A person's social interactions and relationship networks are often considered by psychological researchers in evaluating one's health and well being. It has been found that social support can be a very powerful variable in times of crisis or stressful life events. Many studies have shown increases in mental and physical health to be strongly related to the amount of social support available in a given situation. Nevertheless, many questions remain about the actual importance of social support due to varying opinions and controversies over the evidence that many social support researchers report. Perhaps then it is necessary to review some of the studies and their concluding data in order to evaluate the influence, if any, that social support has upon people and their health.

Much of the research done in the area of social support employs the functional approach as opposed to the structural approach. The structural approach views social networks and their effects on a broad quantitative level while the functional approach takes a more qualitative view by looking at specific functions within a particular relationship. Thus, the functional approach is more commonly used in studies that seek to discover the values of particular aspects of social support. It is commonly divided into three factors: instrumental support, informational support, and emotional support. Instrumental support provides material goods and needs. Informational support allows for more concrete facts and advice. Lastly, emotional support focuses on the expression of caring and concern. In the functional approach, a vast amount of research is focused on the emotional aspect, "reflecting the perception among the scientific and clinical communities--accurate or not--that emotional support is most important" (Helgeson & Cohen, 1996, p.138). Considering the great amount of research completed in the functional framework with a concentration on emotional aspects of social support, the studies evaluated in this discourse will also follow that framework in assessing the influence of social support on health.

Spiegel, Bloom, Kraemer, and Gottheil (1989) set out to discover the medical benefits that social support could produce. They studied women diagnosed with metastatic breast cancer who were all receiving regular oncological care. They divided the group of eighty-six women into two groups. Fifty of the women participated in a psychosocial group treatment in addition to their regular oncological care and the remainder served as the control by continuing solely with their oncological treatment. The psychosocial intervention is hypothesized to have provided the patients with additional social support as the groups facilitated discussion about and provided encouragement for coping with the cancer. The speculation here is that the group may have been an opportunity for the patients "to belong and to express feelings" and to have "an intense bonding with one another and a sense of acceptance through sharing a common dilemma" (Spiegel et al., 1989, p.890). The Spiegel et al. study illustrates the value of peer intervention groups, which are common and often studied sources of social support. It is thought that those in similar situations are able to provide each other with social support which can "meet needs that are not met by naturally occurring social environments" (Helgeson & Cohen, 1996, p.139) because they can better comprehend what each individual is going through. Groups facilitating discussion and sharing experiences are therefore thought to be helpful where other social networks, such as family and friends who have not been in similar situations, fail to be helpful and can even alienate the victim. The Spiegel et al. study results show that patients in the psychosocial group lived an average of 18.9 months longer than those who were not involved in the group intervention. This finding displays strong evidence for the beneficial influence of social support on health as it shows that social support not only improves the quality of life but also the quantity of life.

However, the effects of group interventions are controversial. Although they have been proven to be helpful, as in the Spiegel et al. study, they can often be extremely detrimental. Helgeson and Cohen discuss a variety of problems that could arise from group intervention. For example, it is possible that a patient's self-esteem could be lowered if peers do not share the same feelings or there could be an increase in anxiety and fear if a peer's health declines (Helgeson & Cohen, 1996). Another difficulty is the possibility that a forced or "artificial" intervention may not be as effective as naturally formed support networks (Helgeson & Cohen, 1996, p.145). Thus, while group discussion interventions are formed with the goal of being helpful and comforting, they are not successful in all situations.

Sometimes support is offered with the best of intentions and yet somehow the recipient finds the support unhelpful. This situation occurs commonly in crisis events, such as the loss of a loved one. Lehman, Ellard, and Wortman (1986) found that statements are often made with a helpful intent and yet the bereaved is left feeling misunderstood, as though his feelings are insignificant or unjustified. Lehman et al. hypothesized that perhaps outsiders are disillusioned to the recovery process of one who is recently bereaved and, because of their misconceptions, will often fail to offer helpful support to one in need. To test this hypothesis, Lehman, Ellard, and Wortman set up an experiment in which the bereaved could specifically assess what types of support were unfavorable and which were beneficial, while the control group (those who had not experienced great loss) evaluated which statements or actions would be appropriate to facilitate coping and which would be unsuitable. In addition, the bereaved were asked to rate their own recovery progress while the control group was asked to predict the progress of the bereaved. The results concluded that the outsiders were not actually misinformed about what is helpful support and what is considered unhelpful. In fact, the control group tended to overestimate the recovery time of the bereaved, indicating a greater sympathy and understanding than required in certain instances. All participants demonstrated acute awareness of the importance of the influence of social support and its administration. Thus, the source of helpful and unhelpful support must be deeper than a simple misconception concerning what might be beneficial to the bereaved.

The difference between what is experienced as helpful versus what is unhelpful seems to then lie in the administration of the support. Research has shown that some kinds of support are only helpful in certain conditions. Different situations call for different support; "the right kind of social support [must be given] under the right circumstances and at the right time" (Orford, 1992, p.72). For example, informational support is usually perceived as helpful only when coming from a professional source, whereas emotional support is usually readily accepted from anyone (Lehman et al., 1986). Lehman et al. also notes the possibility that some support may seem unhelpful at first and yet overtime the respondent will begin to see the beneficial intention (Lehman et al., 1986). One last possibility is that although the control group of support providers can predict helpful and unhelpful support, they cannot seem to offer it properly when in such a difficult situation. The providers are likely to be anxious and "feel confused about how to behave or what to say, and may have little past experience to guide them in this situation" (Lehman et al., 1986, p.443). Thus, the researchers in this study concluded that perhaps the providers could benefit from education on how to deal with the stress that arises during an interaction with one in need of support. They suggested that learning how to communicate concern for and understanding of which types of support are most effective and helpful would be very beneficial to the bereaved, thus furthering the idea that proper social support is a necessity in times of life crisis and is favorable in the recovery process.

This communication between the support provider and the support receiver is of key importance in studies of social support, yet very few actually explore the specifics of verbal interaction and thus ignore the "social" aspect of social support. Pistrang, Baker, and Rutter observed three couples by audio recording their conversations and exploring the "complexities of help-intended communication" (Pistrang et al., 1997, p.773). They focused particularly on what they refer to as "help-intended communication," where sometimes a comment would be made with the best intent and yet perceived incorrectly by the receiver. They were able to "examine how support attempts are delivered effectively and why sometimes they fail" (Pistrang et al., 1997, p.779) by reviewing the conversations and discussing what the intended meaning was versus what was perceived. Specific comments were selected to be discussed and analyzed extensively and meticulously after the interaction. The goal was to be able to study the interconnection of context, personal meaning, and perceived understanding within the realm of help-intended communication. The finding was that couples were able to evaluate the dialogue and point out at which junction social support was needed and expected, but perhaps not received or simply misunderstood.

Married couples are often observed in social support studies. Many researchers feel that great importance lies on the naturally occurring support networks and their ability to offer helpful social support. It is believed that such close relationships are crucial in coping with stressful life events. "Marital satisfaction is closely associated with reports of mutual understanding, communication, and gratification between martial partners" (Orford, 1992, p.68). However, Pistrang et al. show that at times this mutual understanding and strong communication can break down in that what is implied is not necessarily what is understood. It is therefore difficult to deem "helpful" and "unhelpful" support without considering the communication, the context, and the circumstances. Despite the occasional failures in communication, Pistrang et al. still maintain the importance of social support and its beneficial influence when communicated successfully.

While the evidence for social support is plagued with methodological issues concerning correlation versus causation and individual differences of opinion among researchers, the vast amount of research has shown social support to be significantly beneficial in influencing health. Though most studies possess conflicting issues and contradictory evidence, it is necessary to look globally at the overall weight of the research findings. Each of the studies discussed above has shown how interpersonal relationships and communication of social support links to one's health. Thus, despite the ongoing and perhaps inevitable controversies over the conceptualization of and research experimentation methods for studying social support, "the evidence for its link with health is generally considered to be strong" and "the breadth and consistency of the research and beneficial effects of social support are impressive" (Orford, 1992, p.74-75). One's health and well being is, at least in part, determined by the support received by one's social networks and interpersonal relations.

Elizabeth Franklin ('99) is a Psychology major.

Helgeson, V.S., & Cohen, S. (1996). Social support and adjustment to cancer: reconciling descriptive, correlational, and intervention research. Health Psychology, 15, 135-148.

Lehman, D.R., Ellard, J.H. & Wortman C.B. (1986). Social support for the bereaved: recipients' and providers' perspectives on what is helpful. Journal of Consulting and Clinical Psychology, 53, 438-446.

Orford, J. (1992). Community Psychology: Theory and Practice. Chichester: Wiley.

Pistrang, N., Baker, C. & Rutter, C. (1997). Social support as conversation: analyzing breast cancer patients' interactions with their partners. Social Science and Medicine, 45, 773-782.

Spiegel, D., Bloom, J.R., Kraemer, H.C. & Gottheil, E. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. The Lancet, 2, 888-891.