surgery include

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partial mastectomy: removal of a portion of the breast containing the tumor, tissue around the tumor, and possibly the chest muscle below the cancer.

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simple or total mastectomy—the entire breast is removed and possibly some lymph nodes under the arm.

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skin-sparing mastectomy: the same amount of internal breast tissue is removed as a simple mastectomy, but the breast remains intact in preparation for breast reconstruction surgery (Mayo Clinic, 2016b).

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modified radical mastectomy: “many of the underarm lymph nodes, the lining over the chest muscles, and sometimes part of the chest wall muscles are removed” (NCI, 2016c).

2. Radiation: Radiation therapy involves using “high-powered beams of energy, such as x-rays to destroy cancer cells” (Mayo, 2016a). Radiation can be administered externally (outside the body with a machine) or internally (place radioactive substances in the body). Treatment schedules vary depending on the stage of the cancer treated (NCI, 2016c).

3. Chemotherapy: Chemotherapy involves administering cancer fighting drugs either by injecting them into the vein or ingesting them in liquid or pill form. They are intended to fight and eliminate cancer cells that have split off from the tumor and migrated to other parts of the body. The way chemotherapy is given depends “on the type and stage of the cancer being treated” (NCI, 2016c). Chemotherapy may be used before surgery to shrink a tumor, thereby facilitating the tumor’s removal.

4. Hormone therapy: Hormone therapy involves administration of drugs that block or decrease the effects of the female hormone estrogen in those women whom estrogen encourages the development of breast cancer. One example of hormone therapy is tamoxifen, a drug in pill form that is usually administered for two to five years after breast cancer surgery.

5. Targeted drugs: Targeted drug treatments attack specific cancer cells without harming normal cells (NCI, 2016c). These drugs may kill the cancer cell or slow the cells’ growth.

6. Clinical trials: Some patients take part in a clinical trial to determine if a new cancer treatment is safe and effective or better than the standard treatments as identified above (NCI, 2016c).

All of the treatment options noted may have side effects, ranging from tiredness, hair loss, and premature menopause to greater vulnerability to infections and diseases because of decreased supply of white blood cells. Additionally, when a woman has surgery on her breast it can affect her self-esteem due to tremendous significance placed on breasts in our society. A women’s perception of herself, how others perceive her, and of the effects on her sexual relationships can be severely affected.

One option, for women who have had a mastectomy is reconstructive surgery. Reconstructive surgery is done to make the breast look as natural as possible. In 2015, 106,338 breast reconstruction procedures were performed in the United States (American Society of Plastic Surgeons, 2016). Reconstruction surgery can be performed during the initial surgery (which must be planned in advance) or at a later time. As a last resort, some women turn to alternative or complementary medicine to help fight their cancer. It should be noted, however, that no alternative treatments have been found to cure breast cancer (Mayo, 2016a). Some of these options are acupuncture, a special diet, meditation, and/or yoga. It is believed these treatments can help treat the patient’s mind, body, and spirit (NCI, 2016b).

These positive health habits include eating breakfast and other meals regularly. Snacking on high-fat and high-sugar foods should be avoided. Moderate eating in order to maintain a normal, healthy weight is important. Smoking and heavy alcohol consumption are dangerous to health and should be avoided. Moderate exercise and adequate sleep also contribute to good health.

Stress is another factor that can affect health (NIMH, 2016). Stress can be caused by positive events (such as marriage or a job promotion) or negative events (death of a relative or divorce). There are three different types of stress: routine stress from a sudden change, or traumatic stress (major accident or disaster). Everyone responds differently to these stressors; however, with continued stress an individual may suffer serious health problems such as digestive issues, weight gain, heart disease, high blood pressure, depression, or other illnesses (NIMH, 2016).

Poor people are likely to suffer stress related to their lack of resources. They may be worrying about what to feed their kids near the end of the month when money has run out. Maybe they’re worried about having their phone disconnected or their electricity turned off because they couldn’t pay the bills.

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Health Changes

In the early 40s, a general slowing down in metabolism usually begins. Individuals who reach this age either begin to gain weight or have to compensate by eating less and exercising more.

Health problems are more apt to arise. Signs of diabetes may occur, and the incidence of gallstones and kidney stones increases. Hypertension, heart problems, and cancer also occur at higher rates during the middle adult years than in the younger years. Back problems, asthma, arthritis, and rheumatism are also more common. Because nearly all these ailments can be treated, middle-aged adults need to have periodic physical examinations in order to detect and treat these illnesses in their early stages.

One major health problem during middle age is hypertension, or high blood pressure. The disorder predisposes people to heart attacks and strokes. The disorder affects about 40 percent of adults in the United States, and is more prevalent among African Americans and poor people (Papalia & Martorell, 2015). Fortunately, the disorder is now often detected by blood pressure screening, and can generally be effectively treated with medication.

The typical middle-aged American is quite healthy. The three leading causes of death for those between the ages of 35 and 54 are, in order, cancer, heart disease, and accidents. Between ages 55 and 64 the leading causes are cancer, heart disease, and strokes (Papalia & Martorell, 2015).

Changes in Physical Appearance

Gradual changes in appearance take place. Some people become alarmed when they discover these changes. Gray hairs begin to appear. The hair may thin. Wrinkles gradually appear. The skin may become dry and lose some of its elasticity. There is a redistribution of fatty tissue; males are apt to develop a “tire” around their waist, and the breasts of women may decrease in size. Minor ailments develop that cause a variety of twinges.

Some studies with interesting results have been conducted on personal appearance. Knapp and Hall (2010) reviewed studies in which slides of both women and men were shown to subjects. The studies found that those judged to be physically attractive were also judged to be brighter, richer, and more successful in their social lives and career.

Having a physically attractive body has become an obsession in our society. Americans spend thousands of hours and millions of dollars on grooming themselves, exercising, and dieting. The “body beautiful” cult leads those who judge themselves to be attractive to believe that they are superior to those they judge to be less attractive.

The Double Standard of Aging

Gray hair, coarsened skin, and crow’s feet are considered attractive in men; they are viewed as signs of distinction, experience, and mastery. Yet the same physical changes in women are viewed as unattractive indicators that they are “over the hill.” Many men in our society view older women as having less value as sexual and romantic partners and even as business associates or prospective employees (Knapp & Hall, 2010). For example, some middle-aged television anchorwomen allege they have been discharged from their positions because normal changes in their physical features are considered unattractive.

Today, the double standard of aging is waning (Papalia et al., 2012). Men too are suffering from the premium placed on youth. Both men and women age 50 and older encounter age discrimination (although it’s illegal) in looking for a job.

In the area of career advancement, men are more apt than women to feel old before their time if they have not achieved career or financial success. Our society places more pressure on men than on women to have a successful career.

Ethical Question 10.2

A gradual deterioration occurs in the sense organs during middle adulthood. Middle-aged adults are apt to develop problems with their vision that may force them to wear bifocals, reading glasses, or contact lenses. As the lens of the eye becomes less elastic with age, its focus does not adjust as readily. As a result, many people develop  presbyopia—which means they become farsighted. They are unable to focus sharply for near vision and thus need reading glasses. The psychological impact of having to wear glasses may be minor or can be fairly serious if the person is fearful about growing older.

During middle age, there is also a gradual hardening and deterioration of the auditory nerve cells. The most common deterioration in middle adulthood is  presbycusis, which is a reduction in hearing acuity for high-frequency tones. Middle-aged men generally have significantly greater losses of high-frequency tones than middle-aged women. Sometimes the hearing loss is enough so that a hearing aid is needed. There are generally some minor changes in taste, touch, and smell as a person grows older. Most of these changes are so gradual that a person makes adjustments without recognizing that changes are occurring.

Changes in Physical Strength and Reaction Time

Changes in Intellectual Functioning

Contrary to the notion that you can’t teach an old dog new tricks, mental functions are at a peak in middle age. Middle-aged adults can continue to learn new skills, new facts, and can remember those they already know well. Unfortunately, many middle-aged people do not fully use their intellectual capacities. Many settle into a job and family life and are less active in using their intellectual capacities than they were in their younger years, when they were attending school or when they were learning their profession or trade. Some middle-aged adults are unfortunately trapped by the erroneous belief that they can’t learn anything new.

If a person is mentally active, that person will continue to learn well into later adulthood. Practically all cognitive capacities show no noticeable declines in middle adulthood. Adults who mistakenly believe that they completed their education in their 20s are apt to show declines in their intellectual functioning in middle adulthood. There is truth in the adage “What you do not use, you will begin to lose.”

There are variations in regard to specific intellectual capacities. People in middle adulthood who use their verbal abilities regularly (either on the job or through some other mental stimulation such as reading) further develop their vocabulary and verbal abilities. There is some evidence that middle-aged adults may be slightly less adept at tests of short-term memory, but this is usually compensated by wisdom gained from a variety of past experiences (Papalia & Martorell, 2015). If middle-aged adults are mentally active, their IQ scores on tests are apt to show slight increases.

Creative productivity is at its optimum point in middle age. Scientists, scholars, and artists have their highest rate of output generally in their 40s—and their productivity tends to level off in the late 40s or 50s (Papalia & Martorell, 2015). There are different age peaks for different types of creative production. In general, the more unique, original, and inventive the production, the more likely it is to have been created in a person’s 20s or 30s rather than later in life. The more a creative act depends on accumulated development, however, the more likely it is to occur in the later years of life.

Middle-aged adults tend to think in an integrative way. That is, they tend to interpret what they see, read, or hear in terms of its personal and psychological meaning. For example, instead of accepting what they read at face value (as younger people are apt to do), middle-aged adults filter information through their own learning and experience. This ability to interpret events in an integrative way has a number of benefits. It enables a person to better identify scams and “con games,” because an integrative thinker is less naive. It enables many adults to come to terms with childhood events that once disturbed them. It enables middle-aged people to create inspirational legends and myths by putting truths about the human condition into symbols that younger generations can turn to for guidelines in leading their lives. Papalia and Martorell (2015) note that people need to be capable of integrative thought before they can become spiritual and moral leaders.

Integrative thinking also enables people in their 40s and 50s to be at the peak of their  practical problem-solving capacities. People in this age group are best able to arrive at quality solutions for everyday problems and crises, such as what is wrong with an automobile that fails to start, how to repair a hole in drywall in a house, and what types of injuries require medical attention.

Life is more meaningful if one’s intellectual capacities are being challenged and used. College instructors are generally delighted to have returning students in their classes, because such students have a wealth of experiences to share and are usually highly committed to learning. Compared to younger students, they are less apt to major in “having a good time.”

When middle-aged adults return to college, they often need a few weeks to get used to the routine of taking notes in classes, writing papers, and studying for exams. A few courses, such as mathematics and algebra, tend to be particularly difficult because returning students have forgotten some of the basic concepts they learned years ago. Because people at age 50 learn at nearly the same rate and in the same way as they did at age 20, most returning students do well in their courses.

Colleges are not the only places that offer adult education courses. Courses are also provided by vocational and technical centers, businesses, labor unions, professional societies, community organizations, and government agencies. The concept of lifelong education has been a boon for many colleges and universities.

In middle adulthood, there is generally only a small amount of deterioration in physical capacities, and almost no deterioration in potential for mental functioning. Cognitive functioning may actually increase well into later adulthood (Lefrancois, 1999). The sad fact is that many people are not sufficiently active, either mentally or physically. As a result, their actual performance, physical and mental, falls far short of their potential performance.

10-3Describe the Midlife Crises Associated with Female Menopause and Male Climacteric

10-3aFemale Menopause

Menopause is the event in every woman’s life when she stops menstruating and can no longer bear children. The median age when menopause occurs is 51 years, although it may occur in women as young as 36, or may not occur until a woman is in her mid-50s. The time span ranging from two to five years during which a woman’s body undergoes the physiological changes that bring on menopause is called the  climacteric. There is some evidence of a hereditary pattern for the onset of menopause, because daughters generally begin and end menopause at about the same age and in the same manner as their mothers.

Menopause is caused by a decrease in the production of estrogen, which leads to a cessation of ovulation. Menopause begins with a change in a woman’s menstrual pattern. This pattern varies between women. Periods may be skipped and become irregular. There may be a general slowing down of flow of blood during menstruation. There may be irregularity in the amount of blood flow and in the timing of periods. Or there may be an abrupt cessation of menstruation. The usual pattern is skipped periods, with the periods occurring further and further apart.

During menopause, a number of biological changes occur. The ovaries become smaller and no longer secrete eggs regularly. The fallopian tubes, having no more eggs to transport, become shorter and smaller. The vagina loses some of its elasticity and becomes shorter. The uterus shrinks and hardens. The hormone content of urine changes. All of these changes are biologically related to cessation of functioning of the reproductive system.

Hot flashes appear to be due to a malfunction of temperature control mechanisms in the hypothalamus (Hyde & DeLamater, 2017). Estrogen deficiency contributes to this malfunction. Hot flashes generally disappear spontaneously after a few years.

There is no clear-cut way to identify the exact time when menopause ends. Most authorities agree that the climacteric can be considered as ending when there has been no menstrual period for one year. Physical symptoms of menopause usually end when ovulation ceases.

Some doctors urge that some type of birth control be continued for two years after the last period in order to prevent pregnancy. “Change-of-life” babies are rare because conception, although possible, is unlikely to occur. Middle-aged pregnancies do present increased health risks. The child has a higher chance of having a birth defect. For example, the risk of Down syndrome is greatest with older parents; the chances rise from 1 in 2,000 among 25-year-old mothers to 1 in 40 for women over 45 (Papalia et al., 2012). Spontaneous abortions are more common in women who become pregnant after the age of 40. In addition, older women are more apt to have a prolonged labor due to the loss of elasticity of the vagina and the cervix.

10-3bMale Climacteric

In recent years, there has been considerable discussion about “male menopause.” In a technical sense, the term is a misnomer, as menopause means the cessation of the menses. The term  male climacteric is more accurate. It should be noted that men who have gone through male climacteric still retain the potential to reproduce.

Sometime between the ages of 35 and 60 men reach an uncertain period in their lives that has been termed a  midlife crisis. It is a time of high risk for divorce, for extramarital affairs, for career changes, for accidents, and even for suicide attempts. All men experience it to some degree and emerge a bit changed, for better or for worse. It is a time of questions: “Is what I’m doing with my life really satisfying and meaningful? Would I be better off if I had pursued a different vocation or career? Do I really want to be married to my partner?”

Male climacteric is a time when a man reevaluates his marriage and his family life. This period of reassessment is often characterized by nervousness, decrease in sexual activity, depression, decreased memory and concentration, decreased sexual interests, fatigue, sleep disturbances, irritability, loss of interest or self-confidence, indecisiveness, numbness and tingling, fear of impending danger, and/or excitability. Other possible symptoms are headaches, vertigo, constipation, crying, hot flashes, chilly sensations, itching, sweating, and/or cold hands and feet.

A man going through male climacteric usually encounters some event that forces him to examine who he is and what he wants out of life. During this crisis, he looks back on his successes and failures, his degree of dependency on others, the outcomes of his dreams, and examines his capabilities for what lies ahead. Depending on what he sees and how he deals with it, this experience can be either exhilarating or demoralizing. He sees the disparity between youth and age, between hope and reality.

Male climacteric is caused by a combination of biological and psychological factors. As a male grows older, his hair thins and begins to turn gray. He develops more wrinkles and tends to develop a “tire” around his waist. His physical energy gradually decreases, and he can no longer run as fast as he once did. There are changes in his heart, his prostate, his sexual capacity, his chest size, his kidneys, his hearing, and his gastrointestinal tract.

The production of testosterone gradually decreases. Testosterone is an androgen that is the most potent naturally occurring male hormone. It stimulates the activity of male secondary sex characteristics, such as hair growth and voice depth, and helps to prevent deterioration in the sex organs in later life. The male sex glands are essential for the vitality of youth. These glands are the first glands to suffer when aging occurs. Two of the subtler changes (as compared to hair loss, wrinkles, slowing blood circulation, and more sluggish digestion) are a decline in the number of sperm in an ejaculation and a reduction of testosterone present in the plasma and urine. The testes lose their earlier vigorous functioning and produce decreasing amounts of hormones. Older men generally take a longer time to achieve an erection. It also takes a longer time before an erection can be regained after an orgasm.

Some men do have greater hormonal fluctuations at climacteric. Hyde and DeLamater (2017) summarize studies that have found evidence of monthly cycles in some men with hormonal fluctuations in a 30-day rhythm.

While biological changes (including the diminishing production of sex hormones) play an important part in male climacteric, perhaps even more important is the problem of being middle-aged in a culture that worships youth. Many of the problems associated with male climacteric are due to psychological factors.

A significant part of male climacteric is due to depression, which is often brought on when a man fears aging and recognizes that His sexual powers are waning (Hyde & DeLamater, 2011). He also realizes that he will never achieve the successes that he envisioned for himself years earlier. His bouts with depression may be so profound that he may contemplate suicide. Depression during this midlife crisis may also be triggered by a reevaluation of childhood dreams, conflicts in need of resolution, new erotic longings and fantasies, sadness over opportunities lost, and a new questioning of values. All of this is coupled with a search for new meaning in life. He realizes half of his life may be gone, and time becomes more precious. He worries about things undone, and there does not seem to be enough time for everything. He has the feeling of missing out on a big chunk of life. The man who is engaged in activities outside his daily job is a less likely candidate for depression. It is unbalanced to be so busy with getting ahead that the pleasures of life are missed. To recapture some of his former enthusiasm and perhaps to shake some of his unsettling doubts and fears, he may drive himself to work harder, to exercise more, or to seek younger women.

A man at midlife is also apt to experience a growing dissatisfaction with his job. He feels a sense of entrapment as the pressure to pay bills forces him to continue working at a job that he finds increasingly boring and unfulfilling. At the same time, his personal identity is deeply entwined with his work roles. His job has provided him with an opportunity to further develop his identity, to enter into a stable set of relationships with colleagues and/or clients, and to explain his place in the world. Now he questions that place. Occupational aspirations may change several times during this period. The emphasis may shift from measuring success in terms of achievement to measuring it in terms of economic security. Also at this time, movement up the occupational ladder is largely completed. If a man has not achieved his work goals by age 40 or 50, he may realize he may never achieve them; he may even be demoted one or two steps down the occupational ladder.

10-3cMidlife Crisis: True or False?

The ease or panic with which a man faces his middle years will depend on how he has accepted his faults and his strengths throughout life. The man who has developed a strong affective bond with his family will fare better than the man who has followed a more isolated and career-oriented course. To age gracefully is to realize that he has done the best he could with his life.

Many physicians will prescribe antidepressant therapy and counseling, and recommend the support and understanding of family and close friends (Hyde & DeLamater, 2011). Men who undergo a midlife crisis need to realize that there is still a great deal of pleasure and satisfaction to be gotten out of life. This is not the end; there are still things left for them to do.

Women go through similar psychological worries (for example, the empty-nest syndrome). Recent research indicates that a declining proportion of women are affected by the empty-nest syndrome because more women are emphasizing careers. Midlife is a time of reassessment for both sexes as people in this age group look over their lives. It is a time of reprioritizing one’s life. With the right attitude, this period can become a time of reappraisal, renewed commitment, and growth.

But the realization of slow deterioration in one’s physical capacities and of a disparity between one’s earlier dreams and present reality is apt to be a crisis for many people.

Some health evidence shows that midlife is a time of crisis for many people. Hypertension, peptic ulcers, and heart disease are most often diagnosed in middle-aged patients. The rate of first admissions for alcoholism treatment is higher for middle-aged individuals than for younger adults (Papalia & Martorell, 2015). These statistics suggest that middle adulthood can be a period of stress and turmoil.

Men who undergo a midlife crisis are apt to have had adjustment problems for a long time. Kaluger and Kaluger (1984, p. 541) conclude, “Midlife crises may be the result of unadjusted adolescents and young adults who grow up to be unadjusted middle-aged adults rather than the result of a universal crisis confined to midlife.”

Married couples now use a greater variety of sexual techniques than couples in earlier generations did. The female-on-top position is increasingly being used, because it gives the female greater control over stimulation of the clitoris than the man-on-top position. Oral sex has also become more popular. Couples today also spend a longer time making love than couples did decades ago. Most couples now spend between 15 minutes and an hour having sex (Hyde & DeLamater, 2011). This change may reflect a greater awareness by married men and women that women are more likely to enjoy sex more and to be orgasmic if intercourse is unhurried.

Crooks and Baur (2011) summarize information on masturbation:

Most men and women, both married and unmarried, masturbate on occasion. Women tend to masturbate more after they reach their 20s than they did in their teens. Kinsey hypothesized that this was due to increased erotic responsiveness, opportunities for learning about the possibility of self-stimulation through sex play with a partner, and a reduction in sexual inhibitions. Masturbation is often considered inappropriate when a person has a sexual partner or is married. Some people believe that they should not engage in a sexual activity that excludes their partners, or that experiencing sexual pleasure by masturbation deprives their partners of pleasure. Others mistakenly interpret their partner’s desire to masturbate as a sign that something is wrong with their relationship. But unless it interferes with mutually enjoyable sexual intimacy in the relationship, masturbation can be considered a normal part of each partner’s sexual repertoire. It is common for people to continue masturbation after they marry. In fact, individuals who engage in sexual activity with their partners more frequently than other individuals also masturbate more often. (p. 233)

Extramarital Sexual Relationships

A few spouses react to an extramarital affair by gradually entering into a consensual extramarital relationship. In such a relationship, extramarital sexual relationships are permitted and even encouraged by both partners. One type of consensual extramarital sex arrangement is  mate swapping. In this arrangement, two or more couples get together and exchange partners, either retiring to a separate place to have sexual relations or having sex in the same room with various combinations of partners.

Ethical Question 10.4

Although some people find abstinence to be very difficult, others experience it as satisfying. Periods of celibacy may be important for self-exploration and recovery from broken romances.

10-5Describe AIDS–Its Causes and Effects; How It Is Contracted; How Its Spread Can Be Prevented; and Understand AIDS Discrimination

10-5aPeople Living with AIDS: A Population-at-Risk

The remainder of this chapter will focus on AIDS (acquired immune deficiency syndrome). AIDS is a devastating disease that has the potential to kill more people than any other. It is a contagious, incurable disease that targets the body’s immune system and generally reduces the body’s capacity to defend itself against disease. The HIV virus (human immunodeficiency virus) and AIDS were first identified in 1981 and quickly became known as a disease affecting only gay men.

AIDS in the United States

In the United States today, HIV/AIDS affects a wide range of individuals. It is estimated that 1,218,400 individuals over the age of 13 have HIV. In 2014, an estimated 44,000 new cases of HIV were diagnosed, with an estimated 13 percent of those individuals not being aware they were affected at the time of the diagnosis (CDC, 2016a). Gay males are the population most affected by HIV, with the greatest number of new cases being young black gay males (CDC, 2016). Despite this, HIV/AIDS is affecting other populations as well. In 2014, HIV transmitted through heterosexual sex accounted for 24 percent of all new HIV diagnoses (CDC, 2016). HIV, mainly acquired through heterosexual contact or injection drug use, is now the leading cause of death in women in the United States between the ages of 25 and 44 (Hyde and DeLamater, 2017). In addition, HIV is increasing in the population of individuals age 50 and older (CDC, 2016).

10-5bWhat Causes AIDS?

AIDS is caused by a type of virus called HIV, an abbreviation for human immunodeficiency virus. A virus is a protein-coated package of genes that invades a healthy body cell and alters the normal genetic apparatus of the cell, causing the cell to reproduce the virus. In the process, the invaded cell is often killed. The HIV virus falls within a special category of viruses called  retroviruses, so named because they reverse the usual order of reproduction within the cells they infect.

HIV invades cells involved in the body’s normal process of protecting itself from disease and causes these cells to produce more of the virus. Apparently, HIV destroys normal white blood cells, which are supposed to fight off diseases invading the body. As a result, the body is left defenseless and can fall prey to other infections. The virus devastates the body’s immune, or defense, system so that other diseases occur and eventually cause death. Without a functioning immune system to combat germs, the affected person becomes vulnerable to bacteria, fungi, malignancies, and other viruses that may cause life-threatening illnesses, such as cancer, pneumonia, and meningitis.

10-5cHow Is AIDS Contracted?

HIV is transmitted through transmission of body fluids, including blood, semen, pre-seminal fluids, rectal/vaginal secretions, and breast milk. HIV is transmitted primarily through sexual intercourse, contaminated blood, contaminated needles, and from an infected woman to her baby during pregnancy or childbirth (Hyde & DeLamater, 2017). In rare cases, it has been transmitted through oral sex, blood transfusions, organ /tissue transplants, eating food that has been pre-chewed by a person with HIV, and deep open-mouth kissing if both partners have sores or bleeding gums. HIV is not spread through saliva (CDC, 2016).

10-5dDiagnosis

Several tests have been developed to determine if a person has been exposed to the AIDS virus. These tests do not directly detect the virus, but rather the antibodies a person’s immune system develops to fight the virus. For a person who has been infected with HIV, it generally takes two to three months before enough antibodies are produced to be detected by the test. The tests only establish the presence of antibodies that indicate exposure to the virus.

10-5eThe Effects of HIV

Once a person is infected with HIV, several years may go by before symptoms of AIDS appear.

Within 2–4 weeks after infection with HIV, an individual may have symptoms (CDC, 2016).

Initial symptoms include dry cough, abdominal discomfort, headaches, oral thrush, loss of appetite, fever, night sweats, weight loss, diarrhea, skin rashes, tiredness, swollen lymph nodes, and lack of resistance to infection. (Many other illnesses have similar symptoms, so it is irrational for people to conclude they are developing AIDS if they have some of these symptoms.)

As AIDS progresses, the immune system is less and less capable of fighting off “opportunist” diseases, making the infected person vulnerable to a variety of cancers, nervous system degeneration, and infections caused by other viruses, bacteria, parasites, and fungi. Ordinarily, opportunistic infections are not life-threatening to people with healthy immune systems, but they are frequently fatal to people with AIDS, whose immunological functioning has been severely compromised.

10-5fTreatment and Prevention of AIDS

AIDS is a syndrome, not one specific disease. AIDS simply makes those infected by the vims increasingly more vulnerable to any disease that might come along. The disease process of AIDS involves a continuum whereby those affected become more and more vulnerable to devastating diseases.

At this time, there is no cure for AIDS. There are a multitude of hurdles to overcome in combating the disease. AIDS is caused by a form of virus, and even with modern technology, we don’t know how to cure a virus. For example, the common cold is caused by a virus; despite millions of dollars spent on research in the hopes of finding an effective cure, such a treatment has not yet been found for this common ailment. Currently, serious research is being undertaken to understand, prevent, and fight AIDS.

A person with AIDS receives medical attention.

A. Ramey/Photo Edit

Prevention can be pursued in two major ways. First, people can abstain from activities and behaviors that put them at risk for contracting the disease. Second, scientists can work on developing a vaccine to prevent contracting the disease, similar to vaccines that prevent polio or measles. A vaccine might either block the virus from attacking a person’s immune system or bolster the immune system so that HIV is unable to invade it.

Ethical Question 10.5

· Abstinence or delay of sexual activity, especially for youth.

· Being faithful, especially for those in committed relationships.

· Condom use, for those who engage in risky behavior. It is advisable to use a condom when having sexual intercourse with a new partner until it is certain that the person does not test positive for HIV. Condoms are 85 to 95 percent effective protecting against HIV if used properly (Hyde & DeLamater, 2017).

Other recommendations include the following:

· Stop injecting drugs and do not share needles with other people. If you are unable to stop your drug use, you need to use only new, sterile needles.

· If pregnant or breast feeding, take medicine to treat HIV (such as ART) as prescribed by your physician.

· If your partner is HIV positive, talk to a physician about PrEP, a medication taken to lower your risk of infection. PrEP stands for Pre-Exposure Prophylaxis, The word “prophylaxis” means to prevent of control the spread of an infection or disease, The goal of PrEP is to prevent HIV infection from taking hold if you are exposed to the virus. This is done by taking one pill every day. PrEP is composed of some of the same medicines used to keep the virus under control in people who are already living with HIV. PrEP is not a vaccine. Studies have found the risk of getting HIV is much lower for those who take PrEP consistently than for those who do not take PrEP (Wahlberg, 2016).

10-5gImpacts of Social and Economic Forces: AIDS Discrimination and Oppression

People who test positive for HIV or who have AIDS are often victimized by discrimination. Many Americans have a “them and us” mentality about those who test positive for HIV or who have AIDS. They want to have no contact with anyone who has HIV. They erroneously think that casual social contact may put them at risk. As a result, people who have the AIDS virus are apt to be shunned, risk losing their jobs, and often are abandoned by family, spouses, lovers, and friends. In some communities, when it becomes public knowledge that a child has the AIDS virus, parents of other children have reacted by not allowing their children to attend the same school and by prohibiting their children from having any contact with the child who is HIV positive.

Jeremy Horner/Corbis Documentary/Getty Images

Ethical Question 10.6

A Perspective

Figuring out the underlying reasons that cause others’ actions often has substantial payoffs. If a salesperson knows what motivates people to buy a certain product, he or she can then structure the sales pitch around this focus. If a social worker knows why a father is abusing his child, the worker then knows what has to be changed to stop the abuse. If a mother knows what discipline techniques will be effective with her children, she is then better prepared to curb their unwanted behavior. The primary focus of this human behavior and social environment text is to provide theoretical frameworks that will help the reader to observe and assess human behavior.

Debbie Peepers is a computer programmer; her husband, Doug, is a mechanical engineer. Although they have had little formal training in assessing human behavior, playing amateur psychologist is one of their favorite leisure activities. As with anything else, assessments of human behavior are apt to be more accurate when one has greater knowledge and awareness of the significant cues to attend to. Professional social workers who will be planning interventions with people and organizations have a special need to develop their assessment skills. Young and middle adulthood provides another developmental stage to examine some of the psychological dynamics of human behavior. Because there is a paucity of psychological theories specifically directed at young and middle adulthood, the primary focus of this chapter will be on describing contemporary theories and models for assessing human behavior throughout the lifespan.

11-1Describe Erickson’s Theories of Psychological Development during Young and Middle Adulthood

11-1aIntimacy versus Isolation

Erikson (1950) theorized that after young people develop a sense of identity, they next face the psychosocial crisis of intimacy versus isolation, which generally occurs in young adulthood (roughly during the 20s).  Intimacy is the capacity to experience an open, tender, supportive relationship with another person, without fear of losing one’s own identity in the process of growing close. In such a relationship, the partners are able to understand, cognitively and emotionally, each other’s points of view. An intimate relationship permits the sharing of personal feelings as well as the disclosure of ideas and plans that are not fully developed. There is respect for each other and mutual enrichment in the interactions. Each person perceives an enhancement of his or her well-being through the stimulating interactions with the other.

Intimacy involves being empathetic and able to give and receive pleasure within the relationship. Although intimacy is often established within the context of a marital relationship, marriage itself does not produce intimacy. In some marriages, there is considerable intimacy (including sharing and mutual respect). However, in empty-shell marriages and in marriages with considerable conflict, there is very little intimacy. There are additional contexts where intimacy is apt to develop. The work setting is one of these, where close friendships are often formed. Close friendships are also apt to develop through membership in social and religious organizations.

Traditional socialization patterns in our society create different problems for males and females in the establishment of intimacy. Many boys are taught to be restrained in expressing their feelings and personal thoughts. They are also socialized to be competitive and self-reliant. They are raised to believe that they should be sexually aggressive and seek to “go as far as possible” in order to demonstrate their virility to their male friends. Males are thus often unprepared for intimate heterosexual relationships—which require that they express their feelings, be supportive rather than competitive, and have a commitment to continuing the relationship rather than piling up sexual trophies.

Traditionally, girls are socialized to be better prepared for the emotional demands of intimacy. They are socialized to express their feelings and personal thoughts and to be nurturant. They may, however, enter an intimate relationship with inappropriate expectations based on traditional gender-role stereotypes. For example, they may expect their partner to be stronger or more resourceful than he is. (The women’s movement has changed gender-role expectations and socialization practices for males and females; hopefully, the difficulties that men and women experience in forming intimate relationships will be reduced in future years.)

The negative pole of the crisis of young adulthood is isolation. People who resist intimacy continually erect barriers between themselves and others. Some people view intimacy as a blurring of the boundaries of their own identity and therefore are reluctant to become involved in intimate relationships. Some people are so busy seeking or maintaining their identity that they cannot share and express themselves in an intimate relationship.

Isolation may also result from situational factors. A young person may be so involved in studying to get into medical school that he or she may not have the time for an intimate relationship. Or a teenage girl may become pregnant, deliver and start raising the child, and then have few opportunities to become involved in a close relationship with an adult.

Isolation may also result from diverging spheres of activity and interest. An example of how isolation may develop in a traditional marriage involves Bill and Mary Ramsey. They married while in their early 20s, after dating for four years and enjoying doing many activities together. They were very much in love. They both wanted a traditional marriage. In their early years of marriage, they had two children, and Mary was content to stay at home to raise them. In her leisure time, she interacted with the other wives in the neighborhood. Bill worked as an insurance agent and spent his leisure hours hunting, fishing, and attending sporting events with male friends. As the years passed, Mary and Bill had less and less in common. Isolation became increasingly evident in their lack of mutual understanding and their lack of support for each other’s needs and life goals.

11-1bGenerativity versus Stagnation

Erikson’s (1963) seventh life-stage developmental crisis is generativity versus stagnation. Generativity involves a concern with and interest in establishing and guiding the next generation. The crisis of generativity versus stagnation is perceived by a middle-aged adult to involve a commitment to improve the life conditions of future generations. The achievement of generativity involves a willingness to care about the people and the things that one has produced. It also involves a commitment to protecting and enhancing the conditions of one’s society.

The achievement of generativity is important for the survival and development of any society. It involves the adult members’ dedicating themselves to contributing their skills, resources, and creativity to improve the quality of life for the young.

11-3Describe Levinson’s Theories of Life Structure, Life Eras, and Transitions during Adulthood

11-3aLevinson’s Theories of Life Structure, Life Eras, and Transitions for Men

Levinson and his colleagues (Levinson, Darrow, Klein, Levinson, & McKee, 1974; Levinson & Levinson, 1978) studied 40 men ages 35 to 45, including business executives, academic biologists, novelists, and hourly workers in industry. These men were interviewed and given personality tests. From these data, Levinson constructed some developmental theories of life changes in adulthood.

At the heart of Levinson’s theory is the concept of  life structure. This term is defined as “the underlying pattern or design of a person’s life at a given time” (Levinson, 1986, p. 6). A person’s life structure shapes and is shaped by the person’s interactions with the environment. Components of the life structure include the people, institutions, things, places, and causes that a person decides are most important, as well as the dreams, values, and emotions that make them so. Most people build their life structures around their work and their families. Other important aspects of one’s life structure may include religion, racial identification, ethnic heritage, societal events (such as wars and economic depressions), and hobbies.

According to Levinson, life involves a number of passages: from the freedom of childhood to entering school; from school to the work world; from not dating to dating; from dating to breaking up or marrying; from marrying to divorce; and so on. Levinson sees some structure to these series of life passages. He asserts that people shape their life structures during the following four overlapping eras (each of which is 20 to 30 years in length):

1. Preadulthood (birth to age 22) is the formative time from conception to the end of adolescence.

2. Early adulthood (age 17 to age 45) is the era in which people make choices that significantly influence their lives, and the era in which people display the greatest energy and experience the most stress.

3. Middle adulthood (age 40 to age 65) is the era in which people tend to have reduced biological capacities but increased social responsibilities.

4. Late adulthood (age 60 and beyond) is the final phase of life.

Early adult transition (ages 17 to 22). During this transition (which may take three to five years), men move from preadulthood into adulthood. A person moves out of his or her parents’ home and becomes more financially and emotionally independent. Going to college or joining the military service serves as a transitional institutional situation between being a child in a family and reaching full adult status.

Entry life structure for early adulthood (ages 22 to 28). This phase has been called “entering the adult world.” During this phase, a young person becomes an adult and builds the entry life structure for early adulthood. Aspects of this phase often include: involvement with work, which may lead to a career choice; intimate relationships with others, which may lead to marriage and children; choosing a home; involvement with social and civic groups; and relationships with family and friends.

Two important features of this phase are a dream and a mentor. During this phase, men often have a dream of their future, which is usually viewed in terms of a career. The vision of becoming a highly successful corporate president or a famous writer spurs them on and energizes their work activities. A man’s success during these apprenticeship years is strongly influenced by finding a mentor. A mentor is older (usually by about 8 to 15 years). The relationship with the mentor is a friendship with adult equality, but the mentor also performs the fatherly tasks of teaching, caring, criticizing, helping, and offering constructive suggestions in both career and personal matters.

Ethical Question 11.1

KidStock/Blend Images/Alamy Stock Photo

Emotional intelligence is not the opposite of cognitive intelligence. Some very bright people score high in EI, whereas others score lower. Some less-than-average scorers on IQ tests score high on EI, whereas others score lower.

Emotional intelligence is not easy to measure.

There are many emotions. How do we rate someone who can handle fear, but not guilt? The usefulness of a certain emotion may also depend on the circumstances; for example, it may not be functional for a person to be happy at a funeral when everyone else is sad.

Daniel Goleman (2006) has drawn on social neuroscience research to propose that social intelligence is made up of social awareness (including social cognition, empathy, attunement, and empathic accuracy) and social facility (including self-presentation, influence, concern, and synchrony).

There are various types of intelligence, including intellectual competencies, emotional intelligence, and social intelligence. Counseling/psychotherapy often involves helping people to modify their patterns of social intelligence, particularly those that cause clients to have problems in their interpersonal relationships.

Some tests have been developed to measure SI (Goleman, 2006). Like IQ tests, SI tests are usually based on a 100-point scale in which 100 is the average score. Most people score between 85 and 115. Scores of 140 are considered to be very high. People with SI scores below 80 may have an autism spectrum disorder. These people are apt to have trouble making friends, and with communication. They might need social skill training. People with SI scores over 120 are considered to be very socially skilled and well adjusted, and probably will excel in jobs that involve direct contact and communication with people.

11-5bSocial Intelligence

Closely related to emotional intelligence is social intelligence.  Social Intelligence (SI) has been defined in a variety of ways.

According to the original definition of Edward Thorndike (1920, p. 228), social intelligence is “the ability to understand and manage men and women, boys and girls, to act wisely in human relations.” According to this definition, it is equivalent to  interpersonal intelligence.

Some authors have restricted the definition of SI to deal only with knowledge of social situations. With this perspective, SI is synonymous with social cognition or social marketing intelligence.

11-6Describe Nonverbal Communication Cues

11-6aMezzo-System Interactions: Nonverbal Communication

In seeking to assess human behavior, it is also important to attend to nonverbal communication. Sigmund Freud (quoted in Knapp & Hall, 1992) noted, “He that has eyes to see and ears to hear may convince himself that no mortal can keep a secret. If his lips are silent, he chatters with his fingertips; betrayal oozes out of him at every pore” (p. 391).

It is impossible not to communicate. No matter what we do, we transmit information about ourselves. Even an expressionless face communicates messages. As you are reading this, stop for a minute and analyze what nonverbal messages you would be sending if someone were observing you. Are your eyes wide open or half closed? Is your posture relaxed or tense? What are your facial expressions communicating? Are you occasionally gesturing? Do you occasionally roll your eyes? What would an observer deduce from these nonverbal cues about what you are feeling at the moment?

At times, nonverbal cues (such as sweating, stammering, blushing, and frowning) convey information about feelings that we desire to hide. By developing skill in reading nonverbal communication, we can be more aware of what others are feeling and better able to interact effectively. Because feelings stem from thoughts, nonverbal cues such as blushing also transmit information about what people are thinking.

11-6bThe Functions of Nonverbal Communication

Nonverbal communication interacts with verbal communication. Nonverbal communication has the following functions in relation to verbal communication:

1. Nonverbal messages may repeat what is said verbally. A husband may say he is really looking forward to becoming a father and repeat this happy anticipation with glowing facial expressions.

2. Nonverbal messages may substitute for verbal ones. If a close friend has just failed an important exam, you can get a fairly good idea what he or she is thinking and feeling by looking at your friend’s facial expressions.

3. Nonverbal messages may accent verbal messages. If someone you are dating says he or she is angry and upset with something you did, the depth of these feelings may be emphasized by pounding a fist and pointing an accusing finger.

4. Nonverbal messages may serve to regulate verbal behavior. Looking away from someone who is talking to you is a way of sending a message that you are not interested in talking.

5. Nonverbal messages may contradict verbal messages. An example of such a double message is someone with a red face, bulging veins, and a frown on the face, yelling, “Me—angry? Hell no, what makes you think I’m upset?” When nonverbal messages contradict verbal messages, the nonverbal messages are often more accurate. When receivers perceive a contradiction between nonverbal and verbal messages, they usually believe the nonverbal (Adler & Towne, 1981, p. 257).

Although nonverbal messages can be revealing, they can also be unintentionally misleading. Think of the times when people have misinterpreted your nonverbal messages. Perhaps you tend to say little when you first wake up, and others have interpreted this as meaning that you are preoccupied with a personal concern. Perhaps you have been quiet on a date because you are tired or because you’re thinking about something that has recently happened. Has your date at times misinterpreted such quietness to mean you are bored or unhappy with the relationship? When you have been thinking deeply about a subject, have you had an expression on your face that others have interpreted as a frown? Nonverbal behavior is often difficult to interpret. A frown, for example, may represent a variety of feelings: being tired or angry; feeling rejected, confused, unhappy, irritated, disgusted, or bored; or simply being lost in thought. Nonverbal messages should not be interpreted as facts, but as clues that need to be checked out verbally to determine what the sender is thinking and feeling.

Gestures are also used in relation to verbal messages for a variety of purposes: repeating, substituting, accenting, contradicting, and regulating. Some people literally speak with their hands, arms, and head movements. Many people are unaware of the number of gestures they use, and then (if videotaped) are surprised to view the extent to which they communicate with gestures.

Psychologists Michael Kraus and Dacher Keltner (2009) found that people of higher socioeconomic status are ruder when conversing with others. Their study showed that body language can signal a person’s socioeconomic status. The researchers videotaped pairs of undergraduate students, who were strangers to one another, during one-on-one interviews. The researchers then observed certain gestures that indicate level of interest in the other person during one-minute slices of each conversation. They found that students whose parents were from backgrounds of higher socioeconomic status (SES) engaged in more “impolite” gestures such as doodling, grooming, and fidgeting. Lower-SES students engaged in more “I’m interested” gestures, such as laughter and raising of the eyebrows. Like a peacock’s tail, the seemingly snooty gestures of higher-SES students indicate modern society’s version of “I don’t need you.” Lower-SES individuals cannot afford to brush off others. They have fewer resources, and tend to be more dependent on others.

11-6eGestures

Most of us are aware that our facial expressions convey our feelings. When we want to hide our true feelings, we concentrate on controlling our facial expressions. We are less aware that our gestures also reveal our feelings, and we put less effort into controlling our gestures when we want to cover up our feelings. As a result, gestures are sometimes better indicators of how we really feel.

People who are nervous tend to fidget. They may bite their fingernails, tap their fingers, rub their eyes or other parts of their body, bend paper clips, or tap a pencil. They may cross and uncross their legs. They may rhythmically swing one leg or move one foot back and forth.

Many gestures provide cues to a person’s thoughts and feelings. Clenched fists, whitened knuckles, and pointing fingers signal anger. When people want to express friendship or attraction, they tend to move closer. Hugs can represent a variety of feelings: physical attraction, good to see you, best wishes in the future, and friendship. Shaking hands is a signal of friendship and a way of saying, “Hello” or “Goodbye.”

Albert Scheflen (1974) notes that a person’s sexual feelings can be signaled through gestures. He describes preening behavior, which is designed to send a message that the sender is attracted to the receiver. Preening behavior includes rearranging one’s clothing, combing or stroking one’s hair, and glancing in a mirror. Scheflen cites a number of invitational preening gestures that are specific to women: exposing or stroking a thigh, protruding the breast, placing a hand on the hip, and exhibiting a wrist or palm. Naturally, these gestures do not always suggest sexual interest; they may occur for a variety of other reasons.

There are also invitational preening gestures for men. As a woman talks, a man may gaze into her eyes intently. As conversation continues, he may lean in farther and farther toward the woman until he starts to close the gap between them. A man may stand with his pelvis thrust forward or sit or stand with legs wide apart. He may also stick his thumbs in his belt hoops, fingers aiming at his pelvic region; or thrust his hands in his pocket, thumbs pointing toward his pelvis. Male preening behaviors may include straightening his jacket or tie, rolling up sleeves or cuffs, or smoothing his hair. He may tend to mimic the woman’s gestures (Renninger, Wade, & Grammar, 2004).

Gestures are also used in relation to verbal messages for a variety of purposes: repeating, substituting, accenting, contradicting, and regulating. Some people literally speak with their hands, arms, and head movements. Many people are unaware of the number of gestures they use, and then (if videotaped) are surprised to view the extent to which they communicate with gestures.

11-6fTouching

Rene Spitz (1945) demonstrated that young children need direct physical contact, such as being cuddled, held, and soothed. Without such direct physical contact, the emotional, social, intellectual, and physical development of children will be severely stunted. Spitz observed that in the 19th century high proportions of children died in some orphanages and other child-care institutions. The deaths were not found to be due to poor nutrition or inadequate medical care, but instead to lack of physical contact with parents or nurses. From this research came the practice of nurturing children in institutions—picking them up, holding them close, playing with them, and carrying them around several times a day. With this physical contact, the infant mortality rate in institutions dropped sharply.

Knapp and Hall (2014) describe findings that suggest that eczema, allergies, and certain other medical problems are in part caused by a person’s lack of physical contact with a parent during infancy. Physical stimulation of children facilitates their intellectual, social, emotional, and physical development.

Adults also need physical contact. People need to know that they are loved, recognized, and appreciated. Touching through holding hands, hugging, and pats on the back are ways of communicating warmth and caring. Unfortunately, we have been socialized to refrain from touching, except in sexual contacts.

Touching someone is in fact an excellent way of conveying a variety of messages, depending on the context. A hug at a funeral will connote caring, while a hug when meeting someone connotes “It’s good to see you.” A hug between parent and child conveys “I love you,” whereas a hug on a date may have sexual meanings. Numerous therapists have noted that communication and human relationships would be vastly improved if people reached out and touched others more—with hugs, squeezes of the hand, kisses, and pats on the back. Touch is crucial for the survival and development of children, and touch is just as crucial for adults, to assure them that they are worthwhile and loved.

11-6gClothing

Clothes keep us warm and cover certain areas of our body so we are not arrested for indecency. But clothes have many other functions. Certain uniforms tell us what a person does and who we can receive services from: for example, uniforms of police officers, firefighters, nurses, physicians, and waiters. People intentionally and unintentionally send messages about themselves by what they wear. Clothes give messages about our occupations, personality, interests, sexuality, groups we identify with, social philosophies, religious beliefs, status, values, mood, age, nationality, and personal attitudes. For example, the way an instructor dresses sends messages to the class as to the kind of atmosphere he or she is seeking to create.

A problem often encountered by women is that they lack a socially dictated business uniform. Men wear ties and suits in bland, dark colors. Women interested in developing professional and business careers are still seeking clothing that will convey the best impression. Often they must choose between “masculine-looking,” unattractive, bland clothing and clothing that is more colorful and aesthetically attractive but considered unprofessional in some settings.

Clothes also affect our self-image. If we feel we are well dressed in a situation, we are apt to be more self-confident, assertive, and outgoing. If we feel we are poorly dressed in a situation, we are apt to feel more reserved, feel less confident, and be less assertive. When we’re feeling at a low tide, dressing up can make us feel better about ourselves and raise our spirits.

There is a real danger of misreading nonverbal messages. We often stereotype others based on skimpy information, and frequently our interpretations are in error—which may lead to serious adverse consequences. One of the authors remembers a client he interviewed in a correctional facility who for the previous four years had lived in an elegant fashion, traveled all over Europe and North America, and stayed in the finest hotels. He financed this lifestyle by writing bad checks. He stated that whenever he needed money, he would carefully dress in an expensive suit and would have no trouble cashing his bogus checks.

11-6hPersonal Space

Each of us carries around a kind of invisible bubble of personal space wherever we go. The area inside this bubble is perceived as our private territory. The only people we are comfortable in allowing to enter our private territory are those we are emotionally close to. We feel we are being invaded when strangers and people we are not emotionally close to enter our private territory.

Edward Hall (1969) identified four distances or zones that we set in our daily interactions. We use these distances to guide us in setting the type of interactions we want to have with others. The particular zone we choose depends on the context of the conversation, how we feel toward the other person, and what our interpersonal goals are. These zones include the intimate zone, the personal zone, the social zone, and the public zone.

Intimate Zone

The  intimate zone begins with skin surface and goes out about 18 inches. We generally let only people we are emotionally very close to enter this boundary, and then mostly in private situations—comforting, conveying caring, making love, and showing love and affection. When we voluntarily let and want someone to enter this zone, it is a sign of trust. We lower our defenses. Think about the dates you have. If the person moves within this zone and sits tight against you, it is a signal that he or she is comfortable with the relationship and may want it to progress further. On the other hand, if the person seeks to maintain a safe distance of two or more feet, the person is still sorting out the relationship or wants a more distant relationship.

When someone moves into this intimate zone without our wanting them to, we feel invaded and threatened. Our posture becomes more upright, and our muscles tense. We may move back and avoid eye contact as a way of signaling we want a more distant relationship. When we are forced to get close to strangers (on crowded buses and elevators), we tend to avoid eye contact and try not to touch others, probably as a way of conveying, “I’m sorry I’m forced to invade your territory. I’ll try not to bother you.”

Personal Zone

The  personal zone ranges from about 18 inches to approximately four feet. This is the distance at which couples stand in public. Interestingly, if someone of the opposite sex at a party stands this close to someone we are dating or are married to, we tend to become suspicious of that person’s intentions. If we see our spouse or date move this close to someone of the opposite sex at a party, we may become suspicious and sometimes jealous.

When two people are romantically involved, they love to be as close as possible to each other.

Social Zone

The  social zone ranges from about 4 feet to about 12 feet. Business communications are frequently exchanged in this zone. The closer part of this zone (from four to about seven feet) is the distance at which people who work together usually converse, and it is the distance at which salespeople and customers usually interact.

The 7- to 12-foot range is the distance for more impersonal and formal situations. For example, this is the distance at which our boss talks to us from behind his or her desk. If we were to pull our chair around to the boss’s side of the desk in order to sit closer, a different kind of relationship would be signaled. Furniture arrangement in an office also conveys signals about the type of relationship the officeholder wants to have. For example, an office in which there is a desk between the officeholder and the customer/client/student suggests that a formal and impersonal interaction is being sought. An office in which a desk is not used as a barrier suggests that a warmer, less formal interaction is allowed.

Public Zone

The  public zone runs outward from 12 feet. Teachers and public speakers often use a distance of 12 to 18 feet from their audience. In the farther distances of public space (beyond 25 feet), two-way communication is difficult. Any speaker who voluntarily chooses to have considerable distance from the audience is not interested in having a dialogue.

11-6iTerritoriality

Territoriality is behavior characterized by identification with an area in such a way as to indicate ownership and defense of this territory against those who may invade it (Knapp & Hall, 2014). Many animals will strike back against much larger organisms if they feel their territory is being invaded.

Territoriality also exists in humans. There are even things we feel we own that we really do not own. Students tend in each class to select a certain seat to sit in. If someone else should happen to sit in your chosen seat, do you feel your territory is being invaded?

11-6jFacial Expressions

For most people, the face and eyes are the primary sources of nonverbal communication. Facial expressions often mirror our thoughts and feelings. Yet facial expressions are a complex source of information for several reasons. First, they can change rapidly. Slow-motion films have shown that a fleeting expression can come and go in as short a time as a fifth of a second (Knapp & Hall, 2014). In addition, researchers have found that there are at least eight distinguishable positions of the eyes and lids, at least eight positions for the eyebrows and forehead, and at least 10 for the lower face (Knapp & Hall, 2014). As a result, we have several hundred different possible expressions, and compiling a directory of them and their corresponding emotions is almost impossible.

Ekman and Friesen (1975) identified six basic emotions that facial expressions reflect: fear, surprise, anger, happiness, disgust, and sadness. These expressions appear to be recognizable in all cultures. People seeing photos of these expressions are quite accurate in identifying these emotions. Therefore, although facial expressions are complex, these six emotions can fairly accurately be identified (Knapp & Hall, 2010).

A word of caution should be noted about reading facial expressions. Because people are generally aware that their facial expressions reflect what they are feeling and thinking, they may seek to mask their facial expressions for a variety of reasons. For example, a person who is angry, but doesn’t want others to see the anger, may seek to hide this feeling by smiling. Therefore, in reading facial expressions we should be aware that the sender may be seeking to conceal his or her real thoughts and feelings.

The eyes are also great communicators. When we want to end or avoid a conversation, we look away from the other person’s eyes. When we want to start a conversation, we often seek out the other’s eyes. We may wait until the receiver looks at us as a signal to begin. The eyes also communicate dominance and submission. When a high-status person and a low-status person are looking at each other, the low-status person tends to look away first. Downcast eyes signal submission or giving in. (Downcast eyes may also signal sadness, boredom, or fatigue.)

Good salespeople are aware that eyes are a sign of involvement. When they know they have caught our eye, they begin their pitch and seek to maintain eye contact. They know there are social norms in our society, such as the courtesy of hearing what a person has to say once we allow the person to begin speaking. These social norms trap us into hearing the sales pitch once eye contact has been made. Good salespeople watch eyes in a store in another way. They observe what items we are looking at and then seek to emphasize those items in their sales pitch.

Eye expressions suggest a wide range of human emotions. Wide-open eyes suggest wonder, terror, frankness, or naivete. Raised upper eyelids may mean displeasure. A constant stare connotes coldness. Eyes rolled upward suggest another’s behavior is unusual or weird.

When we become emotionally aroused or interested in something, the pupils of our eyes dilate. Some counselors are so skilled in reading pupil dilation that they can tell when they touch on a subject that a client is sensitive about.

Voice

The tone of one’s voice often has more influence than do the actual words spoken. The same word or phrase may have many meanings. Therefore, the way we say the word is the meaning we give to the word. For example, Knapp and Hall (2010, p. 367) show how the meaning of the following sentence is changed by the word that is emphasized.

1. He’s giving this money to Herbie. (He is the one giving the money, nobody else.)

2. He’s giving this money to Herbie. (He is giving, not lending the money.)

3. He’s giving this money to Herbie. (The money being exchanged is not from another fund or source; it is this money.)

4. He’s giving this money to Herbie. (Money is the unit of exchange, not a check.)

5. He’s giving this money to Herbie. (The recipient is Herbie, not Eric or Bill or Rod.)

In addition to emphasizing certain words in a sentence, one’s voice can communicate in many other ways. These ways include length of pauses, tone, pitch, speed, volume, and disfluencies (such as stammering or saying, “uh,” “um,” and “er”). All of these factors together have been called  paralanguage. Paralanguage deals with how something is said and not with what is said (Knapp & Hall, 2014).

Paralanguage can communicate the exact opposite of what the verbal message is. You might practice through changing your voice how you would seek to convey literally, and then sarcastically, messages such as

· “I really like you.”

· “I’m having a perfectly wonderful time.”

· “You’re really terrific.”

When paralanguage and the verbal message are contradictory, the former will carry more meaning. When there is a contradiction between words and the way something is said, subjects usually interpret the message in terms of the way it is said (Knapp & Hall, 2014).

An excellent way to learn more about the way you are using paralanguage is to videotape one of your conversations or speeches and then watch the replay. Such a process will also give you valuable feedback about your other forms of nonverbal communication.

11-6kPhysical Appearance

Although it is common to hear people say that only inner beauty really counts, research shows that outer beauty (physical attractiveness) plays an influential role in a broad range of interpersonal interactions. Male college professors tend to give higher grades to females who are physically attractive than to those who are less attractive. In one study, attractive females were more effective in modifying the attitudes of male students on national issues than were less attractive females. Attractive persons, regardless of sex, are rated high on credibility, which greatly increases their ultimate persuasiveness in a variety of areas, including sales, public speaking, and counseling (Knapp & Hall, 2014). Conversely, unattractive defendants are more likely to be judged guilty in courtrooms and more likely to receive longer sentences (Knapp & Hall, 2014). The evidence is clear that initially we respond much more favorably to those perceived as physically attractive than to those seen as less attractive. Attractiveness serves to open doors and create greater opportunities.

Physically attractive people have been found to outstrip less attractive people on a wide range of socially desirable evaluations, including personality, popularity, success, sociability, persuasiveness, sexuality, and often happiness (Knapp & Hall, 2014). For example, attractive women are more apt to be helped and less likely to be the objects of aggressive (nonsexual) acts.

Less attractive people are at a disadvantage from early childhood on. Teachers, for example, interact less (and less positively) with unattractive children. Physical attractiveness is also a crucial factor in determining who we decide to date and who we decide to marry. In many situations, practically everyone prefers the most attractive date regardless of her or his own attractiveness and regardless of being rejected by the most attractive date (Knapp & Hall, 2014).

Ethical Question 11.2

The shape of one’s body suggests certain stereotypes that may or may not be accurate. People who are overweight are judged to be older, more old-fashioned, less strong physically, more talkative, less good-looking, more agreeable and good-natured, more trusting of others, more dependent on others, and more warmhearted and sympathetic. People who are muscular are rated as being stronger, better looking, younger, more adventurous, more self-reliant, more mature in behavior, and more masculine.

People with a thin physique are rated as younger, more suspicious of others, more tense and nervous, less masculine, more pessimistic, quieter, more stubborn, and more inclined to be difficult. Both overweight people and very thin people have been found to be discriminated against when seeking to obtain jobs, buy life insurance, adopt children, and be accepted into college. Being tall is a strong advantage in the business world for men but not for women. Shorter men are shortchanged on salaries and job opportunities (Knapp & Hall, 2014).

We have considerable capacity to improve our physical appearance. Eating well, exercising, learning to manage stress, learning to be assertive, getting adequate sleep, improving grooming habits, and improving choice of clothes will substantially improve physical appearance. Improving physical appearance will open more doors and create more opportunities.

11-6lThe Environment

Most of us have been in immaculate homes that have “un-living rooms” with plastic furniture coverings, lampshade covers, and spotless bare tables that send off-putting nonverbal messages: Do not get me dirty, do not touch, do not put your feet up. In such homes, we are not able to relax; their owners wonder why guests don’t relax and have a good time. They are unaware that the environment is communicating messages that lead guests to feel uncomfortable.

The attractiveness of a room shapes the kind of communication that takes place and also influences the happiness and energy of people working in it. When people are in an unattractive room, they tend to become tired and bored and take longer to complete assigned work than when in an attractive room. When people are in a pleasant room, they display a greater desire to work, and they communicate many more feelings of comfort, importance, and enjoyment. Workers do a better job and generally feel better in an attractive environment (Knapp & Hall, 2014).

The color of rooms apparently affects mood and productivity. In one study, children who were given an IQ test scored about 12 points higher in rooms they described as beautiful than they did in rooms they described as having ugly colors (Knapp & Hall, 2014). The beautiful rooms appeared to stimulate alertness and creativity. Friendly words and smiles increased in the beautiful rooms, and irritability and hostility decreased. The most arousing colors are, in order, red, orange, yellow, violet, blue, and green. The pastel colors of pink, baby blue, and peach are thought to have a calming effect. Some prison and jail administrators are now painting cells in pastel colors, hoping that it will have a calming and relaxing effect on inmates.

Businesses have found that they can control the rate of customer turnover through environmental design. Dim lighting, comfortable seats, and subdued noise levels will encourage customers to talk more and spend more time in a bar or restaurant (Knapp & Hall, 2014). If the goal is to run a high-volume business (as in a fast-food place), businesses can encourage customer turnover with bright lights, uncomfortable seats, and high noise levels (for example, by having poor soundproofing). Chairs can be constructed to be comfortable, or they can be made uncomfortable by putting pressure on the sitter’s back. Airports seek to get travelers into the restaurants and bars where they will spend money by having comfortable chairs, tables where people can converse, and dim lighting. They discourage travelers from sitting in waiting areas by using bright lighting and by having uncomfortable chairs bolted shoulder to shoulder in rows facing outward, which makes conversation and relaxation more difficult.

Casino owners in Las Vegas build their facilities without windows or clocks so that customers will be less aware of how long they have been gambling. The aim is to keep people gambling as long as possible. Without windows, some customers are unaware that they are gambling into the next day.

As indicated earlier, types and placement of furniture in offices convey messages about whether the officeholder wants informal, relaxed communication or formal, to-the-point communication. A round table, for example, suggests the officeholder is seeking to have the communication seen as egalitarian, whereas a rectangular table suggests the communication should recognize status and power differentials. With a rectangular table, the high-status people generally sit at one end of the table. If the meeting is between parties of equal strength, one contingent tends to sit on one side, and the other on the other side, rather than intermingling the members. A classroom in which the chairs are in a circle suggests the instructor wants to create an informal discussion atmosphere. A classroom with the chairs in rows suggests the instructor wants to create a formal, lecture-type atmosphere.

11-7Summarize Glasser’s Choice Theory of Human Behavior

11-7aChoice Theory

William Glasser (1998) developed a  choice theory explanation of human behavior. A major thrust of choice theory is that we carry around pictures in our heads, both of what reality is like and of how we would like it to be. Glasser (1984, p. 32) asserts, “All our behavior is our constant attempt to reduce the difference between what we want (the pictures in our heads) and what we have (the way we see situations in the world).”

Some examples will illustrate this idea. Each of us has a detailed idea of the type of person we would like to date; when we find someone who closely matches our idea, we seek to form a relationship. Each of us carries around a picture album of our favorite foods; when we’re hungry, we select an item and go about obtaining that food.

How do we develop the pictures/albums/ideas that we believe will satisfy our needs? According to Glasser, we begin to create them at an early age (perhaps even before birth) and we spend our whole lives enlarging them. Essentially, whenever what we do gets us something that satisfies a need, we store the picture of it in our personal albums. Glasser (1984) gives an example of this process by describing how a hungry child added chocolate chip cookies to his picture album:

Suppose you had a grandson and your daughter left you in charge while he was taking a nap She said she would be right back, because he would be ravenous when he awoke and she knew you had no idea what to feed an eleven-month-old child. She was right. As soon as she left, he awoke screaming his head off, obviously starved. You tried a bottle, but he rejected it—he had something more substantial in mind. But what? Being unused to a howling baby, and desperate, you tried a chocolate chip cookie and it worked wonders. At first, he did not seem to know what it was, but he was a quick learner. He quickly polished off three cookies. [Your daughter] returned and almost polished you off for being so stupid as to give a baby chocolate. “Now,” she said, “he will be yelling all day for those cookies.” She was right. If he is like most of us, he will probably have chocolate on his mind for the rest of his life. (p. 19)

When this child learned how satisfying chocolate chip cookies are, he placed the picture of these cookies in his personal picture album.

By  pictures, Glasser means perceptions from our five senses of sight, hearing, touch, smell, and taste. The pictures in our albums do not have to be rational. Anorexics picture themselves as too fat and starve themselves to come closer to their irrational picture of thinness. Rapists have pictures of satisfying their power needs and perhaps sexual needs through sexual assault. To change a picture, we must replace it with one that will at least reasonably satisfy the need in question. People who are unable to replace a picture may endure a lifetime of misery. Some battered women, for example, endure brutal beatings and humiliations in marriage because they cannot picture themselves as worthy of a loving relationship.

Glasser believes we are driven by five basic, innate needs. As soon as one need is satisfied, another need (or perhaps two or more acting together) pushes for satisfaction. Our first need is survival. This includes such vital functions as breathing, digesting food, sweating, regulating blood pressure, and meeting the demands of hunger, thirst, and sex.

Our second need is love and belonging. We generally meet this need through family, friends, pets, plants, and material possessions.

Our third need is power. According to Glasser, this need involves getting others to obey us and then receiving the esteem and recognition that accompany power. Our drive for power sometimes conflicts with our need to belong. Two people in a relationship may struggle to control it rather than create an egalitarian relationship.

Our fourth need is freedom. People want the freedom to choose how they live their lives, to express themselves, to read and write what they choose, to associate with whom they want, and to worship or not worship as they believe.

Our fifth need is fun. Glasser believes learning is often fun; this gives us a great incentive to assimilate what we need to satisfy our needs. Classes that are grim and boring are major failings of our educational system. Laughter and humor help fulfill our need for fun. Fun is such a vital part of living that most of us have trouble conceiving of life without it.

Choice theory explains why and how we make the choices that determine the course of our lives. It is an  internal control psychology: Glasser (1998) asserts that we choose everything we do. Following are the major axioms of choice theory:

· 1.

The only behavior we can control is our own. No one can make us do anything we do not want to do, as long as we are willing to endure the consequences (i.e., punishment for not doing what others want us to do). If we choose to do what others want us to do under the threat of severe punishment, we tend to be passive-aggressive by not performing well. When we try to force others to do what they do not want to do, they may choose not to do it—or choose to also be passive-aggressive by not performing well.

· 2.

All we can give or get from other people is information. How we deal with that information is our choice or theirs. A teacher, for example, can assign readings to students, but he is not responsible if some students choose not to read them. The teacher therefore should not feel responsible for those students who choose not to do the readings. The teacher can choose, of course, to give consequences to those students who fail to follow the reading instructions—such as giving them a lower grade.

· 3.

All we can do from birth to death is “behave.” Glasser indicates all behavior is “total behavior” and is made up of four inseparable components: acting, thinking, feeling, and physiology. Each of these components interacts and affects the three other components. (The next two axioms elaborate on this interaction.)

· 4.

All long-lasting psychological problems are relationship problems. Relationship problems are also a partial cause of many other problems, such as fatigue, pain, weakness, and autoimmune diseases (such as fibromyalgia and rheumatoid arthritis). Glasser (1998) states,

Most doctors believe that adult rheumatoid arthritis is caused by the victims’ immune systems attacking their own joints as if these joints were foreign bodies. Another way of putting it is that their own creative systems are trying to protect these people from a perceived harm. If we could figure out a way to stop this misguided creativity, millions of people who suffer from this disease and a host of other relentless diseases, called autoimmune diseases, could be helped. (pp. 137–138)

Our usual way of dealing with an important relationship that is not working out the way we want it to is to choose misery—emotional misery and physical misery.

· 5.

In regard to the brain creating the symptoms in the DSM-5, Glasser (2003) describes how unhappiness may lead the brain to create hallucinations:

Suppose, instead of your creativity presenting an idea to you as a thought, it created a voice uttering a threat or some other message directly into the auditory cortex of your brain. You would hear an actual voice or voices; it could be a stranger or you might recognize whose voice it was. It would be impossible, just by hearing it, for you to tell it from an actual voice or voices. (p. 114)

Since we can hear voices, our brains can create voices that we hear when no one else is around. Since we can see, it can create visual hallucinations. Since we can feel pain, it can create pain—perhaps in greater severity and duration than what we experience from an injury or illness. Since we are able to fear, the brain can and does create disabling phobias.

· 13.

When we have difficulty getting along with other people, we usually make the mistake of choosing to employ  external control psychology, attempting to coerce or control others by nagging, preaching, moralizing, criticizing, or using put-down messages.

· 14.

Because relationships are central to human happiness, improving our emotional and physical well-being involves exploring how we relate to others, and looking for ways to improve how we relate to others (particularly those we feel closest to).

· 15.

· 16.

All behavior (thinking, feeling, acting, and physiology) is chosen, but we have direct control over only the acting and thinking components. We do, however, control our physiology and our feelings through how we choose to act and think. It is not easy to change our actions and thoughts, but it is all we can do. When we succeed in coming up with more satisfying actions and thoughts, we gain a great deal of personal freedom.

· 17.

Whenever you feel as if you don’t have the freedom you want in a relationship, it is because you, your partner, or both of you are unwilling to accept a key axiom of choice theory: You can only control your own behavior. The more you and your partner learn choice theory, the better you will get along with one another. Choice theory supports the Golden Rule.

· 18.

An important step toward identifying and following your intuition is simply taking time (perhaps several times a day) to relax and listen to your “gut feelings.” The inner voice of intuition will present itself in a variety of ways, including images, feelings, and words. When you have an important decision to make, your true feelings can more easily be identified if you are relaxed. When you are relaxed (perhaps through using meditation or some other relaxation technique), your intuition will inform you which alternative is in your best interest. Frequently, your intuition will inform you of creative alternatives that you were previously unaware of.

Human intuition is similar (and perhaps identical) to the instinct in geese that guides them to fly south in fall and north in spring. It is similar to the instinct in dogs that makes them wary upon seeing a bear in the wild—even when they have never seen a bear before.

Your intuition can assist you in making such major decisions as whether to stay in college, choosing a career, whether to end a romantic relationship, what kind of automobile to purchase, and what hobbies to pursue. Your intuition can also lead you to be a more creative, productive, contented, and fulfilled person.

11-9Understand the Issue of Substance Abuse

11-9aChemical Substance Use and Abuse

The remainder of this chapter will focus on a critical issue affecting, in one way or another, nearly every person in our society—chemical substance use and abuse. Nearly everyone has one or more relatives or friends who are abusing alcohol or some other drug. Some of the readers of this text may be personally struggling with this issue.

We begin our discussion with some examples. There was going to be a big party at Evelyn’s on Saturday night. Georgia, a high school junior, couldn’t wait to go. Everybody was going to be there. Evelyn said she had some great weed. Georgia didn’t like to smoke all that much. However, people would think there was something wrong with her if she didn’t, and that was the last thing she wanted.

Marty, age 15, liked to drink a couple of six-packs on the weekend. After all, his father did, and Marty was almost an adult.

Virgil, age 18, liked to get high because then he could forget about all his problems. He wouldn’t have to think about his alcoholic mother and all the problems she and his father were having. He wouldn’t have to worry about all the pressures he had in school. He wouldn’t even have to think about how his girlfriend recently dumped him. He just couldn’t wait until the next chance he had to get high.

Drugs have become part of our daily lives. We use drugs to relax, to increase our pleasure, to feel less inhibited, to get rid of unwanted emotions, to keep awake, and to fall asleep. Practically all Americans use drugs of one kind or another. People have coffee in the morning, soda (which has caffeine) during the day, cocktails before dinner, and aspirin to relieve pain.

When the Pilgrims set sail for America, they loaded on their ships 14 tons of water—plus 10,000 gallons of wine and 42 tons of beer (Robertson, 1980). Ever since, Americans have been widely using and abusing drugs.

Pharmacologically, a drug is any substance that chemically alters the function or structure of a living organism. Such a definition includes food, insecticides, air pollutants, water pollutants, acids, vitamins, toxic chemicals, soaps, and soft drinks. Obviously, this definition is too broad to be useful. For our purposes, a definition based on context is more useful. In medicine, for example, a drug is any substance that is manufactured specifically to relieve pain or to treat and prevent diseases and other medical conditions.

Drug abuse is the regular or excessive use of a drug when, as defined by a group, the consequences endanger relationships with other people, are detrimental to a person’s health, or jeopardize society itself. All of the drugs mentioned earlier are types of chemicals. Another way of referring to drug abuse is  chemical substance abuse. Drug or chemical substance intake becomes abusive when an individual’s mind and/or body are affected in negative or harmful ways.

Both legal drugs, such as alcohol and tobacco, and prescription drugs are frequently abused. Among the most abused prescription drugs are sedatives, tranquilizers, painkillers, and stimulants. Many prescribed drugs have the potential to be psychologically and physiologically addicting. Drug companies spend millions in advertising to convince customers that they are too tense and too irritable, take too long to fall asleep, should lose weight, and so on. These companies then assert that their medications will relieve these problems. Unfortunately, many customers accept this easy symptom-relief approach and end up dependent on pills, rather than making the necessary changes in their lives to be healthy. Such changes include exercise, stress management techniques, positive thinking, and a healthy diet.

Illegal drugs such as cocaine and heroin are also frequently abused. People use them to distort their own realities. They can be used to attain unrealistic “highs” or to escape unpleasant life situations. However, as we will see, heavy drug use can often result in serious physical deterioration and slave-like psychological and physical dependence.

This section will describe a variety of over-the-counter, prescription, and illegal drugs and will examine various issues of drug use and treatment. Finally, the relationship between knowledge about drug use and assessment in social work practice will be proposed.

11-9bSpecific Drugs: What They Are and What They Do

· Age: Older people are less likely to drink than younger people, even if they were drinkers in their youth. Heavy drinking is most common at ages 21 to 30 for men and ages 31 to 50 for women.

· Religion: Nonchurchgoers drink more than regular churchgoers. Heavy drinking is more common among Episcopalians and Catholics, whereas conservative and fundamentalist Protestants are more often nondrinkers or light drinkers. Fewer Jews are heavy drinkers.

· Urban/rural residence: Urban residents are more likely to drink than rural residents.

In the 1980s and 1990s, the federal government put considerable financial pressure on states to raise the drinking age to 21; if a state did not raise the age, federal highway funds were withheld. All states have now raised the drinking age to 21. Many secondary schools, colleges, and universities have initiated alcohol awareness programs. Many businesses and employers have developed Employee Assistance Programs designed to provide treatment services to alcoholics and problem drinkers. Many states have passed stricter drunk-driving laws, and police departments and the courts are more vigorously enforcing such laws. Organizations such as Mothers Against Drunk Driving and Students Against Drunk Driving have been fairly successful in creating greater public awareness of the hazards of drinking and driving. A cultural norm is emerging in many segments that it is stylish not to have too much to drink. Despite these promising trends, rates of alcohol use and abuse in the United States remain extremely high.

What Alcohol Does

Many drinkers believe alcohol is a stimulant, because it relaxes tensions, lessens sexual and aggressive inhibitions, and seems to facilitate interpersonal relationships. However, it acts as a depressant to the central nervous system, reducing functional activity of this system. Its chemical composition and effects are very similar to those of ether (an anesthetic used in medicine to induce unconsciousness).

Alcohol slows down mental activity, reasoning ability, speech ability, and muscle reactions. It distorts perceptions, slurs speech, lessens coordination, and slows down memory functioning and respiration. In increasing quantities, it leads to stupor, sleep, coma, and finally death. A hangover (the aftereffects of too much alcohol) includes headache, thirst, muscle aches, stomach discomfort, diarrhea, and nausea. Alcohol can seriously affect how one drives an automobile. Behavior resulting from excessive alcohol intake can also have negative effects on family, friend, and work relationships.

The effects of alcohol vary with the percentage of alcohol in the bloodstream as it passes through the brain. Generally, the effects are observable when the concentration of alcohol in the blood reaches one-tenth of a percent. Five drinks (a drink is defined as 1 ounce of 86-proof alcohol or 12 ounces of beer or 3 ounces of wine) in 2 hours for a 120-pound person will result in a blood alcohol concentration of one-tenth of a percent, which exceeds the legal criterion in all states for being intoxicated.

Alcohol also has long-term effects on a person’s health. Alcoholics have a life expectancy that is 10 to 12 years less than that of nonalcoholics (Mooney, Knox, & Schacht, 2015). The lifespan is shorter for several reasons. One is that alcohol, over an extended period of time, gradually destroys liver cells and replaces the cells with scar tissue. When the scar tissue is extensive, a medical condition occurs called  cirrhosis. Continued drinking by people impacted by cirrhosis often results in death. Also, although it has no nutritional value, alcohol contains a high number of calories. As a result, heavy drinkers have a reduced appetite for nutritious food and thus frequently suffer from vitamin deficiencies and are more susceptible to infectious diseases. Heavy drinking also causes kidney problems, contributes to a variety of heart ailments, is a factor in diabetes, and appears to contribute to cancer. In addition, heavy drinking is associated with thousands of suicides annually (Mooney, Knox, & Schacht, 2015).

However, for some as yet unknown reason, the life expectancy for light-to-moderate drinkers exceeds that for nondrinkers. Perhaps an occasional drink helps people to relax and thereby reduces the likelihood of developing life-threatening stress-related illnesses.

Combining alcohol with other drugs can have disastrous, and sometimes fatal, effects. Two drugs taken together may have a  synergistic interaction—that is, they interact to produce an effect much greater than either would cause alone. For example, sedatives such as barbiturates (often found in sleeping pills) or Quaaludes taken with alcohol can so depress the central nervous system that a coma or even death may result.

Other drugs tend to create an  antagonistic response to alcohol—one drug negates the effects of the other. Many doctors now caution patients not to drink while taking certain prescribed drugs because the alcohol will reduce, and even totally negate, the beneficial effects of those drugs.

Whether drugs will interact synergistically or antagonistically depends on a wide range of factors: the properties of the drugs, the amounts taken, the amount of sleep of the user, the kind and amount of food that has been eaten, and the user’s overall health and tolerance. The interactive effects may be minimal one day and extensive the next.

When used by pregnant women, alcohol may gravely affect the unborn child by causing mental retardation, deformities, stunting of growth, and other abnormalities. This effect has been termed  fetal alcohol syndrome.

Withdrawal from alcohol, once the body is physically addicted, may lead to the DTs (delirium tremens) and other unpleasant reactions. The DTs include rapid heartbeat, uncontrollable trembling, severe nausea, and profuse sweating.

Barbiturates

Barbiturates, another type of depressant, are derived from barbituric acid, and depress the central nervous system. Barbiturates were first synthesized in the early 1900s, and there are now more than 2,500 different barbiturates. They are commonly used to relieve insomnia and anxiety. Some are prescribed as sleeping pills, and others are used during the daytime by tense and anxious persons. They are also used to treat epilepsy and high blood pressure, and to relax patients before or after surgery. Barbiturates are illegal unless obtained by a physician’s prescription.

Taken in sufficient doses, barbiturates have effects similar to alcohol. Users experience relief from inhibitions, have a feeling of euphoria, feel “high” or in good humor, and are passively content. However, these moods can change rapidly to gloom, agitation, and aggressiveness. Physiological effects include slurred speech, disorientation, staggering, appearance of being confused, drowsiness, and reduced coordination.

Prolonged heavy use of barbiturates can cause physical dependence, with withdrawal symptoms similar to those of heroin addiction. Withdrawal is accompanied by body tremors, cramps, anxiety, fever, nausea, profuse sweating, and hallucinations. Many authorities believe barbiturate addiction is more dangerous than heroin addiction, and it is considered to be more resistant to treatment than heroin addiction. Abrupt withdrawal ( cold turkey, the sudden and complete halting of drug use) can cause fatal convulsions.

Barbiturate overdose may cause convulsions, coma, poisoning, and sometimes death. Barbiturates are particularly dangerous when taken with alcohol, because alcohol acts synergistically to magnify the potency of the barbiturates. Accidental deaths due to excessive doses are frequent. Barbiturates are also the number one drug used for suicide. A number of famous people have fatally overdosed on barbiturates.

Excessive amounts of caffeine cause insomnia, restlessness, and gastrointestinal irritation. Surprisingly, excessive doses can even cause death.

Because caffeine has the status of a “nondrug” in our society, users are not labeled criminals, there is no black market for it, and no subculture is formed to give support in obtaining and using the drug. Because caffeine is legal, its price is low compared to that of other drugs. Users are not tempted to resort to crime to support their habit. Some authorities assert that our approach to caffeine should serve as a model for the way we react to other illegal drugs (such as marijuana) that they feel are no more harmful than caffeine (Kornblum & Julian, 2012).

Amphetamines

Another type of stimulant, amphetamines, are often called “uppers” because of their stimulating effect. When prescribed by a physician, they are legal. Some truck drivers have obtained prescriptions in order to stay awake and more alert while making a long haul. Dieters have received prescriptions to help them lose weight, and they often find that the pills tend to give them more self-confidence and buoyance. Others who have used amphetamines to increase alertness and performance for relatively short periods of time include college students, athletes, astronauts, and executives. Additional nicknames for this drug are speed, ups, pep pills, black beauties, and bennies.

Ethical Question 11.4

Amphetamines are usually taken orally in tablet, powder, or capsule form. They can also be sniffed or injected. “Speeding” (injecting the drug into a vein) produces the most powerful effects and can also cause the greatest harm. An overdose may cause a coma, with possible brain damage and, in rare cases, death. Speeders may also develop hepatitis, abscesses, convulsions, hallucinations, delusions, and severe emotional disturbances. Another danger is that, when sold on the street, the substance may contain impurities that are health hazards.

An amphetamine high is often followed by mental depression and fatigue. Continued amphetamine use leads to psychological dependence. It is unclear whether amphetamines are physically addictive, as the withdrawal symptoms are uncharacteristic of withdrawal from other drugs. Amphetamine withdrawal symptoms include sleep disturbances, apathy, decreased activity, disorientation, irritability, exhaustion, and depression. Some authorities believe such withdrawal symptoms indicate that amphetamines may be physically addicting.

One of the legal uses of certain amphetamines is in the treatment of hyperactivity in children. Hyperactivity (also called  hyperkinesis) is characterized by a short attention span, extensive motor activity, restlessness, and mood shifts. Little is known about the causes of this condition. As children become older, even without treatment, the symptoms tend to disappear. Interestingly, some amphetamines (Ritalin is a popular one) have a calming and soothing effect on hyperactive children—the exact opposite effect occurs when Ritalin is taken by adults. It should be noted that treating uncontrollable children with amphetamines has sometimes been abused. Some of the children for whom Ritalin was prescribed were not really hyperactive. They were normal children who simply refused to submit to what their teachers and parents considered appropriate childhood behavior. As a result, these children were labeled as troublemakers and were introduced to the world of taking a mood-altering drug on a daily basis.

One amphetamine that has had increasing illegal use in recent years is methamphetamine hydrochloride, known on the street as “meth” or “ice.” In liquid form, it is often referred to as “speed.” Under experimental conditions, cocaine users often have difficulty distinguishing cocaine from methamphetamine hydrochloride. Use of this drug has spread, as the “high” lasts longer than that from cocaine and the drug can be manufactured relatively easily in laboratories from products that are sold legally in the United States. As a “last resort,” methamphetamine hydrochloride (Desoxyn) is legally used to treat obesity as one component of a weight-reduction regimen. However, this drug has a serious side effect when used for weight reduction: the user’s appetite returns with greater intensity after withdrawal from the drug.

Cocaine and Crack

Cocaine is obtained from the leaves of the South American coca plant. Although legally classified as a narcotic, it is in fact not related to the opiates from which narcotic drugs are derived. It is a powerful stimulant and antifatigue agent.

In the United States, cocaine is generally sniffed and then absorbed through the nasal membranes. The most common method is “snorting,” sniffing up through a straw or a rolled-up banknote. It may also be injected intravenously, and in South America the natives chew the coca leaf. It may be added in small quantities to a cigarette and smoked. Cocaine has been used medically in the past as a local anesthetic, but other drugs have largely replaced it for this purpose.

Cocaine constricts the blood vessels and tissues, and thereby leads to increased strength and endurance. It also is thought by users to increase creative and intellectual powers. Other effects include a feeling of euphoria, excitement, restlessness, and a lessened sense of fatigue.

Someone snorting cocaine.

Physical effects of cocaine include increased blood pressure and pulse rate, insomnia, and loss of appetite. Heavy users may experience weight loss or malnutrition due to appetite suppression. Physical dependence on cocaine is considered to be a low-to-medium risk. However, the drug appears to be psychologically habituating. Termination of use usually results in intense depression and despair, which drives the person back to taking the drug. Additional effects of withdrawal include apathy, long periods of sleep, extreme fatigue, irritability, and disorientation. Serious tissue damage to the nose can occur when large quantities of cocaine are sniffed over a prolonged period of time. Regular use may result in habitual sniffing and sometimes leads to an anorexic condition. High doses can lead to agitation, increased body temperature, and convulsions. A few people who overdose may die if their breathing and heart functions become too depressed.

Crack, also called “rock,” is obtained by separating the adulterants from the cocaine by mixing it with water and ammonium hydroxide. The water is then removed from the cocaine base by means of a fast-drying solvent, usually ether. The resultant mixture resembles large crystals, similar to rock sugar. Crack is highly addictive. Some authorities claim that one use is enough to lead to addiction. Users generally claim that after they have finished one dose, they crave for another.

Crack is generally smoked, either in a specially made glass pipe or mixed with tobacco or marijuana in a cigarette. The effects are similar to those of cocaine, but the “rush” is more immediate, and the drug gives an intensified high.

An overdose is more common when crack is injected than when it is smoked. Withdrawal effects include an irresistible compulsion to have the drug, as well as apathy, long periods of sleep, irritability, extreme fatigue, depression, and disorientation.

Amyl Nitrate and Butyl Nitrate

Butyl nitrate is legally available in some states without a prescription and has an effect similar to amyl nitrate’s. Trade names under which it is sold are Rush and Locker Room. Similar to amyl nitrate, butyl nitrate vapor is sniffed. It is available at some sexual aid and novelty stores.

Both of these drugs have been used as aphrodisiacs and as stimulants while dancing. The drugs have some short-term, unpleasant side effects that may include fainting, headaches, and dizziness. A few deaths have been reported due to overdoses. Both drugs are classified as stimulants.

Narcotics

The most commonly used narcotic drugs in the United States are the opiates, such as opium, heroin, and morphine. The term narcotic means sleep-inducing. In actuality, drugs classified as narcotics are more accurately called analgesics, or painkillers. The principal effect produced by narcotic drugs is a feeling of euphoria.

The opiates are all derived from the opium poppy, which grows in many parts of the world: Turkey, Southeast Asia, and Colombia have, in the recent past, been major sources of the opiates. The drug opium is the dried form of a milky substance that oozes from the seed pods after the petals fall from the flowers. It has been used for centuries.

Morphine is the main active ingredient of opium. It was first identified early in the 1800s and has been used extensively as a painkiller. Heroin was first synthesized from morphine in 1874. It was once thought to be a cure for morphine addiction, but later was also found to be addictive. Heroin is a more potent drug than morphine.

Opiates affect the central nervous system and produce feelings of tranquility, drowsiness, or euphoria. They produce a sense of well-being that makes pain, anxiety, or depression seem unimportant. Blaze-Gosden (1987) notes that opiates

have been described as giving an orgasmlike rush or flash that lasts briefly but memorably. At the peak of the euphoria, the user has a feeling of exaggerated physical and mental comfort and well-being, a heightened feeling of buoyancy and bodily health, and a heightened feeling of being competent, in control, capable of any achievement, and being able to cope. (p. 95)

Overdoses can cause convulsions and coma and, in rare cases, death by respiratory failure. All opiates are now recognized as highly addictive. Opioid abuse is a serious public health issue in the United States and other countries. The abuse of opioids has reached epidemic proportions in recent years.

Opiate addiction occurs when the user takes the drug regularly for a period of time. Whether addiction will occur depends on the opiate drag taken, the strength of the dosage, the regularity of use, the characteristics of the user, and the length of time taken—sometimes as short as a few weeks. Users rapidly develop a tolerance, and may eventually need a dose that is up to 100 times stronger than a dose that would have been fatal during the initiation to the drug (Abadinsky, 2011).

The withdrawal process is very unpleasant. Symptoms include chills, cramps, sweating, nervousness, anxiety, running eyes and nose, dilated pupils, muscle aches, increased blood pressure, severe cramps, sometimes extreme nausea, and fever. Most addicts are obsessed with securing a fix to avoid these severe withdrawal symptoms.

Addiction to opiates is extremely difficult to break, partly because an intense craving for the drug may recur periodically for several months afterward.

Heroin is the most widely abused opiate. In addition to the above-mentioned effects, heroin slows the functioning parts of the brain. The user’s appetite and sex drive tend to be dulled. After an initial feeling of euphoria, the user generally becomes lethargic and stuporous.

When heroin was first discovered in the late 1880s, it was initially used as a painkiller, as a substitute for morphine, and as a drug taken by many to experience euphoria. A fair number of people became addicted, and in the early 1900s, laws were passed to prohibit its sale, possession, and distribution.

Heroin abuse continues to be regarded by some Americans as our most serious drug problem.

Prostitution among female addicts is also common.

Unsanitary injections of heroin may cause hepatitis and other infections. Communal use of needles can spread AIDS. Also, the high cost of maintaining a heroin habit—often more than $100 daily—may create huge financial problems for the user.

A user injects heroin.

Hallucinogens

Hallucinogens were popular as psychedelic drugs in the late 1960s. These drugs distort the user’s perceptions, creating hallucinations consisting of sensory impressions of sights and sounds that do not exist. The six hallucinogens most commonly used in this country are mescaline (peyote), psilocybin, psilocin, LSD, PCP, and ecstasy. All are taken orally—in capsule form, on a sugar cube, or licked from the back of a stamp.

Peyote is derived from a cactus plant. Mescaline is the synthetic form of peyote. Psilocybin and psilocin are found in approximately 90 different species of mushrooms. They are sometimes called “magic mushrooms.” Both peyote and psilocybin have had a long history of use by certain Native American tribes. Members of the Native American Church, a religious organization, have won the legal right to use peyote on ceremonial occasions (Robertson, 1980).

One of the most popular hallucinogens is LSD (lysergic acid diethylamide). LSD is a synthetic material derived from a fungus (ergot) that grows on rye and other plants. It is one of the most potent drugs known; a single ounce will make up to 300,000 doses.

The effects of LSD vary a great deal, depending on the expectations and psychological state of the user and the context in which it is taken. A given person may experience differing reactions on different occasions. The effects that may be experienced include the apparent “seeing” of sounds; “hearing” of color; colors seeming unusually bright and shifting kaleidoscopically; exaggerations of color and sound; and objects appearing to expand and contract. Users become highly suggestible and easily manipulated.

Bizarre hallucinations are also common. The experience may be peaceful or may result in panic. Some users have developed severe emotional disturbances that resulted in long-term hospitalization. Usually a “trip” will last 6 to 16 hours. Physical reactions include increased heartbeat, goose bumps, dilated pupils, hyperactivity, tremors, and increased sweating. Aftereffects include acute anxiety and depression. Flashbacks sometimes occur after the actual drug experience. Flashbacks may happen at any time and place, with no advance warning. If the user is driving a car when a flashback occurs, a life-threatening condition is present for the user and for others in the vicinity.

There is no evidence of physical or psychological dependence on LSD. Users do develop tolerance to the drug very rapidly as the effects can only be achieved in the future by larger doses. Cessation of use, even for a few days, will restore sensitivity to the drug, enabling the user to take smaller quantities to experience the effects.

Phencyclidine (better known as PCP or angel dust) was developed in the 1950s as an anesthetic. This medical use was soon terminated because patients displayed symptoms of severe emotional disturbance after receiving the drug. PCP is used legally today to tranquilize elephants and monkeys, as they apparently do not experience the adverse side effects.

PCP is primarily used by young people who are often unaware of its hazards. It is usually smoked, often after being sprinkled on a marijuana joint. It may also be sniffed, swallowed, or injected.

PCP is a very dangerous drug. It distorts the senses, disrupts balance, and leads to an inability to think clearly. Effects produced are similar to those of hallucinogens. Larger amounts of PCP may cause a person to become paranoid, lead to aggressive behavior, and may cause the user to display temporary symptoms of severe emotional disturbance. Continued use can lead to prolonged emotional disturbance. Overdose can result in coma or even death. Research has not yet concluded whether PCP induces physical and/or psychological dependence. The drug has the potential to be used (and abused) extensively, as it is relatively easy to prepare in a home laboratory from ingredients and recipes that are widely available. An additional danger of PCP is that even one-time users sometimes have flashbacks in which the hallucinations are reexperienced, even long after use has ceased.

The effects and dangers of mescaline, psilocybin, and psilocin are similar to those of LSD and PCP. The latter two, however, are the most potent of these hallucinogens.

Ecstasy use in high doses can be extremely dangerous. It can lead to dehydration, hypertension, and heart or kidney failure. It can cause a marked increase in body temperature. Chronic use of ecstasy can produce long-lasting, perhaps permanent damage to the neurons that release serotonin, and consequent memory impairment.

Tobacco

The use of tobacco has now become recognized as one of the most damaging drug habits in the United States. Smoking can cause emphysema, cancer of the mouth, ulcers, and lung cancer, and it reduces life expectancy. It significantly increases the risk of strokes and heart disease, particularly in women who use birth control pills. Smoking by a pregnant woman can lead to miscarriage, premature birth, and underweight birth. Yet despite these widely publicized hazards, about 20 percent of the adult population continues to smoke (Abadinsky, 2011).

Tobacco is the number one killer drug. It contributes to far more deaths than all other drugs combined (Kornblum & Julian, 2012). Tobacco is estimated to contribute to more than 400,000 deaths per year in the United States. This is more than double the number of deaths attributed to alcohol abuse and hundreds of times the number of deaths due to cocaine. Most of the tobacco-related deaths are the results of diseases such as heart disease and lung cancer. However, more than 2,000 deaths per year result from fires caused by careless smoking (Kornblum & Julian, 2012). There is also substantial evidence that “passive smoking” (breathing the smoke from others’ cigarettes, cigars, or pipes) is also hazardous to health. One source of evidence for this is that young children whose parents smoke have a higher incidence of pneumonia and other respiratory disorders than young children whose parents do not smoke (Kornblum & Julian, 2012).

In 1988, the surgeon general of the United States, C. Everett Koop, declared that tobacco is as addictive as heroin or cocaine (Rosellini, 1988). Koop noted that people addicted to tobacco are drug addicts. The attitudes of Americans toward tobacco use are gradually becoming more negative. In the past two decades, a movement has developed that is increasingly viewing tobacco as a dangerous drug, and non-smokers are increasingly considering smokers to be pariahs. Some authorities now predict that cigarettes will someday be outlawed in many countries.

Tobacco is highly habit-forming. Nicotine is the primary drag in tobacco. Nicotine has remarkable capacities—it can act as a depressant, a stimulant, or a tranquilizer. Smokers quickly develop a tolerance for nicotine and often gradually increase consumption to one or two packs or more a day.

Special clinics and a variety of other educational and therapeutic programs help people quit smoking. Users undergoing withdrawal become restless, irritable, depressed, and have an intense craving to smoke. Studies show that only a minority of smokers who make determined efforts to quit actually succeed (Kornblum & Julian, 2012).

At the same time that the government is widely publicizing the hazards of drugs, the Department of Agriculture is subsidizing tobacco farmers. While educational programs urge people not to smoke, tobacco companies are permitted to advertise that cigarette smoking is “cool” and “sexy,” connoting rugged manliness in men and social sophistication in women.

In the biggest civil settlement in U.S. history, tobacco companies agreed in 1998 to pay more than $240 billion to the 50 states to settle claims against the industry for health-care costs blamed on tobacco-related illnesses. The payments to the states, which began in 2000, will be distributed over 25 years. A portion of the funds will go to a foundation to study how to reduce teen smoking. A major objective of the deal is to discourage children from smoking by imposing restrictions on advertising and sharp limits on the ways cigarettes are marketed.

Marijuana

Marijuana, or “grass” or “pot,” comes from a variety of the hemp plant, Cannabis sativa. This hemp plant grows throughout the world, and its fibers are legally used to produce rope, twine, paper, and clothing.

The effects of marijuana (and hashish) vary, as with any other drug, according to the mood and personality of the user, circumstances, and the quality of the drug. The effects are rather complicated and may induce a variety of emotions.

Many of the effects are produced because marijuana has sedative properties and creates in the user a sense of relaxed well-being and freedom from inhibition. There may also be mild hallucinations that create a dreamy state in which the user may experience fantasies. Smokers become highly suggestible and may engage in actions (such as sexual activities) in which they would not otherwise be involved. The drug may induce feelings of joyousness, hilarity, and sociability. It may lead to talkativeness, disconnected ideas, a feeling of floating, and laughter. It may also intensify sensory stimulation, create feelings of enhanced awareness and creativity, and increase self-confidence. A person may gradually experience some of these emotions, followed by others.

The threat of physical dependence is rated low, while the threat of psychological dependence is rated as moderate. Withdrawal, however, may be very unpleasant for the user, who may suffer from insomnia, hyperactivity, and loss of appetite.

The short-term physical effects of marijuana are minor: a reddening of the eyes, dryness of the throat and the mouth, and a slight rise in heart rate. There is some evidence that continued use by young teenagers can result in these users becoming apathetic, noncompetitive, and uninterested in school and other activities.

Frequent users may have impairments of short-term memory and concentration, and of judgment and coordination. They may find it difficult to read, to understand what they read, and to follow moving objects with their eyes. Users may feel confident that their coordination, reactions, and perceptions are quite normal while they are still experiencing the effects of the drug; under these conditions, such activities as driving a vehicle may have tragic consequences for them and for others.

An overdose of the active ingredients of cannabis can lead to panic, fear, confusion, suspiciousness, fatigue, and sometimes aggressive acts. One of the most frequently voiced concerns about marijuana is that it will be a stepping-stone to using other drugs. About 60 percent of marijuana users progress to using other drugs (Kornblum & Julian, 2009). However, other factors, such as peer pressure, are probably more crucial determinants of what mind-altering drugs people will progress to. In addition, those who experiment with one drug are more likely to experiment with another.

The attempt to restrict the use of marijuana through legislation has been described as a “second prohibition,” which has had results similar to those of the first, because a large number of people are using the drug and disregarding the law. The unfortunate effect of laws that outlaw the use of marijuana is that they criminalize the private acts of many people who are otherwise law-abiding. Such laws also foster the development of organized crime and the illicit drug market.

For years, debates have raged about the hazards of long-term marijuana use. Some studies claim it causes brain damage, chromosome damage, irritation of the bronchial tract and lungs, and a reduction in male hormone levels. These findings have not been confirmed by other studies, and so the controversy rages on.

One of the reversible, short-term health effects of marijuana use is impairment of motor coordination, which adversely affects driving or machine-operating skills. The drug also impairs short-term memory, slows learning abilities, and may cause periods of confusion and anxiety. Smoking marijuana may affect the lungs and respiratory system in much the same way that tobacco smoke does, and may be a factor in causing bronchitis and precancerous changes.

Marijuana may be useful in treating glaucoma, asthma, certain seizure disorders and spastic conditions, and in controlling severe nausea caused by cancer chemotherapy. In 1996, voters in California and Arizona approved the medical use of marijuana—for example, for treating symptoms of AIDS, cancer, and other diseases.

At the time of the revision of this text, 28 states and the District of Columbia have enacted laws to legalize medical marijuana. In recent years Colorado, Washington, Alaska, California, Massachusetts, Nevada, and Oregon have legalized the sale of marijuana.

Ethical Questions 11.5

Why Do People Use and Abuse Alcohol and Other Drugs?

The effects of using drugs are numerous, ranging from feeling light-headed to death through overdosing. Drag abuse may lead to deterioration in health, relationship problems, automobile accidents, child abuse, spouse abuse, loss of job, low self-esteem, loss of social status, financial disaster, divorce, and arrests and convictions.

A distinction needs to be made between responsible drug use and drug abuse. Many drugs do have beneficial effects when used responsibly; aspirin relieves pain, alcohol helps people relax, tranquilizers reduce anxiety, antidepressant drugs reduce depression, amphetamines increase alertness, morphine is a painkiller, and marijuana is useful in treating glaucoma. Irresponsible drug use is abuse, which was defined earlier in this chapter.

Why do people abuse drugs? The reasons are numerous. Drug companies widely advertise the beneficial effects of their products. The media (such as television and movies) glamorize the mind-altering effects. Many popular songs highlight drinking. Bars and cocktail lounges have become centers for socializing, and they promote drinking. Through such channels, Americans have become socialized to accept drug usage as a part of daily living. Socialization patterns lead many people to use drugs, and for some the use is a stepping-stone to abuse.

Attitudes toward drug use also encourage abuse. For example, some college students believe they should get blitzed or stoned after a tough exam. Ryne Duren (1985), former pitcher for the New York Yankees, asked this question: “I started becoming an alcoholic at age four, even though I had my first drink at age nine—how can this be?” Duren went on to explain that at a very young age he became socialized to believe that a real man was “someone who could drink others under the table,” and that the way to have fun was to get high on alcohol.

Abusers develop an intimate relationship with their drug of choice. Even though this relationship is unhealthy, the drug plays a primary role in the abuser’s life, dictates a certain lifestyle, fills a psychological need, and more often than not takes precedence over family, friends, and work. Most abusers deny their drug usage is creating problems for them, because they know that admitting they have a drug problem means they will have to end their relationship with their best friend, and they deeply believe they need their drug to handle their daily concerns and pressures. Drug abusers are apt to use a number of defense mechanisms in order to continue using drugs. They  rationalize adverse consequences of drug abuse (such as the loss of a job) by twisting or distorting reality to explain the consequences of their behavior while under the influence. They  minimize the adverse consequences of their drug use. They use  projection to place the blame for their problems on others; for example, “If you had a wife like mine, you’d drink too.”

Theories about Drug Use

A variety of theories have been offered as to why people use drugs.  Biological theories assert that physiological changes produced by the drugs eventually generate an irresistible craving for the drug. Some biological theories also postulate that some people are predisposed by their genetic structure to abuse certain types of drugs. For example, some authorities believe that genes play a role in predisposing some people to alcoholism.  Behavioral theories hold that people use drugs because they find them pleasurable and continue to use them because doing so prevents withdrawal distress.  Interactionist theories maintain that drug use is learned from interaction with others in our culture. For example, people drink alcohol because drinking is widely accepted. Interactionist theories assert that those who use illegal drugs such as marijuana or cocaine have contact with a drug subculture that encourages them to experiment with illegal drugs.

11-9dInteraction in Family Systems: A Theoretical Approach to Drug Abuse

Wegscheider (1981) maintains that chemical dependency is a family disease that involves and affects each family member. Although she focuses on the families of alcoholics, much of what she says may also apply to the families of other types of chemical substance abusers.

She cites several rules that tend to characterize the families of drug abusers. First, the dependent person’s alcohol use becomes “the most important thing in the family’s life” (Wegscheider, 1981, p. 81). The abuser’s top priority is getting enough alcohol, and the family’s top priorities are the abuser, the abuser’s behavior, and keeping the abuser away from alcohol. The goals of the abuser and of the rest of the family are at completely opposite poles.

A second rule in an alcoholic family is that alcohol is not the cause of the problem. Denial is paramount. A third family rule maintains that the dependent person is not responsible for his or her behavior and that the alcohol causes the behavior. There is always someone or something else to blame. Another rule dictates that no one should rock the boat, no matter what. Family members strive to protect the family’s status quo, even when the family is miserable. Yet other rules concern forbidding discussion of the family problem either within or outside of the family, and consistently avoiding stating one’s true feelings. Wegscheider (1981) maintains that these rules protect the dependent person from taking responsibility for his or her behavior, and that the rules serve to maintain the drinking problem.

Wegscheider (1981) goes on to identify several roles that family members typically play. In addition to the chemically dependent person, there is the chief enabler, the family hero, the scapegoat, the lost child, and the mascot.

Conditions often continue to deteriorate as the chemically dependent person loses control. A positive influence is needed to offset the negative. The family hero fulfills this role. The family hero is often the person who does well at everything he or she tries. The hero works hard at making the family look as though it is functioning better than it is. In this way, the family hero provides the family with self-worth.

Another role typically played by someone in the family is that of scapegoat. Although the alcohol abuse is the real problem, a family rule mandates that this fact must be denied. Therefore, the blame must be placed elsewhere. Frequently, another family member is blamed for the problem. The scapegoat often behaves in negative ways that draw attention to him or her (e.g., the person gets caught stealing, runs away, or becomes extremely withdrawn). The scapegoat’s role is to distract attention away from the chemically dependent person and onto something else. This role helps the family avoid addressing the problem of chemical dependency.

Often, someone plays the role of lost child. This is a person who seems relatively uninvolved with the rest of the family and never causes any trouble. The lost child’s purpose is to provide relief from some of the pain the family is suffering. At least there is someone in the family who neither requires much attention nor causes any stress. The lost child is simply there.

Finally, chemically dependent families often have someone playing the role of mascot. The mascot is someone who has a good sense of humor and appears not to take anything seriously. Despite how much the mascot might be suffering inside, he or she provides a little fun for the family.

In summary, chemical dependency is a problem affecting the entire family. Each family member suffers from the chemical dependency, yet each assumes a role in order to maintain the family’s status quo and help the family survive. Family members are driven to maintain these roles no matter what happens. The roles eventually become associated with survival.

11-9eThe Application of Theory to Client Situations: Treatment for the Chemically Dependent Person and His or Her Family

One of the first tasks in treatment is for the chemically dependent person to take responsibility for his or her own behavior. The abuser must acknowledge that he or she has a problem before beginning to solve it. Several concepts are critical in working with the family (Wegscheider, 1981). Family members must first come to realize the extent of the problem. They need to identify the chemical abuse as their major problem. Additionally, they need to learn about and evaluate their family dynamics. They need to evaluate their own behavior and break out of the roles that have been maintaining the chemical abuse. The chief enabler, in particular, must stop making excuses and assuming the chemically dependent person’s responsibilities. If the chemically dependent person is sick from a hangover and cannot make it to school or work the next day, it must be that person’s responsibility, not a parent’s or spouse’s, to call in sick.

Family members eventually learn to confront the chemically dependent person and give him or her honest information about his or her behavior. For instance, they are encouraged to tell the dependent exactly how he or she behaved while having a blackout. If the dependent person hit another family member while drunk, this fact needs to be confronted. The confrontation should occur not in an emotional manner but rather in a factual one.

The family also needs to learn about the progression of the disease. We’ve already discussed some characteristics of drug dependence. There is a typical progression of an alcoholic’s feelings and behavior. At first, only occasional relief drinking occurs. Drinking becomes more constant. The dependent person then begins to drink in secret and to feel guilty about drinking. Memory blackouts begin to occur and gradually increase in frequency. The dependent person feels worse and worse about his or her drinking behavior, but seems to have less and less control over it. Finally, the drinking begins to seriously affect the person’s work, family, and social relationships. A job may be lost or all school classes flunked. Perhaps family members leave or throw the dependent person out. The dependent person’s thinking becomes more and more impaired.

Finally, the dependent person may express an honest desire for help. A dependent person on the path to recovery will stop drinking. Meeting with other people who are also alcoholics or addicts is very helpful. Support from others is especially critical at this time in the process of recovery.

Alcoholics Anonymous (AA) is a self-help organization that has provided the support, information, and guidance necessary for many dependent people to continue on in their recovery. The nationwide group is made up of recovering alcoholics. The organization’s success seems to rest on several principles. First, other people who really understand are available to give the recovering dependent person friendship and warmth. Each new member is given a sponsor who can be called for support at any time during the day or night. Whenever the dependent person feels depressed or tempted, there is always the sponsor to turn to.

An AA Meeting

Alcoholics Anonymous (AA) is a remarkable human organization. Its chapters now cover every part of the United States and most of the world. There is more caring and concern among the members for one another than in most other organizations. Group members work together to save each other’s lives and to restore their self-respect and sense of worth. AA has helped more people overcome their drinking problems than all other therapies and methods combined.

AA is supported entirely by voluntary donations from the members at meetings. There are no dues or fees. Each chapter is autonomous, and free of any outside control by the AA headquarters in New York City or by any other body. There is no hierarchy in the chapters. The only office is that of the group secretary. This person chooses a chairperson for each meeting, makes the arrangements for meetings, and sees that the building is open, the chairs are set up, and the tea and coffee put on. The group secretary holds office for only a limited time period; after a month or two the secretary’s responsibilities are transferred to another member.

The only requirement for membership in AA is a desire to stop drinking. All other variables (such as economic status, social status, race, religion) do not count. Members can even attend meetings while drunk, as long as they do not disturb the meeting.

AA meetings are held in a variety of physical locations—churches, temples, private homes, business offices, schools, libraries, or banquet rooms of restaurants. The physical location is unimportant.

When a newcomer first arrives, he or she will usually find people setting up chairs, placing ashtrays, putting free literature on a table, and making coffee. Other members will be socializing in small groups. Someone is apt to introduce himself or herself and other members to the newcomer. If someone is shy about attending the first meeting alone, he or she can call AA and someone will take the person to the meeting and introduce him or her to the other members.

When the meeting starts, everyone sits down around tables or in rows of chairs. The secretary and/or chairperson, and one or more speakers, sit at the head of the table or on a platform if the meeting is in a hall.

The chairperson opens with a moment of silence, which is followed by a group recitation of a nondenominational prayer. The chairperson then reads or gives a brief description of Alcoholics Anonymous and may read or refer to a section of the book Alcoholics Anonymous (a book that describes the principles of AA and gives a number of case examples).

Then the chairperson usually asks if anyone is attending for the first, second, or third time. The new people are asked to introduce themselves according to the following: “Hello, my name is [first name], and this is my first [second, third] meeting.” Those who do not want to introduce themselves are not pressured to do so. New members are the lifeblood of AA, and are the most important people at the meeting in the members’ eyes. (All the longer-term members remember their first meeting and how frightened and inhibited they felt.)

If the group is small, the chairperson usually then asks the longer-term members to introduce themselves and say a few words. If the group is large, the chairperson asks volunteers among the longer-term members to introduce themselves by saying a few words. Each member usually begins by saying, “My name is [first name]; I am an alcoholic,” and then discloses a few thoughts or feelings. (The members do not have to say they are alcoholic, unless they choose to do so. Each member sooner or later generally chooses to say this, to remind himself or herself that he or she is an addictive drinker who is recovering and that alcoholism is a lifelong disease that must be battled daily.) Those who introduce themselves usually say whatever they feel will be most helpful to the newcomers. They may talk about their first meeting, or their first week without drinking, or something designed to make the newcomers more comfortable. Common advice for the newcomers is to get the phone numbers of other members after the meeting so that they can call a member when they feel a strong urge to drink. AA considers such help as vital in recovering. The organization, believes members can remain sober only through receiving the help of people who care about them and who understand what they are struggling with.

AA members want newcomers to call when they have the urge to drink, at any time day or night. The members sincerely believe that by helping others they are helping themselves to stay sober and grow. Members indicate that such calling is the newcomer’s ace in the hole against the first drink, if everything else fails. They also inform newcomers that it is good to call others when lonely, just to chat.

In his own words, a newcomer explains how AA began to help him:

Here’s what happened to me. When I finally hit bottom and called AA for help, a U.S. Air Force officer came to tell me about AA. For the first time in my life, I was talking to someone who obviously really understood my problem, as four psychiatrists had not, and he took me to my first meeting, sober but none too steady. It was amazing. I went home afterward and didn’t have a drink. I went again the next night, still dry, and the miracle happened a second time. The third morning my wife went off to work, my boys to school, and I was alone. Suddenly I wanted a drink more than I had ever wanted one in my life. I tried walking for a while. No good. The feeling was getting worse. I tried reading. Couldn’t concentrate. Then I became really desperate, and although I wasn’t used to calling strangers for help, I called Fred, an AAer who had said that he was retired and would welcome a call at any time. We talked a bit; he could see that talking on the phone wasn’t going to be enough. He said, “Look, I’ve got an idea. Let me make a phone call, and I’ll call you back in ten minutes. Can you hold on that long?” I said I could. He called back in eight, asking me to come over to his house. We talked endlessly, went out for a sandwich together, and finally my craving for a drink went away. We went to a meeting. Next morning I was fine again and now I had gone four days without a drink.

After such discussion, speakers may describe their life of drinking, how drinking almost destroyed their life, how they were introduced to AA, their struggles to remain sober one day at a time, how AA has helped them, and what their life is like now.

At the end of a meeting, the chairperson may ask the newcomers if they wish to say anything. If they do not wish to say much, that is okay. No one is pressured to self-disclose what they do not want to reveal.

Meetings usually end after the chairperson makes announcements. (The collection basket for donations is also passed around. New members are not expected, and frequently not allowed, to donate any money until after the third meeting. If someone cannot afford to make a donation, none is expected.) The group then stands, usually holding hands, and repeats in unison the Lord’s Prayer. Those who do not want to join in this prayer are not pressured to do so. After a meeting, the members socialize. This is a time for newcomers to meet new friends and to get phone numbers.

AA is a cross section of people from all walks of life. Anonymity is emphasized. It is the duty of every member to respect the anonymity of every person who attends. Concern for anonymity is a major reason for two kinds of meetings in AA, open and closed. Anyone is welcome at open meetings. Only people with drinking problems are allowed at closed meetings. Therefore, if a person feels uncomfortable going to an open meeting and has a drinking problem, then closed meetings are an alternative.

Members do not have to believe in God to get help from AA. Many members have lost, or never had, a faith in God. AA does, however, assert that faith in some higher power is a tremendous help in recovery because such a belief offers a source of limitless power, hope, and support whenever one feels one has come to the end of one’s resources.

How does AA help? New members, after years of feelings of rejection, loneliness, misunderstanding, guilt, and embarrassment, find they are not alone. They feel understood by others who are in similar predicaments. Instead of being rejected, they are welcomed. They see that others who had serious drinking problems are now sober, apparently happy that way, and are in the process of recovering. It gives them hope that they do not need alcohol to get through the day and that they can learn to enjoy life without alcohol. They find that others sincerely care about them, want to help them, and have the knowledge to do so.

At meetings, they see every sort of personal problem brought up and discussed openly, with suggestions for solutions being offered from others who have encountered similar problems. They can observe that group members bring up “unspeakable” problems without apparent embarrassment, and that others listen and treat them with respect and consideration. Such acceptance gradually leads newcomers to share their personal problems and to receive constructive suggestions for solutions. Such disclosure leads individuals to look more deeply into themselves and to ventilate deep personal feelings. With the support of other members, newcomers gradually learn how to counter strong desires to drink, through such processes as calling other members.

Newcomers learn that AA is the means of staying away from that first drink. AA also serves to reduce the stress that compels people to drink by providing a comfortable and relaxed environment and by having members help each other, to find ways to reduce the stresses encountered in daily living. AA meetings and members become a safe port that is always there when storms start raging. AA helps members to be programmed from negative thinking to positive thinking. The more positive a member’s thinking becomes, the more stress is relieved, the better he or she begins to feel about himself or herself, the more the compulsion to drink decreases, and the more often and more effectively the person begins to take positive actions to solve his or her problems.

AA also helps the recovering person to understand that alcoholism is a disease. This means that the alcoholic cannot cure himself or herself. He or she need no longer feel guilty about being an alcoholic. What must be done is to stop drinking. AA also encourages introspection. Members are encouraged to look inside themselves and face whatever they see. They are urged to acknowledge that they have flaws and will never be perfect. This perspective often helps people to stop fleeing from the pain of reality and hiding in alcohol or drugs. It helps them to redefine expectations for themselves and to gain control. Within this context, people often can also acknowledge their strengths. They can learn that they do have some control over their own behavior and that they can accomplish things for themselves and for others.

Organizations are also available to provide support for other family members and to give them information and suggestions. For example, AA is an organization for the families of alcoholics, and Alateen is specifically for teenagers within these families. Likewise, self-help organizations similar to AA, such as Narcotics Anonymous, exist to help other types of chemical substance abusers.

Today may treatment approaches are available to chemical substance abusers. Types of facilities and treatment include inpatient and outpatient treatment programs at community mental health centers, chemical abuse rehabilitation centers and medical hospitals, halfway houses, and chemical treatment programs such as Antabuse. When Antabuse is taken, a person who then drinks an alcoholic beverage will soon become flushed, experience a rapid pulse, and feel nauseated, often to the point of regurgitation.

Treatment programs almost always advocate that abusers abstain totally from their drug of choice in the future, because research indicates that even one use will return the abuser to drug abuse. It should also be noted that when abusers complete a treatment program they are urged to view themselves as  recovering, rather than being cured, because they must continually work on abstaining in order to avoid the temptations of using.

It is important that those receiving treatment also make lifestyle changes. The social activities of users almost always revolve around using the drug of choice; to successfully abstain, recovering abusers need to form new friendships and establish drug-free social activities and interests. Making such lifestyle changes is extremely difficult. Many recovering addicts fail in making these changes and then return to using their drug of choice.

Many codependent people have grown up in dysfunctional families. Some are adult children of alcoholics. They marry or become romantically involved with people who abuse alcohol or some other drug. To some extent, the addict fills the needs of the codependent—needs such as caretaking, loneliness, and addiction to destructive behavior such as excessive partying and thrill seeking. Codependency can be viewed as a normal reaction to abnormal stress.

If the addict terminates the use of his or her drug of choice, the codependent’s dysfunctional behaviors generally continue, unless he or she receives treatment. There are a variety of treatment approaches for codependent people—individual psychotherapy, self-help groups (such as Al-Anon and Adult Children of Alcoholics), and codependency therapeutic groups. For many codependent people, treatment involves recognition that they have lives and identities separate from the addict; that the addict alone is responsible for his or her drug abuse; and that their lives and the addict’s will improve by terminating their caretaking and enabling behaviors. Through treatment, many codependent people regain (or gain for the first time) their own identity. Treatment is designed to banish the self-destructive habits that sabotage codependent people’s happiness.

Roles assumed by social workers in treating codependent people include counselor, educator (conveying information about addiction and codependency), facilitator (leading treatment groups), broker (linking codependent people to self-help groups and to other human service resources), and program initiator (developing programs to serve codependent people in communities where such treatment programs are scarce or nonexistent).

11-9gThe Relationship between Knowledge and Assessment

Considerable attention has been given to the issue of chemical substance abuse. This problem was selected because it is especially critical and widespread. To be able to intervene and help facilitate people’s recovery from chemical dependency, social workers need a base of knowledge. Social workers need to know some of the dynamics involved in the behavior of chemically dependent individuals and families, and they need to understand the concept of enabling. Only then can they assess a family accurately and know at what point intervention is needed. With this base of knowledge, they can apply skills to help family members stop their enabling and their maintenance of false rules. Social work skills can also be used to encourage the family to realign responsibility and relinquish it to the chemically dependent person. In summary, the examination of such a major life issue should provide social workers with a starting point on which to begin problem assessment. The intent is to provide a map or guide to begin the process of intervention.

Chapter 12

Sociological Aspects of Young and Middle Adulthood

Chapter Introduction

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Learning Objectives

This chapter will help prepare students to

There is obviously considerable variation in the major social interests of young and middle-aged adults. However, there are some fairly common themes: choosing a personal lifestyle and perhaps marrying; settling into a career; raising children and maintaining a household; participating in hobbies; becoming grandparents; adjusting to relationship changes with a spouse and children after the children leave home; and socializing with friends.

12-1Describe the following Lifestyles and Family Forms That Young Adults May Enter Into: Marriage, Cohabitation, Single Life, Parenthood, and the Life of a Childless Couple

12-1aInteraction in Family Systems: Choosing a Personal Lifestyle

Most people make decisions during their young adult years about how they want to live their adult years. Decisions about lifestyles include whether to marry or stay single; whether to have children; what kind of career to pursue; what area of the country to live in; whether to live in an apartment, duplex, or house. (As time goes on, it is important to remember that a person has a right to make changes in these decisions.) In choosing a lifestyle, what many people experience is not a matter of ideal choice, but rather a result of opportunities. In other words, financial resources, personal deficiencies, discrimination, and so on may greatly limit or modify free choice. In addition, unexpected life events—such as unplanned pregnancy, divorce, or death of a spouse—can dramatically alter a person’s lifestyle and family living arrangements. In regard to lifestyles and family forms, we will take a brief look at marriage, cohabitation, single life, parenthood, and the life of a childless couple.

12-1bMarriage

Marriage is defined as a legally and socially sanctioned union between two people, resulting in mutual obligations and rights. Throughout recorded history, regardless of the simplicity or sophistication of the society, the family has been the basic biological and social unit in which most adults and children live. In addition, all past and present societies sanction the family through the institution of marriage. Clayton (1975) suggests that one of the primary reasons for instituting the custom of marriage was to enable the two partners to enjoy sexuality as fully as possible with a minimum of anxieties and hazards. The natural sex drive of men and women needs to be satisfied, yet control needs to be exercised over the spread of sexually transmitted diseases. Children that result from sexual relationships need to be raised and cared for.

Ethical Question 12.1

Studies reviewed by Papalia and Martorell (2015) reported the following advantages of being single as listed by respondents who were not married: satisfaction of being self-sufficient, increased career opportunities, an exciting lifestyle, mobility, sexual availability, the freedom to change, opportunities to have a variety of experiences, opportunities to play a variety of roles, and opportunities to have friendships with a variety of people. Reported disadvantages of being single include wondering how single people fit into the social world of mostly married people, lack of companionship, concerns about how well friends and family accept unmarried adults, and concerns about how being single affects self-esteem.

12-1eParenthood

Today, children are an economic liability rather than an economic asset. In our society, there is an expectation that Social Security and other retirement programs will care for older parents, rather than this being a responsibility of their children. Children can have negative, as well as positive, effects on lifestyles and on marital relationships. For these and other reasons, married couples in our society over the years have gradually decided to have fewer children. Now most couples usually want zero to three children. Contraception now makes such wishes a reality.

Parenthood has many rewards and many joyful moments. Some of the rewards include having someone to love and return that love, the joy of playing and interacting with a child, watching and helping a child grow and develop, and socializing with other parents.

Parenthood also has many demands and stresses, including discipline problems, increased responsibilities, financial demands, interference with previous lifestyles, cleaning up messes, trying to accomplish some task while stepping over a child, running time-consuming errands, planning a schedule around a child’s needs, listening to a crying or whining child, changing diapers, interrupted rest and sleep, fatigue, and concerns about being able to give less attention to personal appearance.

Children are less likely to lower marital satisfaction in families where the parents wanted to have children, and where the parents have outside resources for helping to care for the children. In marriages that deteriorate after parenthood, one or both partners tend to have low self-esteem, and the husbands are likely to be less sensitive (Belsky & Rovine, 1988). The partners in deteriorating marriages are also more likely to be younger and less educated, to earn less money, and to have been married for fewer years.

Even when parenting has a negative influence on marital satisfaction, it often has a positive effect on the self-concepts of the parents and on their work roles. Thus, parenting appears to contribute to the personal development of an individual.

The Group for the Advancement of Psychiatry (1973) views parenting as a developmental process and has identified the following four stages:

1. Anticipation: This stage occurs during pregnancy when the expectant parents think about how they will raise their children, how their lives will change, and the meaning of parenthood. Some expectant parents have ambivalent feelings about what lies ahead. During this stage, the expectant parents begin the process of viewing themselves as their children’s parents, instead of being their parents’ children.

2. Honeymoon: This stage occurs after the birth of the first child and lasts for a few months. Parents are often very happy about having and holding a baby. It is also a time of adjustment and learning, as attachments are formed between parents and child, and family members learn new roles in relation to one another.

3. Plateau: This stage occurs from infancy through the teenage years. Parents must make frequent adjustments as they adapt their parenting behavior to the level of the child.

4. Disengagement: This stage occurs when the child disengages (e.g., when the child marries). Because the child disengages, the parents should also change their behavior and disengage from the child. Relationships change from parent–child to adult–parent-adult.

These stages illustrate that children have a great effect on parents. The Group for the Advancement of Psychiatry (1973) also notes that parents often judge their parenting on how well their children turn out. When children fulfill their expectations, the parents usually pat themselves on the back for a job well done. The danger of this approach is that if the children fall short of meeting parental expectations (which sometimes are unrealistic), parents are apt to conclude that they have failed. Parents need to realize that the final product is not entirely under their control because children are influenced by many other factors that are external to the family.

12-1fChildless Couples

Having children is recognized legally and religiously as one of the central components of a marriage. Our society still considers that something is wrong with a couple if they decide not to have children.

Fathers generally report less enjoyment in looking after children than mothers do, but fathers who enjoy parenting usually see it as one of their most important life roles.

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Ethical Question 12.2

According to functionalists, social problems occur when society, or some part of it, becomes disorganized.  Social disorganization occurs when a large organization or an entire society is imperfectly organized to achieve its goals and maintain its stability. When disorganization occurs, the organization loses control over its parts.

Functionalists see thousands of potential causes of social disorganization. However, underlying all these causes is rapid  social change, which disrupts the balance of society. In recent years, more technological advances (such as the development of telephones, computers, television, robots, heart transplants, the Internet) have occurred in less time than at any other time in human history. These advances have led basic institutions (such as the family and the educational system) to undergo drastic changes. Technological advances have occurred at such a pace that other parts of the culture have failed to keep pace. This  cultural lag between technological changes and our adaptation to them is viewed as one of the major sources of social disorganization.

Examples of such social disorganization abound. The development of nuclear weapons has the potential to destroy civilization. Advances in sanitation and medical technology have lengthened life expectancy but have also contributed to a worldwide population explosion. Advances in artificial insemination have led to surrogate motherhood, which our society has not yet decided whether to encourage or discourage. The development of technological advances in performing abortions has led to the capacity to terminate pregnancies quite safely on request, but has also led to a national controversy about the desirability of legalized abortions.

Critics of functionalism assert that it is a politically conservative philosophy, as it takes for granted the idea that society as it is (the status quo) should be preserved. As a result, basic social injustices are ignored. Critics also argue that the approach is value-laden, because one person’s disorganization is another person’s organization. For example, some people view divorce as being functional, because it is a legal way to terminate a relationship that is no longer working.

Functionalism has also been criticized as being a philosophy that works for the benefit of the privileged social classes, while perpetuating the misery of the poor and those who are being victimized by discrimination.

12-2cThe Conflict Perspective

The  conflict theory views society as a struggle for power among various social groups. Conflict is thought to be inevitable and in many cases actually beneficial to society. For example, most Americans would view the struggle of the “freedom fighters” during the Revolutionary War as being highly beneficial to our society. (England, however, viewed them as ungrateful insurgents.)

The conflict perspective rests on an important assumption: members of society highly value certain things (such as power, wealth, and prestige), and most of these valued resources are in scarce supply. Because of their scarcity, conflict theory asserts that people—either individually or in groups—struggle with one another to attain them. Society is thus viewed as an arena for the struggle over scarce resources.

Struggle and conflict may take many forms: competition, disagreements, court battles, physical fights and violence, and war. If the struggles usually involved violence, then nearly everyone would be involved in violent activities, and society would be impossible. As a result, norms have emerged that determine what types of conflict are allowable for which groups. For example, participating in a labor strike or acquiring a higher education is an approved way of competing for the limited money available in our society, whereas robbery is not an acceptable way.

From the conflict perspective, social change mainly involves reordering the distribution of scarce goods among groups. Unlike functionalism, which views change as potentially destructive, the conflict approach views change as potentially beneficial. Conflict can lead to improvements, advancements, the reduction of discrimination against oppressed groups, and the emergence of new groups as dominant forces in society. Without conflict, society would become stagnant.

Functionalists assert that most people in society share the same set of values and norms. In contrast, conflict theorists assert that modern societies are composed of many different groups with divergent values, attitudes, and norms—and therefore conflicts are bound to occur. The abortion issue illustrates such a value conflict. Pro-life groups and traditional Roman Catholics believe that the human fetus at any stage after conception is a living human being, and therefore aborting a pregnancy is murder. In contrast, pro-choice advocates assert that an embryo for the first few months after conception is not yet a human being because it is unable to survive outside the womb. They also assert that if the state were to forbid a woman to obtain an abortion, the state would be violating her right to control her own life.

Not all conflicts stem from disagreements over values. Some conflicts arise in part because people share the same values. In our society, for example, wealth and power are highly valued. The wealthy spend considerable effort and resources to maintain their position, whereas the poor and oppressed groups vehemently advocate for equal rights and a more equitable distribution of income and wealth. Labor unions and owners in many businesses are in a continual battle over wages and fringe benefits. Republicans and Democrats continually struggle with one another in the hopes of gaining increased political power.

Whereas functionalism has been criticized as too conservative, conflict theory has been criticized as too radical. Critics say that if there were as much conflict as these theorists claim, society would have disintegrated long ago. Conflict theory has also been criticized as encouraging oppressed groups to revolt against the existing power structure, rather than seeking to work within the existing system to address their concerns.

Ethical Question 12.3

Cooley (1902) observed that it is impossible to make objective measurements of most aspects of our self-concept—such as how brave, likable, generous, attractive, or honest we are. Instead, in order to gauge the extent to which we have these qualities, we have to rely on the subjective judgments of the people we interact with. In essence, Cooley asserted, we learn what kind of person we are by seeing and hearing how others react to us; in effect, the reactions, of others become a mirror or “looking glass” that we use to judge our own qualities.

Another important concept is that social reality is what a particular group agrees it is. Social reality is not a purely objective phenomenon.

The interactionist theory views human behavior as resulting from the interaction of a person’s unique, distinctive personality and the groups he or she participates in. Groups are a factor in shaping one’s personality, but the personality is also shaped by the person’s unique qualities.

The reality we construct is mediated through symbols. We respond to symbolic reality, not physical reality. Sullivan, Thompson, Wright, Gross, and Spady (1980) describe the importance of symbols in shaping our reality:

Symbols are the principal vehicles through which expectations are conveyed from one person to another. A symbol is any object, word, or event that stands for, represents, or takes the place of something else. Symbols have certain characteristics. First, the meaning of symbols derives from social consensus—the group’s agreement that one thing will represent something else. A flag represents love of country or patriotism; a green light means go, not stop; a frown stands for displeasure. Second, the relationship between the symbol and what it represents is arbitrary—there is no inherent connection. There is nothing about the color green that compels us to use that, rather than red, as a symbol for go; a flag is in reality a piece of cloth for which we could substitute anything, as long as we agreed that it stood for country. Finally, symbols need not be tied to physical reality. We can use symbols to represent things with no physical existence, such as justice, mercy, or God, or to stand for things that do not exist at all, such as unicorns.

A direct offshoot of the interactionist perspective is the labeling theory. This theory holds that the labels assigned to a person have a major impact on that person’s life. Labels often become self-fulfilling prophecies. If a child is continually called “stupid” by his or her parents, that child is apt to develop a low self-concept, anticipate failure in many areas (particularly academic), put forth little effort in school and in competitive interactions with others, and end up failing. If a teenage girl gets a reputation as being promiscuous, adults and peers may label her as such, with other girls then shunning her, teenage boys ridiculing her, and perhaps some boys seeking to date her for a one-night stand. If a person is labeled an ex-con for spending time in prison, that person is likely to be viewed with suspicion, have trouble finding employment, and be stigmatized as dangerous and untrustworthy, even though the person may be conscientious and hardworking. Scheff (1966) has developed a labeling theory to explain why some people develop a career of being mentally ill. He asserts that the act of labeling people as mentally ill is the major determinant for their acting as if they were mentally ill. Once they have been labeled, others interact with them as if they were mentally ill, which leads them to view themselves as being mentally ill, and they then enact this role.

The most common criticism of the interactionist theory is that it is so abstract and vaguely worded that it is nearly impossible either to prove or disprove it (Coleman & Cressey, 1984).

12-3Understand Three Social Problems That Young and Middle-Aged Adults May Encounter: Poverty, Empty-Shell Marriages, and Divorce. One-Parent Families, Blended Families, and Mothers Working outside the Home Will Also Be Discussed.

12-3aPoverty: Impacts of Social and Economic Forces

The functionalist, conflict, and interactionist perspectives are further illustrated by discussing how each of these theories explains poverty. Poverty is a problem of major macro-system consequence. It dramatically affects a majority of social welfare resource recipients.

12-3bThe Rich and the Poor

Poverty and wealth are closely related. In most countries of the world, wealth is concentrated in a small percentage of the population. Abundance for a few is created by depriving others.

There are two ways of measuring the extent of economic inequality.  Income refers to the amount of money a person makes in a given period.  Wealth is a person’s total assets—real estate holdings, cash, stocks, bonds, and so forth.

In the words of a pastoral letter issued by a committee of Roman Catholic bishops, “The level of inequality in income and wealth in our society … must be judged morally unacceptable” (quoted in Kornblum & Julian, 2001, p. 225). Paul Samuelson (1980), an economist, provides a dramatic metaphor of the disparity between the very rich and most people in the United States:

If we made an income pyramid out of a child’s blocks, with each layer portraying $1,000 of income, the peak would be far higher than the Eiffel Tower, but almost all of us would be within a yard of the ground. (p. 34)

Given the huge wealth of the richest 20 percent, it is clear that a simple redistribution of some of the wealth from the top one-fifth to the lowest one-fifth could easily wipe out poverty. Of course, that is not politically acceptable to members of the top fifth, who have the greatest control of the government.

In contrast, millions of Americans regularly do not get enough to eat because they are poor. The brain of a child grows to 80 percent of its adult size within the first three years of life. If supplies of protein are inadequate during this period, the brain stops growing, the damage is irreversible, and the child will be permanently retarded (Robertson, 1980).

Coleman and Cressey (1990) describe the effects of having, and not having, wealth:

The poor lack the freedom and autonomy so prized in our society. They are trapped by their surroundings, living in rundown, crime-ridden neighborhoods that they cannot afford to leave. They are constantly confronted with things they desire but have little chance to own. On the other hand, wealth provides power, freedom, and the ability to direct one’s own fate. The wealthy live where they choose and do as they please, with few economic constraints. Because the poor lack education and money for travel, their horizons seldom extend beyond the confines of their neighborhood. In contrast, the world of the wealthy offers the best education, together with the opportunity to visit places that the poor haven’t even heard of.

The children of the wealthy receive the best that society has to offer, as well as the assurance that they are valuable and important individuals. Because the children of the poor lack so many of the things everyone is “supposed” to have, it is much harder for them to develop the cool confidence of the rich. In our materialistic society people are judged as much by what they have as by who they are. The poor cannot help but feel inferior and inadequate in such a context. (p. 161)

12-3cThe Problem

About 15 percent of the population in the United States is living below the poverty line (Mooney, Knox, & Schacht, 2015). The  poverty line is the level of income that the federal government considers sufficient to meet basic requirements of food, shelter, and clothing. In 2016, the poverty line for a family of four in the United States was $24,300. One of the alarming elements about poverty is that many people who do not fall under the government’s poverty line still have very limited incomes and a living standard that is similar to those below the poverty line.

Poverty does not simply mean that poor people in the United States are living less well than people of average income. It means eating diets largely of beans, macaroni, and cheese, or, in severe cases, even dog and cat food. It may mean not having running water, living in substandard housing, and being exposed to rats, cockroaches, and other vermin. It means not having sufficient heat in the winter and being unable to sleep because the walls are too thin to deaden the sounds from the neighbors living next door. It means being embarrassed about the few ragged clothes that one has to wear. It means high susceptibility to emotional disturbances, alcoholism, and victimization by criminals, as well as a shorter life expectancy. It means few opportunities to advance oneself socially, economically, or educationally. It often means slum housing, unstable marriages, and little opportunity to enjoy the finer things in life—traveling, dining out, movies, plays, concerts, sports events.

The financial and housing crises in recent years have led to an increase in the number of homeless individuals and families.

Tony Freeman/Photo Edit

Poverty also often leads to despair, low self-esteem, and stunting of physical, social, emotional, and intellectual growth. A second level of damage from poverty occurs from the feeling that lack of, financial resources is preventing one from having equal opportunities and the feeling that one is a second-class citizen. Poverty hurts deeply when it leads to viewing oneself as inferior or second-class.

12-4The Culture of Poverty: Evaluation of the Theory and Its Application to Client Situations

Why is poverty passed on from one generation to another? Some authorities argue that the explanation is due to a “culture of poverty.” Oscar Lewis (1966), an anthropologist, was a chief proponent of the cultural explanation. Lewis examined poor neighborhoods in various parts of the world and concluded that the poor are poor because they have a distinct culture or lifestyle. The key elements of Lewis’s cultural explanation follow.

The culture of poverty arises after extended periods of economic deprivation in highly stratified capitalistic societies. Such deprivation is brought about by high rates of unemployment and low wages for those who are employed. Economic deprivation leads to the development of attitudes and values of despair and hopelessness. Lewis (1966) described these attitudes and values as follows: “The individual who grows up in this culture has a strong feeling of fatalism, helplessness, dependence and inferiority; a strong present-time orientation with relatively little disposition to defer gratification and plan for the future, and a high tolerance for psychological pathology of all kinds” (p. 23).

Ethical Question 12.4

Homeless people are often forgotten in the shadow of surrounding luxury.

Maxim Shemetov/Reuters

In an even stronger indictment, Ryan (1976) criticized the culture-of-poverty theory as a classic example of blaming the victim. Blaming the poor for their circumstances is a convenient excuse, according to Ryan, for avoiding developing the programs and policies thought necessary to eradicate poverty. The real culprit is the social system that allows poverty to exist. Ryan said bluntly that the poor are not poor because of their culture, but because they do not have enough money.

Pro and con arguments for the culture of poverty theory continue to persist. There are many reasons, both external and internal, why a person may be poor. External reasons include high rates of unemployment, racial discrimination, automation or outsourcing of jobs, lack of job training programs, sex discrimination, a shortage of programs to eradicate poverty, and inflation. Internal reasons include having a physical or mental disability, being alcoholic, having obsolete job skills, becoming a parent at an early age, dropping out of school, and being uninterested in taking available jobs.

12-4aPoverty Is Functional

Obviously, poverty causes many problems, mainly for the poor themselves, but also for the affluent. However, realizing that poverty also has some functions can help us understand why some decision makers are not actively seeking to eradicate poverty. Sullivan and his colleagues (1980, p. 390) listed 11 functions that the poor provide for the affluent:

1. They are available to do the unpleasant jobs that no one else wants to do.

2. By their activities, they subsidize the more affluent. (An example of such an activity is domestic service for low pay.)

3. Jobs are established for those people, such as social workers, who provide services to the poor.

4. The poor purchase goods, such as those of poor quality, that otherwise could not be sold.

5. They serve as examples of deviance that are frowned on by the majority and that thereby support dominant norms.

6. They provide an opportunity for others to practice their “Christian duty” of helping the less fortunate.

8. They contribute to cultural activities by providing, for example, cheap labor for the construction of monuments and works of art.

9. They create cultural forms (e.g., jazz and the blues) that are often adopted by the affluent.

10. They serve as symbolic opponents for some political groups and as constituents for others.

11. They often absorb the costs of change (e.g., by being the victims of unemployment that results from technological advances).

Also, denigrating the poor has the psychological function, for some Americans, of making them feel better about themselves.

Ethical Question 12.5

Cuber and Harroff (1971) identified three types of empty-shell marriages. In a  devitalized relationship, husband and wife lack any real interest in each other or their marriage. Boredom and apathy characterize this marriage. Serious arguments are rare.

Both spouses have to put considerable effort into making a marriage work in order to prevent an empty-shell marriage from gradually developing. The number of empty-shell marriages ending hi divorce is unknown. It is likely that many eventually do.

12-4gDivorce

Our society places a higher value on romantic love than most other societies do. In societies where marriages are arranged by parents, being in love generally has no role in mate selection. In our society, however, romantic love is a key factor in forming a marriage.

Children in this country are socialized from an early age to believe in the glories of romantic love. Magazines, films, TV programs, and books portray “happy-ending” romantic adventures. All of these romantic stories suggest that every normal person falls in love with that one special person, gets married, and lives happily ever after. This happily-ever-after ideal rarely happens.

About one of two marriages ends in divorce (Mooney, Knox, & Schacht, 2015). This high rate has gradually been increasing. Before World War I, divorce was comparatively rare.

Divorce usually leads to a number of difficulties for those involved. First, those who are divorcing face emotional concerns, such as concerns that they have failed, over whether they are able to give and receive love, about a sense of loneliness, over the stigma attached to divorce, about the reactions of friends and relatives, over whether they are doing the right thing by parting, and over whether they will be able to make it on their own. Many people feel trapped because they believe they cannot live with their spouse and cannot live without him or her. Dividing up the personal property is another area that frequently leads to bitter differences of opinions. If there are children, there are concerns about how the divorce will affect them.

Other issues also need to be decided. Who will get custody of the children? Joint custody is now an alternative. With joint custody, both parents have responsibility for decision making involving the children, and they may (or may not) share equally in the physical custody of the children. If one parent is awarded custody, controversies are apt to arise over visiting rights, and how much (if any) child support should be paid. Both spouses often face the difficulties of finding new places to live, making new friends, doing things alone in our couple-oriented society, trying to make it on their own financially, and thinking about the hassles of dating.

Studies show that going through a divorce is very difficult for the spouses (Papalia & Martorell, 2015). People are less likely to perform their jobs well and more likely to be fired during this period. Divorced people have a shorter life expectancy. Suicide rates are higher for divorced men.

Divorce per se is no longer automatically assumed to be a social problem. In some marriages where there is considerable tension, bitterness, and dissatisfaction, divorce is sometimes a solution. It may be a concrete step that some people take to end the unhappiness and to begin leading a more productive and gratifying life. It is also increasingly being recognized that a divorce may be better for the children, as they are no longer subjected to the tension and unhappiness in a marriage that has gone sour.

The rising rate of divorce does not necessarily mean that more marriages are failing. It may simply mean that more people are dissolving empty-shell marriages rather than continuing to live unhappily.

Reasons for Divorce

As noted earlier, many people marry because they believe they are romantically in love. If this romantic love does not grow into rational love, the marriage is apt to fail. Unfortunately, young people are socialized in our society to believe that marriage will bring them continual romance, resolve all their problems, be sexually exciting, be full of adventure, and always be as wonderful as the courtship. (Most young people only need to look at their parents’ marriage to realize such romantic ideals are seldom attained.) Unfortunately, living with someone in a marriage involves carrying out the garbage, washing dishes and clothes, being weary from work, putting up with the partner’s distasteful habits, changing diapers, dealing with conflicts over such things as how to spend a vacation, and differences in sexual interests. Making a marriage work requires that each spouse put considerable effort into making it successful.

Another factor that is contributing to an increasing divorce rate is the unwillingness of some men to accept the changing status of women. Many men still prefer a traditional marriage in which the husband is dominant and the wife plays a supportive (subordinate) role as child rearer, housekeeper, and emotional supporter of her husband. Many women no longer accept such a status and demand an egalitarian marriage in which making major decisions, doing the domestic tasks, raising the children, and bringing home paychecks are shared responsibilities.

About 58 percent of women ages 25 to 64 the United States are now in the labor force (Mooney, Knox, & Schacht, 2015). As a result, women are no longer as dependent financially on their husbands. Women who are able to support themselves are more likely to seek a divorce if their marriage goes sour.

Another reason for the rising divorce rate is the growing acceptance of divorce in our society. With less stigma attached to divorce, more people who are unhappily married are now ending the marriage.

The current trend is toward joint custody in divorce cases. When custody is shared, both parents are more apt to be closely involved with the children.

Ethical Question 12.7

Immediately after a breakup, there is considerable disruption and disorganization in family life. The parents have a variety of stresses to deal with, including economic pressures (partly the result of now maintain in g two households), restrictions on recreational and social activities (more so for the custodial parent, especially if she or he is unemployed), and the need for affectionate and intimate relationships. A number of changes also occur in parent–child interactions. Divorced parents make fewer demands on the children, are less consistent in discipline, communicate less effectively with them, and have less control over them. These differences are greatest during the first year after the breakup. The first two years after a breakup tend to be stressful for everyone in the family.

A child’s reaction to a divorce depends on a variety of factors, including the age and sex of the child, the length of time of severe discord in the marriage, and the length of time between the first separation and the formal divorce. A key factor in how traumatic the divorce will be for the child is how well the parents deal with the child’s concerns, fears, questions, and anxieties. It is much more traumatic when parents do not explain that the breakup is not the child’s fault and if the divorce and custody arrangements are hotly contested.

The trauma of divorce is exacerbated when one or both parents seek to turn the child against the other parent. Transferring anger and bitterness about the breakup to the child also increases the child’s trauma. The many feelings children of divorce may experience include pain, confusion, anger, hate, bitter disappointment, a sense of failure, and self-doubt.

Children need to work through at least six major issues in order to maintain positive emotional adjustment. First, children need to accept that their parents’ marriage is over. They need to understand that their parents will no longer be together and that their access to one or both parents will be changed. Second, children need to withdraw from any conflicts their parents might be having and get on with their own lives and activities. Third, children need to cope with their loss. This might include their loss of contact with a parent, home situation, family rules, or family routines. Fourth, children need to acknowledge and cope with their strong feelings of anger at their parents and of self-blame. They need to forgive all involved, stop dwelling on what went wrong, and attend to the present and future. Fifth, children need to understand that the situation is permanent. They need to relinquish any dreams they might have that their parents will get together someday. Sixth, children need to maintain a realism about their own relationships with other people. They need to understand and accept that just because their parents’ relationship failed, it does not mean their own close relationships will fail.

Although the period during and immediately following a divorce is traumatic for both parents and children, the negative effects appear to lessen after two years. The worst disturbance seems to occur during the first year after the divorce. It seems that after a while the single-parent family is able to make adjustments to the new financial and social situation and regain its homeostasis. Over time, fathers also tend to become less and less available to their children. Perhaps children learn to accept their mother as the primary, single family leader. They have to (and do) adjust to the fact that a father is not always available.

Social Work Roles: Marriage Counseling

The primary social service for people who are considering a divorce, or who have an empty-shell marriage, is marriage counseling. (Those who do divorce may also need counseling to work out adjustment problems—such as adjusting to a single person’s life. Generally, such counseling is one-on-one, but at times it may include the ex-spouse and the children, depending on the nature of the problem.)

Marriage counseling is provided by a variety of professionals, including social workers, psychologists, guidance counselors, psychiatrists, and members of the clergy. It is also provided by most direct social service agencies.

Marriage counselors generally use a problem-solving approach in which

· (1)

problems are identified;

· (2)

alternative solutions are generated;

· (3)

the merits and shortcomings of the alternatives are examined;

· (4)

the clients select one or more alternatives to implement; and

· (5)

the extent to which the problems are being resolved by the alternatives are later assessed.

Because the spouses “own” their problems, they are the primary problem solvers.

Married couples may encounter a wide range of problems. A partial list includes sexual problems, financial problems, communication problems, problems with relatives, interest conflicts, infidelity, conflicts over how to discipline and raise children, and drug or alcohol abuse problems. Marriage counselors seek to have spouses precisely identify their problems and then use the problem-solving format to resolve the issues. At times, some couples may rationally decide a divorce is in their best interests.

Marriage counselors try to see both spouses together during sessions. Practically all marital conflicts involve both partners, and therefore are best resolved when both partners work together to resolve them. (If the spouses are seen separately, each spouse is apt to become suspicious of what the other is telling the counselor.) By seeing both together, the counselor can facilitate communication between the partners and have them work together on resolving their concerns. Seeing both partners together allows each partner the opportunity to refute what the other is saying. Only in rare cases is it desirable to hold an individual session with a spouse. For example, if one partner wants to work on unwanted emotions connected with an incestuous relationship in the past, meeting individually with that spouse might be desirable. When an individual session is held, the other spouse should be told why the session is being held and what will be discussed. If the other spouse is not informed, he or she might suspect that negative information is being related, which will increase his or her distrust of both the spouse and the counselor.

If some of the areas of conflict involve other family members (such as the children), it may be desirable to include them in some of the sessions. For example, if a father is irritated because his 14-year-old daughter is often disrespectful, the daughter may be invited to the next session to work on this subproblem.

The self-help organization Parents Without Partners serves divorced people, unwed mothers or fathers, and stepparents. It is partially a social organization, but it is also an organization to help members adjust to raising a family alone. Social workers may function as brokers in linking divorcing parents to this organization.

Divorce mediation helps spouses who have decided to obtain a divorce resolve such issues as dividing the personal property, resolving custody and child-support issues, and working out possible alimony arrangements. Some social workers are now receiving specialized training to provide divorce mediation services.

12-4hOne-Parent Families

About one child in four in the United States lives in a home with only one parent present. Several reasons account for this: divorce, desertion, death of a spouse, and births outside marriage. About 90 percent of these families are headed by women. The rate of female-headed homes in African American families is nearly three times that in white families—more than 60 percent (Papalia & Martorell, 2015). These rates have increased significantly over the past four decades. The traditional family configuration (two parents, one a mother who remains in the home to provide full-time child care) is becoming less and less common.

It must be taken into consideration that this research was done during a time when a father’s absence was considered an anomaly. Female-headed, one-parent families are much more common today. Possible negative influences on children, such as feeling different from other children or being stigmatized for their family situations, may no longer have as much adverse impact.

Poverty affects one-parent families significantly more than it does two-parent families. Differences in the average income levels of one-parent, female-headed families and two-parent families are striking. Twenty-nine percent of female-headed families are living in poverty, compared to 7 percent of two-parent families (Mooney Knox, & Schacht, 2015).

Because practically all marital conflicts involve both partners and therefore are best resolved when the partners work together on resolving their conflicts, marriage counselors try to see both spouses together.

iStock.com/FatCamera

Some difficulties in adjustment can be anticipated (Lefrancois, 1999). Jealousies arise between new siblings. These jealousies may focus on the sharing of parental attention with the new partner and new siblings. Another issue for children is adjusting to a new parent, who may have different ideas, values, rules, and expectations. Yet another adjustment involves sharing space and property when children aren’t used to sharing with these new people, or to sharing at all. Finally, if one member of the couple comes into the relationship with no child-rearing experience, an adjustment is apt to be necessary by all family members to allow time for the new parent to learn and adapt.

People come into a blended family with ideas and issues based on past experiences. Old relationships and ways of doing things still have their impacts. A blended family differs somewhat from a traditional family in that more people are involved—for example, ex-spouses, former in-laws, and an assortment of cousins, uncles, and aunts. The new couple can have both positive and negative interactions with this large supporting cast. If a prior marriage has ended bitterly, the unresolved emotions that remain will affect the present relationship.

A blended family was created when this woman married a single dad.

The area of greatest stress for most stepparents is child rearing. A stepchild, used to being raised in a somewhat different way, may balk at having to conform to a new set of rules. The stepchild may also have difficulty accepting the stepparent as one who has the right to parent him or her. Such a difficulty is more likely to arise if the stepchild feels sad because the missing parent is not present. If the new couple disagree about how to raise children, the chances of conflict are substantially increased. Stepparents and stepchildren also face the problem of adjusting to each other’s habits and personalities. Stepparents should not rush into establishing a relationship with stepchildren; a gradual approach is more likely to result in a trusting and positive relationship. Lefrancois (1999) notes that becoming a stepparent is usually more difficult for a woman because children tend to be emotionally closer to their biological mother and have spent more time with her than with the father.

A second myth about blended families is that “step is less.” In other words, this myth asserts that stepchildren will never hold the same place in the hearts of parents that biological children do. This myth does not take into account the fact that people can learn to love each other and are motivated to bind members of their new family together.

The third myth about blended families is that the moment they become joined as one family, they will have instant love for each other. Relationships take time to develop and grow. The idea of instantly having strong love bonds for each other does not make sense. People involved in any relationship need time to get to know each other, test each other out, and grow to feel comfortable with each other. Kail and Cavanaugh (2010) reviewed the research literature on stepparenthood and made the following conclusions:

1. Integration tends to be easier in families that have been split by divorce than by death, perhaps because the children realize the first marriage was not working out.

2. Stepparents and stepchildren come to the blended family with unrealistic expectations that love and togetherness will rapidly occur.

3. Children tend to see a stepparent of the opposite sex as playing favorites with their own children.

4. Most children continue to miss and admire the absent biological parent.

5. Male children tend to more readily accept a stepparent, particularly if the new parent is also male.

6. Adolescents have greater difficulty accepting a stepparent than young children or adult children.

Stepfamilies need to pursue at least four tasks in order to achieve integration. The first task involves acknowledging that losses from old relationships do exist. In addition to the bad times suffered in these prior relationships, there are also memories of the good times. Recalling how good things used to be may elicit feelings of sadness that these times are gone and anger that they can be no more. As Janzen and Harris (1986) put it, “In this case, help is usually needed to assist stepfamily members in sorting out feelings, identifying sources of sadness and anger, and looking at the new family as an opportunity to develop and share meaningful relationships, without being disloyal to friends and relatives or desecrating pleasant memories from previous experiences” (p. 284).

A second task for stepfamilies is the creation of new customs and traditions. New ways of doing things need to be established to replace the old ways used in the old family structures. New traditions involve a combination of values and activities enjoyed by all new blended family members. For instance, one side of a newly blended family member celebrated at home on New Year’s Eve and the other side celebrated the New Year on New Year’s Day. A completely new tradition might be established where the family spends the New Year’s holiday at a resort and celebrates both on New Year’s Eve and New Year’s Day.

The third task for blended families involves establishing new alliances within the family. Alliances may involve not only the new couple’s relationship with each other, but also relationships among siblings and between parents and children. Spending time on activities together is one of several ways of working on alliances.

The fourth task for blended families is integration. Parents have the responsibility of providing organization for the family. Children need to have their limits defined and consistently upheld. One difficulty is that children are faced with a new stepparent attempting to gain control, when they have not yet enjoyed many supportive and positive experiences with this individual. It is important, therefore, for the new stepparent to provide nurturance and positive feedback to stepchildren, in addition to making rules and maintaining control.

Berman (1981) and Visher and Visher (1983) give the following suggestions to help parents in blended families increase the chances of positive relationships developing between adults and children:

2. Allow time for loving relationships to develop between stepparents and stepchildren. Stepparents need to be aware that their stepchildren will probably have emotional ties to their absent biological parent, and that the stepchildren may resent the breakup of the former family. Some children may even feel they are responsible for the separation of their biological parents. Some may try to make life difficult for the stepparent so that he or she will leave, with the hope that the biological parents will then reunite. Stepparents need to be perceptive and understanding of such feelings, and patiently allow their stepchildren time to work out their concerns and to bond.

3. New rituals, traditions, and ways of doing things that seem right and enjoyable for all members of the blended family need to be developed. Sometimes it is helpful to move to a new house or a new apartment that does not hold memories of a past life. Leisure time should be given structure so that the children spend some time alone with the biological parent of the family, some time alone with the stepparent, some time with both of these parents together, and perhaps some time with the absent parent or parents. The new couple also need time to be alone. New rituals need to be developed for holidays, birthdays, and other special days.

4. Seek social support. Parents in blended families should seek to share their concerns, feelings, frustrations, experiences, coping strategies, and triumphs with other stepparents and stepchildren. Such sharing allows parents in blended families to view their own situations more realistically and to learn from the experiences of others.

12-4jMothers Working outside the Home

A major break with tradition has occurred with the surge of married women entering the workforce over the past several decades. Employment of married women with children under 18 has risen from 24 percent in 1950 to 40 percent in 1970 to 70 percent in 2013 (Mooney Knox, & Schacht, 2015). Among female-headed one-parent families, 71 percent of the mothers were employed (Mooney Knox, & Schacht, 2015). Most working mothers work full-time.

Many questions have been raised concerning the effects of working mothers (and single working custodial fathers) on the social and emotional development of children. The traditional view stressed the importance of a stable, supportive, caregiver being available consistently to meet the needs of children. In other words, it was important for a mother to remain in the home and coordinate the family’s care and activities. However, research indicates that women do not have to remain home in order to maintain a well-adjusted family.

Reviews of the research on working mothers and their children conclude that if the mother is satisfied with her job and the provision for child care is reasonably good and suitable, there is no adverse effect on the child’s development (Papalia & Martorell, 2015). Many contemporary researchers emphasize the positive effects of a mother’s employment on her entire family.

Some questions have been raised concerning the effects on children under age 3 when mothers work outside the home. These questions tend to revolve around the issue of maternal deprivation (i.e., that infants are emotionally deprived if they do not have enough contact with their mothers). Concerns were initially raised after some early research indicated that institutionalized infants suffered negative effects. This research related these negative effects to the fact that the mother was absent. However, could these effects have been due to the fact that the infants received inadequate care and very little attention from anyone? It may not necessarily be that they specifically missed their mothers.

There is no simple answer to the question about the effects on children of their mothers’ working. Children need consistent nurturance, guidance, and care. Home conditions vary widely. Not all biological mothers provide adequate care and attention to their young children. Also, the conditions under which a mother works vary tremendously. Some mothers love their jobs; others hate having to work. The level of the mother’s overall satisfaction with life must affect the child.

Another issue is the role of the father in caring for children in those cases where a father is present in the home. Can’t the father be a primary participant in child care? It’s interesting that the term  maternal deprivation is commonly used, whereas the parallel term  paternal deprivation is not. In reality, mothers, whether they work outside the home or not, generally maintain the primary responsibility for child care in our society.

Child rearing is most often seen as the mother’s responsibility. However, perhaps this idea was more credible when few women worked outside the home. Perhaps changing attitudes to encourage shared parenting would be in the best interest of families.

12-4kThe “Sandwich” Generation

Many middle-aged adults are “sandwiched” between two generations—their parents and their children. This puts great demands and pressures on them. Because older adults are the fastest-growing age group in terms of numbers in our society, an increasing proportion of middle-aged adults will find themselves providing care for their parents as well as their children. Some middle-aged adults have their children and a parent or two living with them. People find it difficult to find the time and resources to respond to the needs and demands of their work, their children, and their parents.

Middle-aged adults who feel the obligations of caring for both their children and their aging parents may be torn between love and resentment. They love both their children and their parents—but may resent that caring for their parents may deprive them of any chance to fulfill their dreams of getting involved in more enjoyable activities.

For members of the sandwich generation who are working outside the home, flexible work schedules can help alleviate the stresses associated with both caregiving responsibilities and work responsibilities. The Family and Medical Leave Act, adopted in 1993, guarantees family caregivers some unpaid leave. In addition, some large corporations provide time off for caregiving.

12-5Understand Material on Assessing and Intervening in Family Systems

12-5aAssessing and Intervening in Family Systems

Families are characterized by multiple ongoing interactions. When social workers intervene with families, there is much to observe and understand. The dimensions of family interaction that will be discussed here include communication, family norms, and problems commonly faced by families. In addition, two prominent family-assessment instruments will be described: the ecomap and the genogram.

12-5bVerbal and Nonverbal Communication

Communication involves transmitting information from one person to another, using a common system of symbols, signs, or behaviors. Verbal communication involves the use of words and will be addressed first.

The first phase of verbal communication involves the translation of thoughts into words. The information sender must know the correct words and how to put them together. Only then will the information have the chance of being effectively received. The sender may be vague or inaccurate in forming the message, and interruptions and distractions may detract from the communication process.

The information receiver then must be receptive to the information. That is, he or she must be paying attention both to the sender and to the sender’s words. The receiver must understand what the specific words mean. Inaccuracies or problems at any point in this process can stop the information from getting across to the receiver. At any point, distortions may interfere.

Verbal communication patterns inside the family include who talks a lot and who talks only rarely. They involve who talks to whom and who defers to whom. They also reflect the subtle and not so subtle qualities involved in family members’ relationships.

For example, a 17-year-old son asks his father, “Dad, can I have the car next Saturday night?” Dad, who’s in the middle of writing up his tax returns (which are due in two days), replies “No.” Harry interprets this to mean that his father is an authoritarian tyrant who does not trust him with the family car. Harry stomps off in a huff. However, what Dad was really thinking was that he and Mom need the car this Saturday because they’re taking their best friends, the Jamesons, out for their twentieth wedding anniversary. Dad was also thinking that perhaps the Jamesons wouldn’t mind driving. Or maybe he and Harry could work something out to share the car. At any rate, Dad really meant that he was much too involved with the tax forms to talk about it and would rather discuss it during dinner.

This is a good example of ineffective communication. The information was vague and incomplete, and neither person clarified his thoughts or gave feedback to the other. There are endless variations to the types of ineffective communication that can take place in families. Social workers can often help to clarify, untangle, and reconstruct communication patterns.

One especially important aspect of assessing messages is whether they are congruent or incongruent. Communication is incongruent when two or more messages contradict each other’s meaning. In other words, the messages are confusing. Contradictory messages within families disturb effective family functioning.

Nonverbal messages can sometimes contradict verbal messages. For example, a recently widowed woman says, “I’m sorry Frank passed away,” with a big grin on her face. The information expressed by the words indicates that she is sad. However, her accompanying physical expression shows that she is happy. Her words are considered socially appropriate for the situation. However, in this particular case, she seems relieved to get rid of “the old buzzard” and happy to be the beneficiary of a large life insurance policy.

Social workers need to help families identify and understand that inappropriate, ineffective norms can be changed. For example, it simply is not in Mrs. Myers’s best interest to be putting in more than 100 hours a week on home-schooling and domestic tasks. If a social worker became involved (perhaps after a referral from Mrs. Myers’s physician, who is concerned about her blood pressure), that social worker could help Mrs. Myers (and probably eventually Mr. Myers) to examine the family norms that are adversely affecting12-5dFamily System Assessment: The Ecomap

An  ecomap is a paper-and-pencil assessment tool that practitioners use to assess specific troubles and plan interventions for clients. The ecomap is a drawing of the client/family in its social environment. An ecomap is usually drawn jointly by the social worker and the client. It helps both the worker and the client achieve a holistic or ecological view of the client’s family life and the nature of the family’s relationships with groups, associations, organizations, other families, and individuals. It has been used in a variety of situations, including marriage and family counseling, and adoption and foster-care home studies. The ecomap has also been used to supplement traditional social histories and case records. It is a shorthand method for recording basic social information. The technique helps users (clients and practitioners) gain insight into clients’ problems and better sort out how to make constructive changes. The technique provides a “snapshot view” of important interactions at a particular point in time. The primary developer of the technique is Ann Hartman (1978).

Barb and Mike Haynes meet with Maria Garcia, Adult Services Worker. They indicate that they feel a moral obligation to continue caring for Ruth in their home, because Ruth spent most of her adult years caring for Mike and his brother and sister when they were children. Barb and Mike also indicate that they have a 2-year-old child, Erin, at home. This is a second marriage for both Barb and Mike, and they are paying for Mike’s son, Brian, to attend the state university. With such expenses, both believe they need to continue to work. Mike’s oldest sister, Mary Kruger, is a single parent who has two children in high school. Mary Kruger has a visual disability but has been able to be the primary caregiver for Ruth and Erin during the daylight hours when Mike and Barb are at work. Recently, Mary informed Mike and Barb that caring for Ruth is becoming too difficult and that some kind of alternative care is needed. Ms. Garcia suggests that adult day care for Ruth may be a useful resource.

Mike adds that it is emotionally devastating to see his mother slowly deteriorate. He indicates he is in a double bind; he feels an obligation to care for his mother, but doing so is causing major disruptions in his family life. The stress has resulted in marital discord with Barb, and he adds that both he and Barb have become increasingly short in temper and patience with Erin.

Mr. Nolan inquires as to the specifics of the “scuffle.” Chris says he came home after having a few beers. His dinner was cold, and he “got on” Karen for not cleaning up the house. He adds that Karen then started mouthing off, and he slapped her to shut her up. Mr. Nolan inquires whether such incidents had occurred in the past. Chris indicates, “A few times,” and adds that getting physical with Karen is the only way for him to “keep her in line.” He says he works all day long in his small business as a concrete contractor, while his wife sits at home watching soap operas. He feels she is not doing her fair share and the house usually looks like a disaster.

Mr. Nolan asks Chris if he feels that getting physical with his wife is justifiable. He responds, “Sure,” and adds that his dad frequently told him, “Spare the rod, and spoil both the wife and the kids.” Mr. Nolan asks Chris if his dad was abusive to him when he was a child. Chris indicates that he was and adds that to this day he detests his dad for abusing him and his mother.

· (1)

marital problems between the husband and wife;

· (2)

difficulties between parents and children;

· (3)

personal problems of individual family members; and

· (4)

stresses imposed on the family by the external environment.

Family problems do not necessarily fall neatly into one or another of these categories. Frequently, families experience more than one category of problems. Nor are these problem categories mutually exclusive. Many times, one problem will be closely related to another. Consider, for instance, the wife and mother of a family who is a department store manager and the primary breadwinner for her family. The store at which she has been working for the past 11 years suddenly goes out of business. Despite massive efforts, she is unable to find another job with similar responsibilities and salary. This can be considered a family problem caused by stresses in the environment. However, this is also a personal problem for the wife and mother. Her sense of self-worth is seriously diminished by her job loss and inability to find another position. She becomes cranky, short-tempered, and difficult to live with. The environmental stress she is experiencing causes her to have difficulties relating to both her children and spouse. The entire family system becomes disturbed.

The first category of problems typically experienced by families is marital problems between the husband and wife. Although problems between spouses affect all family members, intervention may target a subsystem of the family—in this case, the marital subsystem. In other words, a social worker may work with the couple alone instead of the entire family to solve a specific problem. When the marital pair gets along better, the entire family will be positively affected. A marital problem case example follows.

Gianna and Mark Di Franco were married in 1998. Both had been previously divorced. Gianna had two children from a prior marriage, and Mark had four. Gianna was a financial planner who owned her own company. Mark was vice president of a much larger company. Both earned about the same amount. On the night before they were married, Mark presented Gianna with a prenuptial agreement. It stated that the assets each brought into the marriage would be kept separate, and would be the property of the person bringing it into the marriage if a divorce occurred. The agreement also stated that each spouse would pay an equal share of the family expenses. Mark said he would not marry Gianna unless she signed the agreement. Gianna did not want to call off the wedding, so she signed the agreement.

After three years of marriage, Gianna had two major concerns. First, when Mark became angry with her, he would refuse to talk to her—often for as long as two weeks. Gianna often did not know “what she did wrong.” Mark, after pouting for a while, would eventually start talking again. When she asked why he’d stopped communicating, he’d always respond, “If you can’t figure it out, I’m not going to tell you.”

Gianna’s second concern was financial. Mark became president of his company and received a big increase in salary. Gianna, on the other hand, saw her earnings sliced nearly in half as the stock market drop in the early 2000s resulted in much less business for her company. She asked Mark several times to pay more of the family expenses. He always pulled out the prenuptial agreement and said he wanted to pay his extra money into trust funds for his four children.

The financial situation and the communication problem became such major issues for Gianna that she went to see a family social worker. The social worker indicated that progress on these issues could only be made if Mark came in for joint counseling. Mark at first refused to go. Gianna had to give him an ultimatum: “Either go with me for counseling, or I’m filing for divorce.”

Mark relented and went for counseling with Gianna. At first, he refused to change the prenuptial agreement, but eventually he realized that if he didn’t pay more of the household expenses, and if he didn’t start communicating with Gianna about his concerns, she was going to file for divorce. He thus agreed to pay more of the family expenses. However, the communication issue was more of a hurdle for him. He was raised in a family in which he learned the pattern of not communicating from his father, who also would stop speaking for a week or two to his wife when he was angry with her. Gianna adopted the strategy of making a counseling appointment for Mark and her whenever Mark stopped talking to her for a day or two.

Richard B. Stuart (1983) developed a Couple’s Pre-Counseling Inventory, which is used to assess a couple’s problems. Each member of the couple is asked to fill out the questionnaire separately. Later, answers can be shared during counseling, and misconceptions each has about how the other person feels can be clarified. Areas that are evaluated include happiness with the relationship; caring behaviors liked by the partner; perceptions of caring behaviors liked by the partner; communication; how conflict is managed; how moods and other aspects of personal life are managed; sexual interaction; how children are managed; willingness to make changes; marital history; and specific goals each person wants to pursue.

The second major type of family problem involves relationships between parents and children, including parents’ difficulties controlling their children and, especially as children reach adolescence, communication problems.

12-6Summarize Material on Social Work with Organizations, including Several Theories of Organizational Behavior

LO 5

When we first talk with students in classes about social work with organizations, they tend to yawn and show little interest. They tend to view such material as being irrelevant to their lives. Their interest, however, is usually accelerated when we note that most social workers are employed in agencies (which are organizations), and that it is critical that social work students learn “how to survive and thrive” in agencies/organizations.

12-6aSocial Work with Organizations

Organizations are “

· (1)

social entities that

· (2)

are goal-directed,

· (3)

are designed as deliberately structured and coordinated activity systems, and

· (4)

are linked to the external environment” (Daft, 2007, p. 10).

Social entities involve groups of people, all having their own strengths, needs, ideas, and quirks. Organizations are  goal-directed in that they exist to accomplish some purpose or meet some need. As an  activity system, an organization is made up of a coordinated series of units accomplishing different tasks yet working together to achieve some common end. Finally, organizations are in constant interaction with other people, decision makers, agencies, neighborhoods, and communities in the external social environment as they strive to achieve goals.

Managers treated workers crudely, sometimes even to the point of physical abuse. Since employees could not strike back directly for fear of losing their jobs, they found another way to do it. They symbolically fed their supervisor to a log-shredding machine! They did this by purposely destroying good sheets of veneer, which made the supervisor look bad when monthly efficiency reports were prepared. (p. 31)

In the 1890s and 1900s, some progressive employers thought that if these feelings could be alleviated, employees might feel more like working, which would increase productivity. To satisfy the employees’ security needs, a number of companies began to provide welfare programs such as pension programs, child-care centers, health insurance, and life insurance.

The custodial approach leads to employee dependence on the organization. According to Davis and Newstrom (1989), “If employees have ten years of seniority under the union contract and a good pension program, they cannot afford to quit even if the grass looks greener somewhere else!” (p. 31).

12-6dThe Scientific Management Model

One of the earliest and most important schools of thought on the management of functions and tasks in the workplace was based on the work of Frederick Taylor (1947). Taylor was a mechanical engineer, an American industrialist, and an educator. He focused primarily on management techniques that would lead to increased productivity. He asserted that many organizational problems in the workplace involved misunderstandings between managers and workers. Managers erroneously thought that workers were lazy and unemotional, and they mistakenly believed they understood workers’ jobs. Workers mistakenly thought that managers cared most about exploiting them.

To solve these problems, Taylor developed the scientific management model, which focused on the need for managers to conduct a scientific analysis of the workplace. One of the first steps was to conduct a careful study of how each job could best be accomplished. An excellent way to do this, according to Taylor, was to identify the best worker at each job and then carefully study how he or she did the work. The goal of this analysis was to discover the optimal way of doing the job—in Taylor’s words, the “one best way.” Once this best way was identified, tools could be modified to better complete the work, workers’ abilities and interests could be fitted to particular job assignments, and the level of production that the average worker could sustain could be gauged.

Once the level of production for the average worker was determined, Taylor indicated that the next step was to provide incentives to increase productivity. His favorite strategy was the piece-rate wage, in which workers were paid for each unit they produced. The goals were to produce more units, reduce unit cost, increase organizational productivity and profitability, and provide incentives for workers to produce more.

Taylor’s work has been criticized as having a “technicist” bias, because it tends to treat workers as little more than cogs on a wheel. No two workers are exactly alike, so the “one best way” of doing a job is often unique to the person doing it. In fact, forcing the same work approach on different workers may actually decrease both productivity and worker satisfaction. In addition, Taylor’s approach has limited application to human services providers. Because each client is unique, each situation has to be individualized, and therefore it is difficult (if not impossible) to specify the “one best way” to provide a service.

12-6eThe Human Relations Model

In 1927, the Hawthorne Works of the Western Electric Company in Chicago began a series of experiments designed to discover ways to increase worker satisfaction and worker productivity (Roethlisberger & Dickson, 1939). Hawthorne Works manufactured telephones on an assembly line. Workers needed no special skills, and they performed simple, repetitive tasks. The workers were not unionized, and management sought to find ways to increase productivity. If job satisfaction could be increased, employees would work more efficiently, and productivity would then increase.

The company tested the effects on productivity of a number of factors: rest breaks, better lighting, changes in the number of work hours, changes in the wages paid, improved food facilities, and so on. The results were surprising. Productivity increased, as expected, with improved working conditions; but it also increased when working conditions worsened. This latter finding was unexpected and led to an additional study.

The investigators discovered that participation in these experiments was extremely attractive to the workers, who felt they had been selected by management for their individual abilities. As a result, they worked harder, even when working conditions became less favorable. In addition, the workers’ morale and general attitude toward work improved, because they felt they were receiving special attention. Participating in a study enabled them to work in smaller groups and become involved in making decisions. Working in smaller groups allowed them to develop a stronger sense of solidarity with their fellow workers. Being involved in decision making decreased, their feelings of meaninglessness and powerlessness about their work.

The results of this study, and of other similar studies, led some researchers to conclude that the key variables affecting productivity are social factors. Etzioni (1964) summarized some of the basic tenets of the human relations approach:

· The level of production is set by social norms, not by physiological capacities.

· Noneconomic rewards and sanctions significantly affect the behavior of the workers and largely limit the effect of economic incentive plans.

· Workers do not act or react as individuals but as members of groups.

· The role of leadership is important in understanding social factors in organizations, and this leadership may be either formal or informal.

Numerous studies have provided evidence to support these tenets (Netting, Kettner, & McMurtry, 1993). Workers who are capable of greater productivity often will not excel because they are unwilling to exceed the “average” level set by the norms of the group, even if this means earning less. These studies have also found that attempts by management to influence workers’ behavior are often more successful if targeted at the group as a whole, rather than at individuals. Finally, the studies have documented the importance of informal leadership in influencing workers’ behavior in ways that can either amplify or negate formal leadership directives. This model asserts that managers who succeed in increasing productivity are most likely responsive to the workers’ social needs.

One criticism of the human relations model is (surprisingly) that it tends to manipulate, dehumanize, oppress, and exploit workers. The model leads to the conclusion that management can increase productivity by helping workers become content, rather than by increasing economic rewards for higher productivity. The human relations model allows for concentrated power and decision making at the top. It is not intended to empower employees in the decision-making process or to assist them in acquiring genuine participation in the running of the organization. The practice of dealing with people on the basis of their perceived social relationships within the workplace may also be a factor in perpetuating the “good old boys” network; this network has disadvantaged women and people of color over the years. Another criticism of the human relations approach is that a happy workforce is not necessarily a productive workforce, because the norms for worker production may be set well below the workers’ levels of capability.

12-6fTheory X and Theory Y

Douglas McGregor (1960) developed two theories of management. He theorized that management thinking and behavior are based on two different sets of assumptions, which he labeled Theory X and Theory Y.

Theory X managers view employees as being incapable of much growth. Employees are perceived as having an inherent dislike for work and attempting to evade work whenever possible. Therefore, X-type managers believe they must control, direct, force, or threaten employees to make them work. Employees are also viewed as having relatively little ambition, wishing to avoid responsibilities, and preferring to be directed. Theory X managers therefore spell out job responsibilities carefully, set work goals without employee input, use external rewards (such as money) to push employees to work, and punish those who deviate from established rules.

Because Theory X managers reduce responsibilities to a level at which few mistakes can be made, work usually becomes so structured that it is monotonous and distasteful. These Theory X assumptions, of course, are inconsistent with what behavioral scientists assert are effective principles for directing, influencing, and motivating people. Theory X managers are, in essence, adhering to an autocratic model of organizational behavior.

Employees who work for Y-type managers are generally more creative and productive, experience greater work satisfaction, and are more highly motivated than employees who work for X-type managers. Under both management styles, expectations often become self-fulfilling prophecies.

12-6gThe Collegial Model

A useful extension of Theory Y is the  collegial model, which emphasizes the team concept. Employees work together closely and feel a commitment to achieving a common purpose. Some organizations—such as university departments, research laboratories, and most human services organizations—have a goal of creating a collegial atmosphere to facilitate achieving their purposes. (Sadly, many such organizations are unsuccessful in creating such an atmosphere.)

Creating a collegial atmosphere is highly dependent on management’s building a feeling of partnership with employees. When such a partnership develops, employees feel needed and useful. Managers are then viewed as joint contributors rather than as bosses. Management is the coach that builds a better team. Davis and Newstrom (1989) described some of the approaches to developing a team concept:

The feeling of partnerships can be halt in many ways. Some organizations have abolished the use of reserved parking spaces for executives, so every employee has an equal chance of finding one close to the workplace. Some firms have tried to eliminate the use of terms like “bosses” and “subordinates,” feeling that those terms simply create perceptions of psychological distance between managers and nonmanagers. Other employers have removed time clocks, set up “fun committees,” sponsored company canoe trips, or required managers to spend a week or two annually working in field or factory locations. All of these approaches are designed to build a spirit of mutuality, in which every person makes contributions and appreciates those of others. (p. 34)

If the sense of partnership is developed, employees produce quality work and seek to cooperate with coworkers, not because management directs them to do so, but because they feel an internal obligation to produce high-quality work. The collegial approach thus leads to a sense of self-discipline. In this environment, employees are more apt to have a sense of fulfillment, to feel self-actualized, and to produce higher-quality work.

12-6hTheory Z

William Ouchi described the Japanese style of management in his 1981 best-seller Theory Z. In the late 1970s and early 1980s, attention in the U.S. business world became focused on the Japanese approach to management, as markets long dominated by U.S. firms (such as the automobile industry) were taken over by Japanese industries. Japanese industrial organizations had rapidly overcome their earlier reputation for poor-quality work and were setting worldwide standards for quality and durability.

Theory Z asserted that the theoretical principles underlying Japanese management went beyond Theory Y. According to Theory Z, a business organization in Japan is more than the profitability-oriented entity that it is in the United States. It is a way of life. It provides lifetime employment. It is enmeshed with the nation’s political, social, and economic network. Furthermore, its influence spills over into many other organizations, such as nursery schools, elementary and secondary schools, and universities.

The basic philosophy of Theory Z is that involved and committed workers are the key to increased productivity. Ideas and suggestions about how to improve the organization are routinely solicited, and implemented where feasible. One strategy for accomplishing this is the  quality circle, where employees and management routinely meet to brainstorm about ways to improve productivity and quality.

In contrast to American organizations, Japanese organizations tend not to have written objectives or organizational charts. Most work is done in teams, and decisions are made by a consensus. The teams tend to function without a designated leader. Cooperation within units, and between units, is emphasized. Loyalty to the organization is also emphasized, as is organizational loyalty to the employee.

12-6iManagement by Objectives

Fundamental to the core of an organization is its purpose—that is, the commonly shared understanding of the reason for its existence.

Management theorist Peter Drucker (1954) proposed a strategy for making organizational goals and objectives the central construct around which organizational life is designed to function. In other words, instead of focusing on employee needs and wants, or on organizational structure, as the ways to increase efficiency and productivity, Drucker proposed beginning with the desired outcome and working backward. The strategy is first to identify the organizational objectives or goals and then to adapt the organizational tasks, resources, and structure to meet those objectives. This management by objectives (MBO) approach is designed to focus the organization’s efforts on meeting these objectives. Success is determined, then, by the degree to which stated objectives are reached.

This approach can be applied to the organization as a whole, as well as to internal divisions or departments. When the MBO approach is applied to internal divisions, the objectives set for each division should be consistent with and supportive of the overall organizational objectives.

In many areas, including human services, the MBO approach can also be applied to the cases serviced by each employee. Goals are set with each client, tasks to meet these goals are then determined, and deadlines are set for the completion of these tasks. The degree of success of each case is then determined at a later date (often when a case is closed) by the extent to which stated goals were achieved.

An adaptation of the MBO approach, called strategic planning and budgeting (SPB), became popular in the 1990s and is still widely used. The process involves first specifying the overall vision or mission of an organization, then identifying a variety of more specific objectives or plans for achieving that vision, and, finally, adapting the resources to meet the specific high-priority objectives or plans. Organizations often hire outside consultants to assist in conducting the SPB process.

One major advantage of the MBO approach for an organization or its divisions is that it produces clear statements (made available to all employees) about the objectives and the tasks that are expected to be accomplished in specified time periods. This type of activity tends to improve cooperation and collaboration. The MBO approach is also useful because it provides a guide for allocating resources and a focus for monitoring and evaluating organizational efforts.

An additional benefit of the MBO approach is that it creates diversity in the workplace. Prior to this approach, those responsible for hiring failed to employ women and people of color in significant numbers. As affirmative action programs were developed within organizations, the MBO approach was widely used to set specific hiring goals and objectives. The result has been significant changes in recruitment approaches that have enabled more women and minorities to secure employment.

12-6jTotal Quality Management

The theorist most closely associated with developing the concept of total quality management (TQM) is W. Edwards Deming (1986). Deming was a statistician who formed many of his theories during World War II, when he instructed industries on how to use statistical methods to improve the quality of military production. Following World War II, Deming taught the Japanese his theories of quality control and continuous improvement, and he is now recognized, along with J. Juran (1989) and others, as having laid the groundwork for Japan’s industrial and economic boom.

Omachonu and Ross (1994) define TQM as “the integration of all functions and processes within an organization in order to achieve continuous improvement of the quality of goods and services. The goal is customer satisfaction” (p. 1). TQM is based on a number of ideas. It means thinking about quality in terms of all functions of the enterprise and as a start-to-finish process that integrates interrelated functions at all levels. It is a systems approach that considers every interaction between the various elements of an organization.

TQM further maintains that customer satisfaction is the main purpose of the organization. Therefore, quality includes continuously improving all the organization’s processes that lead to customer satisfaction. The customer is seen as part of the design and production process, as the customer’s needs must be continually monitored.

In recent years, numerous organizations have adopted a TQM approach to improve their goods and services. One of the reasons that quality is being emphasized more is because consumers are increasingly shunning mass-produced, poorly made, disposable products. Companies are realizing that to remain competitive in global markets, quality of products and services is essential. Ford’s motto, “Quality Is Job One,” symbolizes this emphasis.

There are a variety of approaches to TQM, largely because numerous theoreticians (business gurus) have advanced somewhat diverse approaches.

In regards to human service agencies, the following are guiding principles of TQM:

· The first and major principle is to satisfy the customer. The customer is the one paying for the service (which may be the funding source, or if it is paying clients—then it would be these clients). Human service agencies satisfy customers by providing them with value for funds they provide. The agencies that provide value for what the customers buy will get more repeat business and referral business, and will have reduced complaints and reduced service expenses. Human service agencies should ask funders what they need, and provide more of what they ask for.

· Human service agencies should instill pride into every employee. Helping every employee to enjoy his or her work will lead to higher motivation of employees to do well, which in turn will result in these agencies becoming more productive. Agencies should provide a forum or seek to create high morale at work so that employees at all levels feel free to voice their opinions when they think they have good ideas. Agencies should review the suggestions and implement the best ones. Employees should be inspired, and empowered, to do their best. The number of layers of authority should be reduced to enhance employee empowerment. A focus of human service agencies should be to instill pride into every employee.

· Complaints from customers or from employees should be viewed as opportunities for improvement. In reviewing a complaint or a suggestion, the focus should be on quality evaluative information and data, rather than on opinions or egos.

· Supervisors should seek to keep their supervisees happy and productive by providing good task suggestions, the tools they need to do their job and good working conditions. Supervisors should also reward productive employees with praise and good pay.

· Employees are an excellent source of ideas for improvements. They often can provide suggestions on how to improve a system/process and eliminate waste or unnecessary work.

12-6kSummary Comments about Models of Organizational Behavior

Any of these models can be successfully applied in some situations. Which model to apply to attain the highest productivity depends on the tasks to be completed and on employee needs and expectations. For example, the autocratic model will probably work well in military operations, where quick decisions are needed to respond to rapidly changing situations or crises, and where personnel expect autocratic leadership. However, this model does not generally work well in human services organizations, in which employees are expecting the Theory Y style of management.

Survive and Thrive in an Agency

Two of the most relevant organizational theories for social workers are Theory X and Theory Y. These theories were described earlier in this chapter. Theory X supervisors rely heavily on the threat of punishment to gain employee compliance. This managerial style is more effective when used to motivate a workforce that is not inherently motivated to perform.

It is critical for newly hired social workers in an organization to observe and determine if supervisors believe in a Theory X or Theory Y style of management. If a worker has Theory X supervisors, then that worker can best “survive” by doing what the supervisors tell him or her to do. That worker should make few (or no) suggestions for changes in the organization because suggestions for changes will irritate the supervisors. To feel fulfilled/gratified as a person, a worker in this situation should seek recognition from outside sources—such as their church or other place of worship, an athletic team, friends, or family members. (Remember, Theory X organizations are not apt to give recognition to workers—such as promotions or praise—other than paying them.)

If a worker has Theory Y supervisors, then that worker can best “survive/thrive” by making suggestions for changes—as these are expected and appreciated. Also, workers can expect to be praised and promoted for work that is well done. When working for Theory Y supervisors, a worker is more apt to find recognition and become more ego-invested with that organization.

How can a new worker determine if his organization has primarily Theory X or Theory Y supervisors? It is essential that new workers in a social service organization observe carefully the actions of their supervisors, rather than simply listening to their words.

Theory X supervisors are apt to say they cherish suggestions for changes, but “the proof is in the pudding,” as the saying goes. I worked for an organization where the president/executive director said, frequently, that she cherished and invited suggestions for changes. However, if a worker made a suggestion for a change that appeared to be a slight criticism of her, she either made it her mission to discharge that worker, or made the job so distasteful for the worker that the worker eventually left. (A president/executive director can make a job distasteful in a variety of ways—such as providing no pay increases, assigning heavy work responsibilities, assigning evening or weekend work, and rewriting that worker’s job description to be more onerous.)

12-6lServant Leadership and Theory Y

Value Conflicts between a Helping Professional and Bureaucracies

Any of these differences in value orientations can become an arena of conflict between helping professionals and the bureaucracies in which they work. Knopf (1979) summarized the potential areas of conflict between bureaucracies and helping professionals:

The trademarks of a BS (bureaucratic system) are power, hierarchy, and specialization; that is, rules and roles. In essence, the result is depersonalization. The system itself is neither “good” nor “bad”; it is a system. I believe it to be amoral. It is efficient and effective, but in order to be so it must be impersonal in all of its functionings. This then is the location of the stress. The hallmark of the helping professional is a highly individualized, democratic, humanized, relationship-oriented service aimed at self-motivation. The hallmark of a bureaucratic system is a highly impersonalized, valueless (amoral), emotionally detached, hierarchical structure of organization. The dilemma of the HP (helping person) is how to give a personalized service to a client through a delivery system that is not set up in any way to do that. (pp. 21–22)

Numerous helping professionals respond to these orientation conflicts by erroneously projecting a “personality” onto the bureaucracy. The bureaucracy is viewed as being fraught with red tape, and officialism, uncaring, cruel, the enemy. A negative personality is sometimes also projected onto the officials, who may be viewed as being paper shufflers, rigid, deadwood, inefficient, and unproductive. Knopf (1979) states,

A bureaucratic system is neither good nor bad. It has neither a personality nor a value system of its own. It is simply a structure developed to carry out various tasks.

A helping person may have various emotional reactions to these conflicts in orientation with bureaucratic systems. Common reactions are anger at the system, self-blame (“It’s all my fault”), sadness and depression (“Poor me,” “Nobody appreciates all I’ve done”), and fright and paranoia (“They’re out to get me,” “If I mess up I’m gone”).

Knopf (1979) identified several types of behavior patterns that helping professionals choose in dealing with bureaucracies.

The warrior leads open campaigns to destroy and malign the system. A warrior discounts the value of the system and often enters into a win-lose conflict. The warrior generally loses and is dismissed.

The gossip is a covert warrior who complains to others (including clients, politicians, and the news media) how terrible the system is. A gossip frequently singles out a few officials for criticism. Bureaucratic systems often make life very difficult for the gossip by assigning distasteful tasks, refusing to promote, giving very low salary increases, and perhaps even dismissing.

The complainer resembles a gossip but confines complaints to other helping people, to in-house staff, and to family members. A complainer wants people to agree in order to find comfort in shared misery. Complainers desire to stay with the system, and generally do.

The dancer is skillful at ignoring rules and procedures. Dancers are frequently lonely, often reprimanded for incorrectly filling out forms, and have low investment in the system or in helping clients.

The defender is scared, dislikes conflict, and therefore defends the rules, the system, and bureaucratic officials. Defenders are often supervisors and are viewed by others as bureaucrats.

The machine is a bureaucrat who takes on the orientation of the bureaucracy. Often a machine has not been involved in providing direct services for years. Machines are frequently named to head study committees and policy groups and to chair boards.

The executioner attacks people within an organization with enthusiasm and vigor. An executioner usually has a high energy level and is impulsive. An executioner abuses power by indiscriminately attacking and dismissing not only employees but also services and programs. Executioners have power and are angry (although the anger is disguised, denied). They are not committed to either the value orientation of helping professionals or the bureaucracy.

Knopf (1979) listed 66 tips on how to survive in a bureaucracy. The most useful suggestions are summarized here:

1. Whenever your needs, or the needs of your clients, are not met by the bureaucracy, use the following problem-solving approach:

· (1)

Precisely identify your needs (or the needs of clients) that are in conflict with the bureaucracy; this step is defining the problem.

· (2)

Generate a list of possible solutions. Be creative in generating a wide range of solutions.

· (3)

Evaluate the merits and shortcomings of the possible solutions.

· (4)

Select a solution.

· (5)

Implement the solution.

· (6)

Evaluate the solution.

2. Obtain knowledge of how your bureaucracy is structured and how it functions. This knowledge will reduce fear of the unknown, make the system more predictable, and help in identifying rational ways to best meet your needs and those of your clients.

3. Remember that bureaucrats are people who have feelings. Communication gaps are often most effectively reduced if you treat them with as much respect and interest as you treat clients.

4. If you are at war with the bureaucracy, declare a truce. The system will find a way to dismiss you if you remain at war. With a truce, you can identify and use the strengths of the bureaucracy as an ally, rather than having the strengths be used against you as an enemy.

5. Know your work contract and job expectations. If the expectations are unclear, seek clarity.

6. Continue to develop your knowledge and awareness of specific helping skills. Take advantage of continuing education opportunities (e.g., workshops, conferences, courses). Among other advantages, your continued professional development will assist you in being able to contract from a position of competency and skill.

8. Be aware that you can’t change everything, so stop trying. In a bureaucracy, focus your change efforts on those aspects that most need change and that you have a fair chance of changing. Stop thinking and complaining about those aspects you cannot change. It is irrational to complain about things that you cannot change or to complain about those things that you do not intend to make an effort to change.

Practically every decision is also based on certain assumptions. Without assumptions, nothing can be proved. Assumptions are made in every research study to test any hypothesis. For example, in a market research survey, analysts assume that the instruments they use (such as a questionnaire) will be valid and reliable. It cannot even be proved the sun will rise in the east tomorrow without assuming that its history provides that proof.

Every decision maker in an organization brings not only his or her objective knowledge and expertise to the decision-making process, but also his or her value orientations.  Value orientation means an individual’s own ideas about what is desirable and worthwhile. Most values are acquired through prior learning experiences in interactions with family, friends, educators, organizations such as a church, and anyone else who has made an impression on a person’s thinking.

Philosopher Edward Spranger (1928) believed that most people eventually come to rely on one of six possible value orientations. Although it is possible for a person to hold values in all six orientations, each person tends to lean more heavily toward one type in the decision-making process. The six value orientations are as follows:

· Theoretical. A person with a theoretical orientation strives toward a rational, systematic ordering of knowledge. Personal preference does not count as much as being able to classify, compare, contrast, and interrelate various pieces of information. The theoretical person places value on simply knowing what exists—and why.

· Economic. An economic orientation places primary value on the utility of things, and practical uses of knowledge are given foremost attention. Proposed plans of action are assessed in terms of their costs and benefits. If the costs outweigh the benefits, the economically oriented person is not likely to support the plan.

· Aesthetic. An aesthetic orientation is grounded in an appreciation of artistic values, and personal preferences for form, harmony, and beauty are influential in making decisions. Because the experience of single events is considered an important end in itself, reactions to aesthetic qualities will frequently be expressed.

· Social. A social orientation is an empathetic one that values other people as ends in themselves. Concern for the welfare of people pervades the behavior of the socially oriented decision maker, and primary consideration is given to the quality of human relationships.

· Political. A political orientation involves a concern for identifying where power lies. Conflict and competition are seen as normal elements of group activity. Decisions and their outcomes are assessed in terms of how much power is obtained, and by whom, because influence over others is a valued goal.

· Religious. A person with a religious orientation is directed by a desire to relate to the universe in some meaningful way. Personal beliefs about an “absolute good” or a “higher order” are employed to determine the value of things, and decisions and their outcomes are placed into the context of such beliefs.

Ethical Question 12.8

Note that the three dimensions described in the following sections—conservative, liberal, and developmental—are portrayed in a purist fashion, implying that proponents rigidly adhere to the prescribed views. As with Democrats and Republicans, in real life, most people reflect a unique combination of these views.

12-7bConservative Perspective

Conservatives (a term derived from the verb to conserve) tend to resist change. They emphasize tradition and believe rapid change usually results in more negative than positive consequences. In economic matters, conservatives feel that the government should not interfere with the workings of the marketplace. They encourage the government to support (e.g., through tax incentives) rather than regulate business and industry. A free market economy is thought to be the best way to ensure prosperity and fulfillment of individual needs. Conservatives embrace the old adage, “That government governs best which governs least.” They believe that most government activities constitute threats to individual liberty and to the smooth functioning of the free market.

Conservatives generally view individuals as being autonomous—that is, as being self-governing. Regardless of what a person’s situation is, or what problems he or she has, each person is thought to be responsible for his or her own behavior. People are thought to choose whatever they are doing, and they therefore are viewed as being responsible for whatever gains or losses result from their choices. Conservatives view people as having free will, and thus as able to choose to engage in behaviors such as hard work that help them get ahead, or activities such as excessive leisure that contribute to failing (or being poor). Poverty and other problems are seen as being the result of laziness, irresponsibility, or lack of self-control. Conservatives believe that social welfare programs force hardworking, productive citizens to pay for the consequences of the irresponsible behavior of recipients of social welfare services.

Conservatives generally advocate the residual approach to social welfare programs (Wilensky & Lebeaux, 1965). The residual view holds that social welfare services should be provided only when an individual’s needs are not properly met through other societal institutions, primarily the family and the market economy. Social services and financial aid should not be provided until all other measures or efforts have failed and the individual’s or family’s resources are fully used up. In addition, this view asserts that funds and services should be provided on a short-term basis (primarily during emergencies) and should be withdrawn when the individual or the family again becomes capable of being self-sufficient.

The residual view has been characterized as “charity for unfortunates.” Funds and services are not seen as a right (something that one is entitled to) but as a gift, and the receiver has certain obligations; for example, in order to receive financial aid, recipients may be required to perform certain low-grade work assignments. Under the residual view, there is usually a stigma attached to receiving services or funds.

Conservatives believe that dependency is a result of personal failure, and they also believe it is natural for inequality to exist among humans. They assert that the family, religious organizations, and gainful employment should be the primary defenses against dependency. Social welfare, they believe, should be only a temporary function that is used sparingly. Prolonged social welfare assistance, they believe, will lead recipients to become permanently dependent.

Conservatives believe charity is a moral virtue and that the “fortunate” are obligated to help the “less fortunate” become productive, contributing citizens. If government funds are provided for health and social welfare services, conservatives advocate that such funding should go to private organizations, which are thought to be more effective and efficient than public agencies in providing services. Conservatives tend to believe that the federal government is not a solution to social problems but is part of the problem. They assert that federally funded social welfare programs tend to make recipients dependent on the government, rather than assisting recipients to become self-sufficient and productive.

Ethical Dilemma

Are the Poor to Blame for Being Poor?

Liberals view the family as an evolving institution, and therefore they are willing to support programs that assist emerging family forms—such as single-parent families and same-sex marriages.

12-7dDevelopmental Perspective

Liberals for years have criticized the residual approach to social welfare as being incongruent with society’s obligation to provide long-term assistance to those who have long-term health, welfare, social, and recreational needs. Conservatives, on the other hand, have been highly critical of the institutional approach as they claim it creates a welfare state in which many recipients simply become dependent on the government to meet their health, welfare, social, and recreational needs—without seeking to work and without contributing in other ways to the well-being of society. It is clear that conservatives will attempt to stop the creation of any major social program that moves the country in the direction of being a welfare society. They have the necessary legislative votes to stop the enactment of programs that are “marketed” to society as being consistent with the institutional approach.

A Peace Corps volunteer teaches a group of Costa Rican boys.

Paul Conklin/PhotoEdit

Is there a view of social welfare that can garner the support of both liberals and conservatives? Midgley (1995) contends that the  developmental view (or perspective) offers an alternative approach that appears to appeal to liberals, conservatives, and to the general public. Midgley defines this approach as a “process of planned social change designed to promote the well-being of the population as a whole in conjunction with a dynamic process of economic development” (p. 25).

This perspective has appeal to liberals because it supports the development and expansion of needed social welfare programs. The perspective has appeal to conservatives because it asserts that the development of certain social welfare programs will have a positive impact on the economy. The general public also would be apt to support the developmental perspective. Many voters oppose welfare, as they believe it causes economic problems (e.g., recipients living on the government dole, rather than contributing to society through working). Asserting and documenting that certain proposed social welfare programs will directly benefit the economy is attractive to voters.

What are the characteristics of the developmental approach? It advocates social interventions that contribute positively to economic development, thus promoting harmony between economic and social institutions. The approach regards economic progress as a vital component of social progress, and it promotes the active role of government in economic and social planning (in direct opposition to the residual approach). Finally, the developmental approach focuses on integrating economic and social development for the benefit of all members of society.

The developmental approach can be used in advocating for the expansion of a wide range of social welfare programs. It can be argued that any social program that assists a person in becoming employable contributes to the economic well-being of a society. It can also be argued that any social program that assists a person in making significant contributions to his or her family, or to his or her community, contributes to the economic well-being of a society, as functional families and functional communities are good for businesses. Members of functional families tend to be better employees, and businesses desire to locate in communities that are prospering and that have low rates of crime and other social problems.

A few examples will illustrate how the developmental approach can be used to advocate for the expansion of social welfare programs. It can be argued that job training, quality child care, and adequate health insurance will all benefit the economy because they will help unemployed single parents obtain employment. All of these programs will facilitate the parents being able to work. It can be argued that providing mentoring programs and other social services will help at-risk children stay in school and eventually contributing to society as adults by obtaining employment and contributing to their families and to the communities in which they live. It can be argued that rehabilitative programs in the criminal justice system will help correctional clients become contributing members of society. It can be argued that alcohol and drug treatment programs, nutritional programs, eating disorder intervention programs, stress management programs, and grief management programs will help people with issues in these areas to handle them better, thereby increasing the likelihood that they will become contributors to the economy and to the well-being of society.