Dimensions of Human Behavior

Elizabeth D. Hutchison

Leanne Wood Charlesworth

Dimensions of Human Behavior
Person and Environment

Seventh Edition

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Dimensions of Human Behavior

Person and Environment

Seventh Edition

Elizabeth D. Hutchison
Emeritus
Virginia Commonwealth University
Leanne Wood Charlesworth
Nazareth College

and contributing authors

Copyright © 2025 by Sage.

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Library of Congress Cataloging-in-Publication Data

Names: Hutchison, Elizabeth D., author. | Charlesworth, Leanne

Wood, author.

Title: Dimensions of human behavior: person and environment /

Elizabeth D. Hutchison, Emeritus, Virginia Commonwealth University,
Leanne Wood Charlesworth, Nazareth University and contributing
authors.

Description: Seventh Edition. | Thousand Oaks, California: SAGE,

[2024] | Revised edition of Dimensions of human behavior, [2019] |
Includes bibliographical references and index.

Identifiers: LCCN 2023042525 | ISBN 9781071831458 (paperback) |

ISBN 9781071831519 (epub)

Subjects: LCSH: Social psychology. | Human behavior. | Social

structure. | Social service.

Classification: LCC HM1033.D56 2024 | DDC 302–

dc23/eng/20231026

LC record available at https://lccn.loc.gov/2023042525

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Marketing Manager: Jennifer Haldeman

Brief Contents

1. Case Studies
2. Preface
3. Acknowledgments
4. About the Editors
5. About the Contributors
6. About the Case Study Contributors

7. Part I A Multidimensional Approach for Multifaceted Social Work

1. Chapter 1 Human Behavior: A Multidimensional Approach

2. Chapter 2 Theoretical Perspectives on Human Behavior

8. Part II The Multiple Dimensions of Person

1. Chapter 3 The Biological Person

2. Chapter 4 The Psychological Person: Cognition, Emotion,
Personality, and Self
3. Chapter 5 The Psychosocial Person: Relationships, Stress,
and Coping
4. Chapter 6 The Spiritual Person

9. Part III The Multiple Dimensions of Environment

1. Chapter 7 The Physical Environment

2. Chapter 8 Cultures
 3. Chapter 9 Social Structure and Social Institutions: Global
and National
4. Chapter 10 Families
5. Chapter 11 Small Groups
6. Chapter 12 Organizations
7. Chapter 13 Communities
8. Chapter 14 Social Movements
10. Glossary
11. References
12. Index

Detailed Contents

1. Case Studies
2. Preface
3. Acknowledgments
4. About the Editors
5. About the Contributors
6. About the Case Study Contributors

7. Part I A Multidimensional Approach for Multifaceted Social Work

1. Chapter 1 Human Behavior: A Multidimensional Approach

1. A Case Study About Person and Environment

1. Case Study 1.1: Joshua, Making a New Life

2. Human Behavior: Individual and Collective

1. Organization of Book

3. A Multidimensional Approach

1. Personal Dimensions
2. Environmental Dimensions
3. Time Dimensions
 4. Advancing Human Rights and Social, Racial, Economic,
and Environmental Justice: A Global Perspective

1. Human Rights and Social, Racial, Economic, and

Environmental Justice
2. Anti-oppressive and Anti-racist Practice
3. Diversity
4. Equity and Social Inclusion

5. Knowing and Doing

1. Knowledge About the Case

2. Knowledge About the Self
3. Values and Ethics

6. Scientific Knowledge: Theory and Research

1. Theory
2. Empirical Research
3. Critical Use of Theory and Research
7. Implications for Social Work Practice
8. Key Terms
9. Active Learning

2. Chapter 2 Theoretical Perspectives on Human Behavior

1. A Case Study About Human Behavior Theory

1. Case Study 2.1: COVID-19 in the Family

2. Multiple Theoretical Perspectives for a Multidimensional

Approach

1. Systems Perspective

1. Critical Analysis of the Systems Perspective

2. Critical Perspective
 1. Critical Analysis of the Critical Perspective

3. Social Constructionist Perspective

1. Critical Analysis of the Social Constructionist

Perspective

4. Psychodynamic Perspective

1. Critical Analysis of the Psychodynamic

Perspective

5. Developmental Perspective

1. Critical Analysis of the Developmental

Perspective

6. Learning Perspective

1. Critical Analysis of the Learning Perspective

7. Humanistic-Existential Perspective

1. Critical Analysis of the Humanistic-Existential

Perspective
3. The Merits of Multiple Perspectives
4. Implications for Social Work Practice
5. Key Terms
6. Active Learning

8. Part II The Multiple Dimensions of Person

1. Chapter 3 The Biological Person

1. Six Case Studies of the Biological Person

1. Case Study 3.1: Cheryl’s Legs and Head

2. Case Study 3.2: A Diabetes Diagnosis for Jenna
3. Case Study 3.3: Shay and Terry
 4. Case Study 3.4: HIV: Thomas’s Hero
5. Case Study 3.5: Louise and Huntington’s and
Stewart’s Obesity and Cardiovascular Disease
6. Case Study 3.6: Juan and Belinda’s Sexual Life in
Retirement
2. An Integrative Approach for Understanding the
Intersection of Interior (Proximal) Biological Health and
Illness and Exterior (Distal) Environmental Factors

3. Systems Taxonomy: Six Interior (Proximal) Environment

Systems

1. Nervous System
2. Endocrine System
3. Immune System
4. Cardiovascular System
5. Musculoskeletal System
6. Reproductive System
4. Interactions of Exterior (Distal) Environments and
Interior (Proximal) Health Environment
5. Implications for Social Work Practice
6. Key Terms
7. Active Learning

2. Chapter 4 The Psychological Person: Cognition, Emotion,

Personality, and Self

1. Two Case Studies of Cognition, Emotion, Personality,

and Self

1. Case Study 4.1: Janna Smith, Unemployed and

Worried
2. Case Study 4.2: Charles Miller, Making a New Start
2. Cognition, Emotion, Personality, and Self: An
Introduction

3. Theories of Cognition
 1. Piaget’s (Stage) Theory of Cognitive Development
2. Information Processing Framework
3. Bandura’s Social Learning/Social Cognitive Theory
4. Gardner’s Theory of Multiple Intelligences
5. Salovey and Mayer’s Theory of Emotional
Intelligence
6. Theories of Moral Development and Reasoning

4. Theories of Emotion

1. Noncognitive Physiological Theories of Emotion

1. James and Lange Theories of Emotion

2. Cannon-Bard Theory of Emotion
3. Izard’s Differential Emotions Theory (DET)
4. Davidson’s Theory of Six Emotional
Dimensions

2. Cognitive Theories of Emotion

1. The Schachter-Singer Two-Factor Theory of

Emotion
2. Lazarus’s Cognitive Appraisal Theory of
Emotion
3. Weiner’s Attribution Framework of the
Emotional Process
4. LeDoux and Brown’s Higher-Order Theory of
Emotional Consciousness
5. Connection of Positive Emotions and Affect
With Happiness and Well-Being

5. Theories of Personality

1. Trait Perspectives of Personality

2. Cognitive-Affective Theories of Personality
3. Pancha Kosha Theory of Personality: An Eastern-
Based Theory
 4. Biological Influences on Personality and Mental
Illness
6. Theories of the Self

7. Cognitions, Emotions, Personality, Self, and Evidence-

Supported Interventions (ESIs)

1. Shapiro’s Eye Movement Desensitization and

Reprocessing (EMDR)
2. Beck’s Cognitive-Behavior Therapy (CBT)
3. Linehan’s Dialectical Behavior Therapy (DBT)
8. Implications for Social Work Practice
9. Key Terms
10. Active Learning

3. Chapter 5 The Psychosocial Person: Relationships, Stress,

and Coping

1. A Case Study About the Psychosocial Person

1. Case Study 5.1: Dan’s Dilemma

2. The Self in Relationships and Relationships in the Self

1. Relational and Intersubjective Theories

2. Attachment Theory

1. Impact of Early Nurturing on Development

3. Feminist Theories of Relationships
4. Social Identity Theory

3. The Concept of Stress

1. Categories of Stress
2. Stress and Crisis
3. Traumatic Stress

4. Coping Processes
 1. Biological Coping Processes
2. Psychological Coping Processes

3. Social Coping Processes

1. The Nature of Social Support

2. Virtual Support
3. How Social Support Aids in Coping
4. How Social Workers Evaluate Social Support
4. Spiritual or Religious Coping Processes
5. Coping and Traumatic Stress

5. Perspectives on Coping

1. Medical (Psychiatric) Perspective

2. Psychological Perspective
3. Sociological Perspective
4. Anthropological Perspective
5. Public Health Perspective
6. Social Work Perspective
6. Implications for Social Work Practice
7. Key Terms
8. Active Learning

4. Chapter 6 The Spiritual Person

1. Eight Case Studies of Spirituality and Religion

1. Case Study 6.1: Caroline’s Challenging Questions

2. Case Study 6.2: Naomi’s Health Crisis
3. Case Study 6.3: Matthew’s Faith Journey
4. Case Study 6.4: Trudy’s Search for the Sacred
5. Case Study 6.5: Leon’s Two Worlds
6. Case Study 6.6: Jean-Joseph’s Serving the Spirits
7. Case Study 6.7: Amira’s Quest for Self
8. Case Study 6.8: Beth’s Framework for Living

2. The Spiritual Dimension

 1. The Meaning of Spirituality
2. Spirituality in the United States and Globally

3. Theories of Spiritual Development

1. Fowler’s Stages of Faith Development

2. Transpersonal Theories

4. The Role of Spirituality in Social Work

1. Developments in the Profession

2. Spirituality and Human Diversity

1. Race and Ethnicity

2. Sex and Gender
3. Sexual Orientation and Gender Identity
4. Disability
5. Age
3. Spiritually Sensitive Social Work Practice

4. Assessment

1. Micro, Mezzo, and Macro Social Work Practice

5. Implications for Social Work Practice
6. Key Terms
7. Active Learning

9. Part III The Multiple Dimensions of Environment

1. Chapter 7 The Physical Environment

1. Two Case Studies of Human Behavior and the Physical

Environment

1. Case Study 7.1: Ben Watson’s Experience With

Accessible and Inaccessible Environments
2. Case Study 7.2: Shanthi’s Need for Healthy
Affordable Housing in Chennai, India
 2. Theories of Human Behavior and the Physical
Environment

1. Theories of Place
2. Theories of Spatial Behavior
3. Behavior Settings Theories

3. The Natural Environment

1. Positive and Negative Effects of Human Interaction

with the Natural Environment
2. Natural Disasters and Human Behavior

4. The Built Environment

1. Housing

1. Houselessness
2. Race-Based Housing Segregation and Racial
Health Disparities
2. Technology
3. Healing Environments
4. Inclusion, Diversity, Equity, and Accessibility in Built
Environments
5. Ecological Justice, Sustainability, and Environmental
Justice: A Social-Racial-Economic-Ecological Justice
Perspective
6. Implications for Social Work Practice
7. Key Terms
8. Active Learning

2. Chapter 8 Cultures

1. A Case Study About Cultures

1. Case Study 8.1: Rubina, Living Across Cultures

2. What Is Culture?

3. Theories of Culture
 1. Materialist Perspective
2. Mentalist Perspective
3. Other Theoretical Perspectives

4. Major Concepts in the Study of Culture

1. Values
2. Beliefs
3. Symbols
4. Language
5. Norms
6. Subcultures and Countercultures
7. Ideal Culture Versus Real Culture
8. Ethnocentrism and Cultural Relativism

5. Culture and Power

1. Race
2. Ethnicity
3. Gender
4. Sexuality
5. Social Class
6. Disability

6. Genes, Culture, and Cultural Change

1. Coevolution of Genes, Culture, and Behavior

2. Cultural Change
7. Implications for Social Work Practice
8. Key Terms
9. Active Learning

3. Chapter 9 Social Structure and Social Institutions: Global

and National

1. A Case Study About Social Structure and Social

Institutions
 1. Case Study 9.1: Osvaldo Jimenez, Finding His Way
as an Undocumented Student in the United States
2. Patterns of Social Life
3. Patterns of Inequality in Social Life

4. Contemporary Trends in Global and U.S. Social

Institutions

1. Trends in the Government and Political Institution

2. Trends in the Economic Institution
3. Trends in the Educational Institution
4. Trends in the Health Institution
5. Trends in the Mass Media Institution
6. Trends in the Social Welfare Institution
7. Trends in the Religious Institution
8. Trends in the Family and Kinship Institution
5. Diversity, Equity, and Inclusion in Social Institutions
6. Implications for Social Work Practice
7. Key Terms
8. Active Learning

4. Chapter 10 Families

1. A Case Study About Family

1. Case Study 10.1: The Sharpe Family Adapts

2. What Is a Family?

3. Theoretical Perspectives for Understanding Families

1. Family Systems Perspective

2. Exchange and Choice Perspective on Families
3. Symbolic Interaction Perspective on Families
4. Intersectionality Perspective on Families
5. Life Course Perspective on Families
6. Family Stress Perspective

4. Diversity in Family Formation and Structure

 1. Family Formation
2. Multigenerational and Nuclear Family Households
3. Single-Parent Families
4. Childless Couples
5. Repartnered Families
6. Adoptive and Foster Families

5. Challenges to Family Life

1. Economic Hardship
2. Racialized Bias and Discrimination
3. Anti-LGBTQ+ Bias and Discrimination
4. Migration
5. Domestic and Family Violence
6. Divorce and Cohabitation Dissolution
7. Problematic Substance Use
6. Implications for Social Work Practice
7. Key Terms
8. Active Learning

5. Chapter 11 Small Groups

1. A Case Study About Small Groups

1. Case Study 11.1: The Sexuality and Gender Group

at a Women’s Residential Substance Abuse
Treatment Facility

2. Small Groups in Social Work

1. Therapy Groups
2. Mutual Aid Groups
3. Psychoeducational Groups
4. Self-Help Groups
5. Task Groups
6. Technology-Facilitated Groups
3. Dimensions of Group Structure

4. Group Composition
 1. Heterogeneity Versus Homogeneity
2. Social Justice Issues in Social Work Groups

5. Basic Group Processes

1. Theories of Group Processes

1. Psychodynamic Theory
2. Symbolic Interaction Theory
3. Status Characteristics and Expectation States
Theories
4. Exchange Theory
5. Self-Categorization Theory

2. Group Development

1. Stage Theories and Models

2. Process Models

3. Group Dynamics

1. Formal and Informal Leadership

2. Formal and Informal Roles
3. Communication Networks
4. Group Cohesiveness

6. Interdisciplinary Teams and Leadership

1. Interdisciplinary Teams and Social Work

2. Social Work Leadership
7. Implications for Social Work Practice
8. Key Terms
9. Active Learning

6. Chapter 12 Organizations

1. A Case Study About Organizations

 1. Case Study 12.1: Changing Leadership, Changing
Times at Beacon Center

2. Organizations: An Introduction

1. Ubiquitous Across the Human Life Course

2. Formal and Informal Features of Organizations

3. Theoretical Perspectives on Organizations

1. Demographic Perspective

1. Theories of Internal Organizational

Demography
2. Organizational Ecology: A Macro Demographic
Theory

2. Relational Perspective

1. Resource Dependence Theory

2. Social Capital Theory
3. Social Network Theory

3. Cultural Perspective

1. National Culture Approach

2. Institutional Approach
3. Diversity and Inclusion Approach
4. Organizational Culture Interacting With
Organizational Learning Approaches

4. Impact of Organizations on Society

1. Burnout: A Negative Organizational Outcome

5. Human Service Organizations

1. Leadership in Human Service Organizations

6. Implications for Social Work Practice
 7. Key Terms
8. Active Learning

7. Chapter 13 Communities

1. Three Case Studies of Community

1. Case Study 13.1: Creating Community on Wood

Street, Oakland, California
2. Case Study 13.2: A Rural West Virginia Community
Struggling to Recover
3. Case Study 13.3: The Korean Parents’ Network for
People with Disabilities (KPNPD)

2. Communities: An Introduction

1. What Is Community?
2. Geographical and Relational Communities

3. Theoretical Approaches to Community

1. Ecological Approach

2. Relational Approach

1. Social Capital and Social Network Theories

2. Sense of Community Theory
3. Cultural Approach
4. Critical Approach
4. Social Work and Communities
5. Issues and Themes in Community Practice
6. Implications for Social Work Practice
7. Key Terms
8. Active Learning

8. Chapter 14 Social Movements

1. A Case Study About a Social Movement

 1. Case Study 14.1: Fighting for Our Water, Land, and
Air

2. Social Movements: An Introduction

1. Movements on the Left and Right

2. Movement–Countermovement Interactions

3. Theoretical Perspectives on Social Movements

1. Mobilizing Structures Perspective

1. Informal and Formal Structures

2. Information and Communication Technology
(ICT)

2. Cultural Framing Perspective

1. Diagnostic Framing
2. Prognostic Framing
3. Motivational Framing

3. Political Process Perspective

1. Political Opportunities
2. Political Threats

4. Emerging Perspectives

1. The Role of Emotions in Social Movement

Mobilization
2. The Intersectionality Approach

4. Social Movement Trajectories and Outcomes

1. Social Movement Trajectories

2. Social Movement Outcomes
5. Social Work and Social Movements
6. Implications for Social Work Practice
 7. Key Terms
8. Active Learning
10. Glossary
11. References
12. Index

Case Studies
Preface
The first edition of this book was published 25 years ago, but the
work on it began several years before that. Much has happened in
the world and in our understanding of human behavior since then. As
we did the research for this seventh edition, we were struck by the
momentous changes in the multidisciplinary research on human
behavior that have occurred since the confluence of the COVID-19
pandemic and the international transmission of the video of George
Floyd’s murder by Minneapolis police in 2020. Other increasingly
important themes in human behavior theory and research include the
continuing effects of colonialism on both colonized and colonizing
people, intersecting systems of identity and oppression, and the
important role that non-human elements play in human behavior.
Most chapters of the book have been substantially revised since the
sixth edition as we tried to integrate and synthesize these evolving
themes.

Whatever roles we play or settings in which we work, human behavior

is the focus of the practice of social work. Sometimes we concentrate
on individual behavior; other times the attention is on behavior in
families, groups, communities, organizations, social institutions,
societies, or some other configuration of relationships. We wrote this
book because we think all social work practice should be grounded in
the best scientific understanding of human behavior. The more we
learn about human behavior, the more complex it appears and the
more we recognize it as dynamic, not static, and influenced by many
factors. Scientific knowledge about human behavior will always be
partial, never complete or final. In addition, published research
always lags behind human experience. Even as this book goes to
press, new evidence will appear to contradict or expand upon what is
reported here. You are a part of the evolving story of human behavior.
We hope this book will inspire you to continue to learn about this
story. Social work practice involves ongoing learning, unlearning, and
relearning.

About This Book

This book uses social work’s time-honored person-in-environment
approach to develop understanding of human behavior, recognizing
that aspects of persons and environments are totally intertwined with
each other. Consistent with contemporary behavioral science theory
and research, we present human behavior as multidimensional. As
with the first six editions of the book, we identify relevant dimensions
of both person and environment and present up-to-date theory and
research about each of these dimensions, integrating material that
demonstrates how the dimensions are totally intertwined.

The same 12 dimensions of person and environment are used in this

book that were presented in the previous six editions, but the theory
and research about each dimension has changed over time,
remarkably so since the sixth edition. During the work to produce the
first edition, we received feedback that some dimensions covered in
the book were not essential knowledge for social workers; more
specifically, the need for chapters on the biological person, spiritual
person, physical environment, social structure and social institutions,
and social movements was questioned. More recently, we have not
received that feedback as often. The embeddedness of biological
processes in all of human behavior is now accepted across
behavioral science disciplines. Spirituality and religion are recognized
as important, even central, to the lives of many people. We could not
begin to fulfill the recently articulated social work commitment to
environmental justice without a solid understanding of interactions of
humans with the physical environment. Commitment to social, racial,
economic, and environmental justice requires an understanding of
institutional racism and oppression, marginalization, and social
exclusion. Theory and research about social movements are
essential to help social workers navigate this commitment to justice in
a neoliberal era that emphasizes austerity, privatization, shrinking of
the social welfare system, limited government, and individual
solutions for societal problems.

Council on Social Work Education Nine Core Competencies

We have included material throughout the chapters in this book to
assist readers to develop the nine core social work competencies
identified by the Council on Social Work Education (CSWE) in its
2022 Educational Policy and Accreditation Standards. Material is
presented throughout the book to assist the reader to engage in
personal reflection related to personal biases and social work values.
The critical thinking questions presented in each chapter further
assist in ongoing critical examination of personal biases, conceptual
frameworks, and empirical research. Issues of human rights and
social, racial, economic, and environmental justice are emphasized
throughout the book, as are issues of racism, oppression, diversity,
equity, and inclusion. All chapters present multidisciplinary and
interprofessional research findings about human behavior that can be
used to improve practice, policy, and programs. A number of chapters
include material on relevant social policies, using social justice, anti-
racist, and anti-oppressive lenses to analyze historical, social, racial,
cultural, economic, and global influences on policy development.
Theories of human behavior are a major focus of the book and are
covered in every chapter. Each chapter includes practice principles
for applying knowledge about human behavior for engagement,
assessment, intervention, and evaluation, but evaluation of practice
receives scant attention in the book. The multidisciplinary and
interprofessional theoretical content includes theories of individual
behavior, as well as theories of families, small groups, communities,
organizations, social institutions, and social movements.

The following grid provides selected examples of coverage of CSWE

competencies in the book:
Breadth and Depth

When Lib Hutchison was engaged in MSW study during the turbulent
late 1960s, some students were rebelling about the use of a singular
human behavior theory—Erikson’s psychosocial theory—for what
was called the Human Growth and Development (HG&D) curriculum.
The students argued that this use of a singular theory was not
sufficient to understand what was happening in the world being
changed by the civil rights, student, and anti-war protest movements
of the 1960s. A day was set aside to discuss the HG&D curriculum,
and the question was raised should the curriculum be deep or wide.
Lib’s answer to the question was “yes.” Social workers need an
understanding of human behavior that is both deep and wide, but it is
a daunting task to develop such a knowledge base. Knowledge about
human behavior is spread across a number of disciplines and
encompasses a number of conceptual frameworks. Social work’s
knowledge of human behavior must be multidisciplinary and
multitheoretical.

We have tried to present a book that is both wide and deep in its
study of human behavior. Width of knowledge is essential because of
the many types of settings in which social workers work; if we have a
narrow band of knowledge, no matter how impressive it is in depth,
we will understand the practice situations we encounter from this
perspective. When we have a wide understanding of the complexity
of human behavior, we can continue to add depth to that
understanding to fit the situations we encounter.

General Knowledge and Unique Situations

The purpose of the behavioral sciences is to help us understand

general patterns in person–environment transactions. The purpose of
social work assessment is to understand unique configurations of
person and environment dimensions. Social workers must interweave
what they know about unique situations with general scientific
knowledge. To assist you in this process, we begin each chapter with
one or more case studies, which we then interweave with
contemporary theory and research. Most of the case studies change
some elements of the stories to protect the confidentiality of the
people involved.

In some chapters, one case study is used to demonstrate how the

same situation can be looked at from multiple perspectives. In other
chapters, multiple case studies are presented to invite the reader to
begin to engage with the diversity represented in personal and
environmental dimensions. In this edition, we have continued to
expand the representation of human diversity and intersecting
systems of privilege and oppression in the case studies. Two
international case studies have been added.

New in This Edition

The book continues to be organized as it was in the first edition, in

three parts: Part I includes two introductory chapters, Part II includes
four chapters about dimensions of the person, and Part III includes
eight chapters on environmental dimensions. Instructors will find
extensive updating in all chapters and substantial revision in a
number of chapters. The more substantial overall revisions for this
edition include the following:

A more critical conceptual approach is taken throughout the

book, with more attention to themes of justice and injustice,
racism and other forms of oppression, marginalization, and social
exclusion.
The impact of the COVID-19 pandemic on individuals and social
systems receives attention throughout the book.
Non-human elements of ecological systems receive greater
attention in a number of chapters.
Some exhibits have been updated and new exhibits are added in
most chapters.
Eight new case studies have been added, and four have been
updated to reflect contemporary issues.

Major chapter by chapter revisions include:

Chapter 1: Human Behavior: A Multidimensional Approach. The
discussion of human rights and social, racial, economic, and
environmental justice; anti-oppressive and anti-racist practice;
and diversity, equity and inclusion is expanded. Four new
exhibits are presented.
Chapter 2: Theoretical Perspectives on Human Behavior. A new
case study is introduced. There is some reorganization of
theoretical perspectives, with seven presented instead of the
eight that appeared in the sixth edition. Systems, social
constructionist, psychodynamic, and developmental perspectives
continue to be discussed. The critical perspective replaces the
conflict perspective. The exchange and choice perspective no
longer appears, but some of the content is included with the
discussion of the learning perspective. The learning perspective
replaces the behavioral perspective with much more attention to
cognitive theories. The humanistic-existential perspective
replaces the humanistic perspective with more attention to
existential approaches. The revised chapter emphasizes the way
that multiple theoretical perspectives have become more critical
over time. A more focused critical analysis of each perspective is
included. New visual metaphors are used to represent the
theoretical perspectives.
Chapter 3: The Biological Person. One new case study is
introduced. The revision expands on the interconnectedness of
all elements of the body and surroundings. Transhumanism and
posthumanism conceptual frameworks are added.
Chapter 4: The Psychological Person: Cognition, Emotion,
Personality, and Self. The chapter has been completely rewritten.
Two new case studies are introduced. A number of new theories
of cognition and emotion are presented. Theories of personality
are introduced. Three evidence-supported interventions are
overviewed. The revised chapter includes Eastern and well as
Western ways of thinking about self and personality. Ten new
exhibits are presented.
Chapter 5: The Psychosocial Person: Relationships, Stress, and
Coping. Discussion of social coping processes and spiritual or
religious coping processes are added. Anthropological and public
health perspectives are added to the discussion of perspectives
on coping. One new exhibit is presented.
Chapter 6: The Spiritual Person. The discussion of theories of
spiritual development is shortened. The discussion of spirituality
and human diversity becomes a more central part of the chapter
and is presented in greater depth and in a more critical
framework. Disability and age are added to the discussion of
human diversity. The discussion of spiritually sensitive social
work has been reorganized. Seven new or revised exhibits are
presented.
Chapter 7: The Physical Environment. A new case study of
housing insecurity in India is introduced. The discussion of
theories of human behavior and the physical environment is
reorganized, with three types of theories analyzed: theories of
place, theories of spatial behavior, and behavior settings
theories. A section on natural disasters is added to the
discussion of the natural environment. Two sections are added to
the discussion of the built environment: (1) a section on housing,
including historical discussion of race-based housing
segregation, and (2) inclusion, diversity, equity, and accessibility
in the built environment. A section on ecological justice,
sustainability, and environmental justice is added from the critical
perspective of social-racial-economic-ecological justice. Seven
new exhibits are presented, and one is updated.
Chapter 8: Cultures. Colonialism theories of culture are
introduced in the discussion of theories of culture, and discussion
of Indigenous cultures is expanded. The discussion of symbols
emphasizes an intersectional approach. The discussion of the
role of culture in social and economic inequality is expanded.
New discussion of the role of ableism in disempowering disabled
people is introduced.
Chapter 9: Social Structure and Social Institutions: Global and
National. A new case study is introduced. Exhibits are updated to
reflect new data. A revised section on patterns of inequality in
social life is added. The impact of the COVID-19 pandemic on
the major social institutions is analyzed. Greater attention is paid
to the public health system in the discussion of the health
institution. The current international focus on social protection is
emphasized in the analysis of the social welfare institution. A
section on diversity, equity, and inclusion in social institutions is
added.
Chapter 10: Families. An intersectionality perspective on families
replaces the feminist perspective in the discussion of theoretical
perspectives on families. The section on diversity in family
structures has been reorganized, and sections on family
formation and adoptive and foster families are added. The
section on challenges to family life has been reorganized and
greatly revised, with new sections on economic hardship,
racialized bias and discrimination, anti-LGBTQ+ bias and
discrimination, and migration.
Chapter 11: Small Groups. Discussion of a conceptual framework
for social justice and small groups is added.
Chapter 12: Organizations. The case study is updated to
demonstrate how one human service organization managed the
COVID-19 pandemic. New attention is paid to informal features
of organizations. The section on theoretical perspectives on
organizations is completely revised in keeping with recent
developments in the field. The theoretical perspectives are now
categorized as demographic, relational, and cultural. This new
categorization demonstrates growing attention to organizational
culture and to inclusion and exclusion in organizational life. A
section on the impact of organizations on society is added. A
section on human service organizations is added, with an
emphasis on the impact of neoliberalism on human service
organizations. Eight new exhibits are added.
Chapter 13: Communities. Two new case studies are added,
including an international case study from South Korea. The
section on theoretical approaches to community has been
completely revised, with new categories of ecological approach,
relational approach, cultural approach, and critical approach. The
section on social work and communities has been completely
revised as has the section on issues and themes in community
practice. Four new exhibits are added.
 Chapter 14: Social Movements. The case study is updated and
reflects a more global approach. New content on social
movements on the right and movement–countermovement
interactions are added to reflect new trends in the social
movement literature. The sections on the mobilizing structures
and the political process perspectives are reorganized to reflect
trends in research. A discussion of the emerging intersectionality
approach to social movements is added. A section on social
movement trajectories and outcomes is added. The section on
social work and social movements is revised to propose a model
for developing critical consciousness for social work activism.
Four new exhibits are added.

A Word About Diversity Language

In their study of human diversity, human behavior researchers

continuously struggle to find respectful language to define different
identity groups. You have probably noticed that the language used to
describe identity groups is ever-changing and that not every member
of a given identity group embraces the same language at a given
point in time. There are personal, generational, regional, and other
types of variations in preferred diversity language. We have also
found that different researchers define and measure identity groups in
different ways—and the U.S. Census Bureau uses its own,
sometimes peculiar, language to describe and measure identity
groups. In this book, when we report on human behavior research,
we use the language of the researcher so as not to distort their work.
Likewise, when we report on census data or research based on
census data, we use the language of the Census Bureau. That
means that different terms are used at different points to describe the
same identity group.

Throughout the text, we adhere to a style guide to support the latest

recommendations from the seventh edition of the Publication Manual
of the American Psychological Association—among other copyediting
style manuals—regarding bias-free language. Style guides are meant
to be updated over time in order to react to changes in our
communities, academia, and our sensibilities. In consideration of this,
we recognize that they are not ever set in stone and continue to
evolve.

One Last Word

Learning about human behavior is a lifelong process. We hope that

this book gives you a good base for your ongoing learning about
human behavior and the many possibilities for social work action. You
can help us in our learning process by letting us know what you liked
or didn’t like about the book.

Elizabeth D. Hutchison

Reno, Nevada

[email protected]

Leanne Wood Charlesworth

Nazareth University

[email protected]

Acknowledgments
A project like this book is never completed without the support and
assistance of many people. A seventh edition stands on the back of
the first six editions, and over the years a large number of people
have helped to keep this project going. We are grateful to all of them,
some of them known to us and others working behind the scenes.

Steve Rutter, former publisher and president of Pine Forge Press,

shepherded every step of the first edition and provided ideas for
many of the best features of the second edition, which are carried
forward in the third, fourth, fifth, sixth, and seventh editions. Along
with Paul O’Connell, Becky Smith, and Maria Zuniga, he helped to
refine the outline for the second edition, and that outline continues to
be used in this book. Becky Smith worked as a developmental editor
for the first two editions and taught us so much about writing and
readers. Kassie Graves provided disciplined and creative editorial
assistance from 2006 to 2016, for the third, fourth, and fifth editions of
this book. We are grateful for the assistance Dr. Maria E. Zuniga
offered during the drafting of the second edition. She provided many
valuable suggestions for how to improve the coverage of cultural
diversity in each chapter. Her suggestions improved the second
edition immensely and have stayed with us as lasting lessons about
human behavior in a multicultural society.

For this edition, we are happy to be working with the talented,

professional, and supportive team at Sage. Megan O’Heffernan has
been a smart, dedicated, kind, and supportive content development
editor, who kept us on track and was quick to respond to our
questions. We are happy to be working with Megan again. Terri Lee
Paulsen has been the copy editor, making the words flow better and
catching the reference mistakes. She is a delight to work with.
Veronica Stapleton Hooper joined the seventh edition as production
editor, the person who turns words and ideas into a beautiful and
inviting book. Gail Buschman served as cover designer, and Jennifer
Haldeman as marketing manager. Many more people at Sage have
worked behind the scenes to help us complete this project. Three we
know of are Adeline Grout, Eve Oettinger, and Lara Parra. We wish
we could thank the whole Sage team by name.

We are grateful once again to work with a fine group of contributing

authors, including some new ones who have come on board to help
with this seventh edition. What a great addition they have been! The
contributing authors were gracious about timelines and incorporating
ideas from the editors. Most important, they were committed to
providing a state-of-the-art knowledge base for understanding the
multiple dimensions of human behavior for use in social work
practice. We are also grateful for collaborators who have provided
rich case studies for Chapters 1, 7, 8, 9, and 13.
The students we have taught over the years deserve a special note of
gratitude. They have provided helpful feedback about what worked
and didn’t work with the book and pushed us to be more inclusive in
language and content. Many things we have learned from them show
up in the pages of this book. Lib Hutchison is grateful to former
student Leanne Wood Charlesworth for joining the work on this
seventh edition. The book has benefitted greatly from her ideas and
contributions.

Our deepest gratitude goes to our families, who have supported us as

we worked to bring this project to fruition. We appreciate the
patience, love, and support.

The editors and Sage would like to thank the following reviewers for
their in-depth feedback, which was invaluable in guiding the revision
of this edition:

Emily Greenfield, Rutgers University

Agnieszka Halarewicz, Hunter College, City University of New York

About the Editors

Elizabeth D. Hutchison

Elizabeth D. Hutchison received her MSW from the George

Warren Brown School of Social Work at Washington University in
St. Louis and her PhD from the University at Albany, State
University of New York. She was on the faculty in the social work
department at Elms College from 1980 to 1987 and was chair of
the department from 1982 to 1987. She was on the faculty in the
School of Social Work at Virginia Commonwealth University from
1987 to 2009, where she taught courses in human behavior and
the social environment, social work and social justice, and child
and family policy; she also served as field practicum liaison. She
has been a social worker in health, mental health, aging, and
child and family welfare settings and engaged in volunteer work
with incarcerated women and environmental justice for farm
workers in the Coachella Valley of California. She is committed to
providing social workers with comprehensive, current, and useful
frameworks for thinking about human behavior. Her other
research interests focus on child and family welfare. She lives in
Reno, Nevada, where she enjoys hiking around Lake Tahoe and
being a hands-on grandmother to two humans and one dog. She
collaborates with the Unitarian Universalist Fellowship of
Northern Nevada on local social, racial, economic, and
environmental justice issues.

Leanne Wood Charlesworth

Leanne Wood Charlesworth received her MSW from the

University at Albany and PhD from the School of Social Work at
Virginia Commonwealth University. She began her career as a
 social worker in the child welfare systems in Washington, DC,
and Virginia. After obtaining her PhD, she worked in the research
and evaluation field in Baltimore. In 2003, she joined the
Nazareth College Department of Social Work in Rochester, New
York, as a full-time faculty member, teaching human behavior
and the social environment, research methods, introduction to
social work, field seminar, and an elective on secondary trauma
and self-care. She also began collaborating with the local
homeless services provider network on a variety of initiatives,
including a Photovoice project and the local annual Project
Homeless Connect. More recently, she has taken on the roles of
BSW program director and department chair.

About the Contributors

Linwood Cousins

Linwood Cousins, MSW, MA, PhD, is professor emeritus in the

School of Social Work at Western Michigan University. He is a
social worker and an anthropologist who practiced in child
welfare and family and community services. His research,
teaching, and practice interests focused on the sociocultural
manifestations of race, ethnicity, and social class as well as other
aspects of human diversity in the community life and schooling of
African Americans and other ethnic and economic minorities.

Elizabeth P. Cramer

Elizabeth P. Cramer, PhD, LCSW, ACSW, is professor in the

Virginia Commonwealth University School of Social Work, where
she teaches courses in direct practice; power, privilege, and
oppression; interpersonal violence; and a doctoral level course
on social work education and teaching. She approaches her
teaching from a trauma-informed lens and incorporates mutuality,
kindness, and universal design in her courses. Her primary
research/scholarship areas are abuse of people with disabilities
and abuse prevention programs for teens and for people with
disabilities. She is the principal investigator of the I-CAN!
Accessibility Project, funded by the Virginia Department of
Criminal Justice Services, whose mission is to promote
awareness about abuse of people with disabilities and to
advocate for equal access to services and legal protections. She
also serves on the project team for Leadership for Empowerment
and Abuse Prevention (LEAP), an abuse prevention program for
people with intellectual disability.

Cory Cummings

Cory Cummings, LCSW, PhD, is assistant professor of social

work at Nazareth University in Rochester, New York, where he
teaches a range of graduate courses, mostly in the area of
advanced practice skills. His scholarship focuses on promoting
health equity and wellness for groups impacted by
disadvantages and disparities. This includes work with LGBTQ+
older adults, the peer mental health recovery community, and the
use of community-based participatory research methods. Dr.
Cummings has a practice background working in community
mental health, including case management, individual and group
therapy, and management/administration.

Elizabeth DePoy

Elizabeth DePoy, MSW, PhD, is professor of interdisciplinary

studies and social work and cooperating faculty in mechanical
engineering. After completing her initial undergraduate degrees
in occupational therapy and French literature, she shifted her
academic and scholarly focus to a more macro social justice
perspective by pursuing a masters in social work; from there her
doctoral efforts focused on applied epistemology. She has been
centrally involved in curriculum development and instruction in
both the graduate and undergraduate programs in
interdisciplinary disability studies and teaches in those programs
along with teaching a graduate online research sequence in the
School of Social Work and serving on doctoral committees in
mechanical engineering. Her scholarship is acknowledged
nationally and internationally in the fields of disability and design,
and research and evaluation methodology. With Dr. Stephen
Gilson, she is an inventor of several mobility devices, one on
exhibit at the Cooper Hewitt, Smithsonian Design Museum. She
has earned over $1.4 million in extramural funding for individual
and collaborative research.

Stephen French Gilson

Stephen French Gilson, MSW, PhD, is professor and coordinator

of interdisciplinary disability studies at the Center for Community
Inclusion and Disability Studies; professor at the School of Social
Work at the University of Maine; and senior research fellow at
Ono Academic College Research Institute for Health and Medical
Professions, Kiryat Ono, Israel. After he completed his
undergraduate degree in art, he shifted his career to social
justice, pursuing a master’s in social work. Realizing that
knowledge of human biology and physiology was foundational to
his work, he completed a PhD in medical sciences. Synthesizing
the diversity and richness of this scholarly background, Dr.
Gilson engages in research in disability theory, disability as
diversity, design and access, social justice, health and disability
policy, and the atypical body. He teaches courses in disability as
diversity, policy, and human behavior from a legitimacy
perspective. In 2017, he received a Trustee Professorship award
from the University of Maine to support his international study of
social practice art. His most recent research integrates and
applies artistry, design, and commitment to human rights to the
development of aesthetically designed adaptive equipment. The
AFARI, a three-wheeled outdoor fitness mobility support, is now
on exhibit at the Cooper Hewitt, Smithsonian Design Museum in
New York. Along with his wife, Dr. Liz DePoy, Dr. Gilson is the
owner of an adapted rescue farm in Maine. Living his passion of
full access, the barn and farm area have been adapted not only
to better assure human access and animal caretaking but also to
respond to the needs of the disabled and medically involved
animals that live on the farm. Two other major influences on Dr.
Gilson’s writing, research, and work include his passion for and
involvement in adaptive alpine skiing and dressage.

Tawanda L. Hubbard

Tawanda L. Hubbard, DSW, MSW, LCSW, is an associate

professor of professional practice at Rutgers University School of
Social Work (RUSSW), where she teaches advanced practice
courses. She obtained her BS in Business Administration with a
concentration in Management from Bloomfield College and her
MSW and DSW from RUSSW. She is a PhD candidate in Family
Science and Human Development at Montclair State University.
Dr. Hubbard has over 19 years of experience in child welfare,
mental and behavioral health, case management, advocacy, and
clinical practice, with a small private practice and consulting firm.
She is trained in family therapy (Ackerman, Bowen, and
Multicultural Intergenerational approaches), EMDR, and certified
in REBT and child sexual abuse therapy. Dr. Hubbard’s research
agenda focuses on mental and relational health and well-being in
Black women and families, young Black women aging out of
foster care and transitioning successfully into adulthood,
dismantling structural inequities, and promoting inclusive and
transformative leadership and practices in human service
organizations. Dr. Hubbard was honored in 2022 and 2023 with
the outstanding clinical specialization professor award at
RUSSW.

Jeanne M. Koller

Jeanne M. Koller, PhD, MSW, LCSW, is an assistant professor in

the School of Social Work at Monmouth University. She earned
her doctorate at Rutgers University School of Graduate Studies,
master’s degree at Hunter College, and undergraduate degree at
the University of Massachusetts, Amherst. Dr. Koller has 26
years of clinical social work experience, and her areas of interest
include behavioral health, aging, and LGBT+ issues. She
primarily teaches advanced-year clinical MSW courses but also
teaches across the BSW, MSW, and DSW curriculums.
Soon Min Lee

Soon Min Lee, MSW, PhD, is professor in the Department of

Social Welfare at Sejong Cyber University, Seoul, Korea. She
received the MSW from the University of Illinois Urbana-
Champaign and her PhD in Social Work at Virginia
Commonwealth University. Her major areas of interest are social
work ethics and mental health of people with disabilities. She
currently teaches social work practice, social work practice skills,
community social work, and social work ethics at the
undergraduate level.

Michael J. Sheridan

Michael J. Sheridan, MSW, PhD, has 25-plus years of

experience as a social work educator, teaching courses on
spirituality and social work, transpersonal theory, diversity and
social justice, research methods and statistics, human behavior
theory, social work practice, international social development,
and conflict resolution and peacebuilding. Her major research
and scholarship focus has been on the effective and ethical
integration of spirituality within social work practice and
education. She also served as the director of the Center for
Spirituality and Social Work at Catholic University of America.
Her previous practice experience includes work in mental health,
health, corrections, and youth and family services. Most recently
she was special advisor with the Office of Intramural Training &
Education at the National Institutes of Health (NIH), where she
provided a variety of diversity and wellness trainings and
programs. She continues to consult with NIH, providing online
training and group facilitation. She is also an active collaborator
with the Universalist Unitarian Justice Ministry of North Carolina.

Joseph Walsh

Joseph Walsh, MSW, PhD, LCSW, is a former professor in the

School of Social Work at Virginia Commonwealth University. He
was educated at Ohio State University and worked for 40 years
 in community mental health settings. His major areas of interest
are clinical social work, serious mental illness, and
psychopharmacology. He taught courses in social work practice,
human behavior and the social environment, and the dynamics
of the social worker–client relationship, while maintaining a small
clinical practice. Dr. Walsh enjoys teaching ESL classes,
volunteering at a medical hospital and local library, appearing in
plays and short films, and spending time with his grandchildren.
He especially enjoys appearing in musical theater productions.

About the Case Study Contributors

R. Shawn Allen

R. Shawn Allen, DSW, MSW, LCSW, is an associate professor of

social work at Concord University. Shawn earned his DSW from
Tulane University, MSW from West Virginia University, and BSW
from Concord University. His practice background includes being
one of the first regional coordinators of the West Virginia Aging
and Disability Resource Center, where he assisted older adults
and persons living with disabilities with services such as
information and referral, options counseling, benefits counseling,
and short-term case management. Additionally, he serves on
numerous committees throughout West Virginia, helping to
promote services for older adults and persons living with
disabilities. His research interests include ethical social work
practice in rural areas, the effect of the opioid epidemic in
Appalachia, and service barriers influencing the lives of rural
older adults.

Najwa Awad

Najwa Awad, LCSW-C, PMH-C, is a graduate from the School of

Social Work at Virginia Commonwealth University. She is an
author and psychotherapist in private practice, with a focus on
providing trauma-informed, culturally sensitive counseling to
women and minorities. She has special interests in EMDR,
helping underserved Muslim communities and speaking in public
forums about reducing stigma toward seeking mental health
treatment.

Jennifer Cullison

Jennifer Cullison, PhD, is an assistant professor of history at

California State University, Stanislaus. She teaches courses on
immigration and ethnic history, Mexican American history, U.S.
history, public history, and oral history. Previously, Dr. Cullison
was at the University of Nevada, Reno, where she headed a
university–civic partnership called the Realities of Undocumented
Immigrants Oral History Project. Her research focuses on U.S.
immigration policy history and the human experience of
undocumented immigrants and people detained by U.S.
immigration regimes (the Immigration and Naturalization Service
or Immigration and Customs Enforcement). Her work seeks to
aid efforts to dismantle and re-envision both the U.S. carceral
state and U.S. immigration policy. Since 2008, she has been
involved in collaborations and movements to support people
impacted by U.S. immigration policy.

G. Gladston Xavier

G. Gladston Xavier, PhD, MSW, MA, goes by the name “Ashok”

and is an associate professor with the Department of Social
Work, Loyola College, in Chennai, India. Ashok earned his PhD
and MSW degrees from Loyola College, University of Madras,
and his MA in Conflict Transformation from Eastern Mennonite
University in Harrisonburg, Virginia. His practice experience
includes sustained engagement in conflict transformation, trauma
healing, playback theatre, and peacebuilding work with refugees
and displaced persons of Sri Lanka, India, and Afghanistan. His
major areas of work include human rights advocacy, refugee
empowerment, community development, community-based
conflict transformation, and planning and implementing disaster
response. In 2020, he initiated and led the psycho-social
response of Chennai City; the project reached thousands of
persons during the COVID-19 pandemic in India. He was a
Fulbright Scholar in Residence with Eastern Mennonite
University Social Work Program in 2021–2022.
Part I A Multidimensional Approach for
Multifaceted Social Work
Devyani Hakakian is beginning her workday at an international
advocacy organization devoted to women’s rights.
Sylvia Gomez and other members of her team at the
rehabilitation hospital are meeting with the family of an 18-year-
old male who is recovering from head injuries sustained in a
motorcycle accident.
Mark Bernstein is on the way to the county jail to assess the
suicide risk of an inmate.
Caroline O’Malley is knocking at the door of a family reported to
her agency for child abuse.
Helen Moore is preparing a report on environmental justice for a
legislative committee.
Juanita Alvarez is talking with an unhoused man about taking
his psychotropic medications.
Stan Weslowski is meeting with a couple who would like to
adopt a child.
Andrea Thomas is analyzing the results of a needs assessment
recently conducted at the service center for older adults where
she works.
Anthony Pacino is wrapping up a meeting of a cancer support
group.
Sam Belick is writing a social history for tomorrow’s team
meeting at the high school where he works.
Sharlena Cook is preparing to meet with a group of Head Start
parents to discuss parenting issues.
Sarah Sahair has just begun a meeting of a recreational group
of 9- and 10-year-old girls.
Jane Kerr is facilitating the monthly meeting of an interagency
coalition of service providers for substance-abusing women and
their children.
Ann Noles is planning a fund-raising project for the local Boys’
and Girls’ Club.
 Meg Hart is wrapping up her fourth counseling session with a
lesbian couple.
Chien Liu is meeting with a community group concerned about
youth gang behavior in their neighborhood.
Mary Wells is talking with one of her clients at the rape crisis
center.
Nagwa Nadi is evaluating treatment for post-traumatic stress
disorder at a Veteran’s Administration hospital.

What do these people have in common? You have probably guessed

that they all are social workers. They work in a variety of settings,
and they are involved in a variety of activities, but they all are doing
social work. They all are involved in activities to engage with,
assess, and intervene in human behavior. Social work is a
multifaceted profession, and because it is multifaceted, social
workers need a multidimensional understanding of human behavior.
This book provides such an understanding. The two chapters in Part
I introduce you to a multidimensional way of thinking about human
behavior and set the stage for subsequent discussion. In Chapter 1,
you are introduced to the multiple dimensions of person,
environment, and time that serve as the framework for the book, and
you are introduced to social work’s emphasis on human rights;
social, racial, economic, and environmental justice; and diversity,
equity, and social inclusion. You also are given some tools to think
critically about the multiple theories and varieties of research that
make up our general knowledge about these dimensions of human
behavior. In Chapter 2, you encounter seven theoretical perspectives
that contribute to multidimensional understanding. You learn about
their central ideas and their scientific merits. Most important, you
consider the usefulness of these seven theoretical perspectives for
social work.
1 Human Behavior: A Multidimensional Approach

Elizabeth D. Hutchison

Learning Objectives

1.1 Recognize one’s own emotional and cognitive reactions to a

case study.
1.2 Analyze the historical connection between social work and
the person-in-environment perspective.
1.3 Outline the elements of a multidimensional person-in-
environment approach to human behavior.
1.4 Advocate for an emphasis on a global perspective; human
rights and social, racial, economic, and environmental justice;
and anti-racism, diversity, equity, and inclusion in social work’s
approach to understanding human behavior.
1.5 Summarize four ingredients of knowing how to do social
work.
1.6 Analyze the roles of theory and research in guiding social
work practice.
1.7 Apply knowledge of the multidimensional person-in-
environment framework; human rights and social, racial,
economic, and environmental justice; anti-racism, diversity,
equity, and inclusion to recommend guidelines for social work
engagement, assessment, intervention, and evaluation.

A Case Study About Person and Environment

Case Study 1.1: Joshua, Making a New Life

Joshua spent the first 10 years of his life in the city of Uvira, in the
South Kivu Province of the Democratic Republic of Congo (DRC),
formerly Zaire. He is the fourth oldest child in a family that included 11
children. He is of the Banyamulenge ethnic group, and his family
spoke Swahili, Kinyamulenge, and French while living in Uvira. He
was raised Christian in the United Methodist Church. Joshua’s family
lived comfortably in Uvira. His mother owned a boutique that sold
clothes, shoes, lotions, accessories, and petroleum. His father bought
cows, had them butchered, and then sold the meat.

Of his life in Uvira, Joshua recalls that a typical day included getting
up for breakfast and spending the day at school. After school, he did
chores and sometimes helped his mom in her boutique. Then he
played soccer until dinner. It was a good life.

All of that changed in 2003. The long-standing Congo civil war was
getting closer to his family’s home in Uvira. Joshua recalls hearing
gunshots about 15 miles away. His family left their home in Uvira in
the middle of the night by foot and walked across the Burundi border
to the nearby Gatumba refugee camp run by the United Nations High
Commissioner for Refugees (UNHCR). They were joined on the walk
and in the camp by a lot of other people from Uvira. Life was hard in
the crowded camp, where people slept in tents with mosquitoes
buzzing around. Sometimes there was not enough water or food for
the whole camp. The hygiene in the camp was not good, and a lot of
people were sick. Joshua lost a lot of friends and family in the camp.
He recalls that the children were not able to attend school in the
camp.

A terrible thing happened on August 13, 2004. There was a heinous

massacre at the Gatumba refugee camp, killing 166 refugees and
seriously wounding over 100 more. News reports indicate that
refugees who were members of the Banyamulenge ethnic group were
the specific target of the massacre. Joshua’s mom died of gunshot
wounds, and his 8-year-old sister’s body was never found. The whole
camp was burned down, and Joshua’s family was separated. Joshua,
who was 11 years old at the time, ran with his 7-month-old sister.
They were first in the hospital and then taken in by a stranger with
whom they stayed for several weeks before finding their father and
other siblings. Their father had been shot during the massacre and
was taken to the hospital. Two of Joshua’s siblings were also found in
the hospital. Other siblings had found safety a few miles away at a
makeshift camp. After finding his father and siblings, Joshua and his
7-month-old sister stayed with an extended family relative in
Bujumbura, Burundi, for about 4 months. His father went to a hospital
in Kenya, and some siblings were in an orphanage. At some point,
Joshua and some older siblings went back to Uvira in the DRC. They
stayed in the house where they had lived before they fled and were
able to go to school again, but not right away.

In 2006, Joshua’s father was discharged from the hospital, came

back to Uvira, and took all the family back to Bujumbura, Burundi,
where he filed for refugee status. Joshua and his siblings went to a
few interviews for the refugee status application, but mostly the
process was handled by his father, and Joshua doesn’t know much
about it.

In May 2007, Joshua’s family, consisting of a single father and 10

children, arrived in Boise, Idaho. Joshua was almost 14 years old,
and he felt excited and eager to begin school. He was also struck by
how cold the weather was. Joshua’s father received Supplemental
Security Income (SSI) because of disability related to wounds from
the massacre. His father also had to continue with treatment for his
wounds, was hospitalized from time to time, and continues to receive
periodic treatment. His father is now ordained as a pastor in a local
African church and currently serves on a committee for the local
African community. He received his citizenship in 2013.

The language issue was really hard at first for Joshua, but it was
even harder for his older siblings and father. Joshua graduated from
high school in 2011, from community college in 2013, and from
university in May 2017. He received citizenship in September 2017
and was married in October 2017. He coaches local Nations United
and Boys & Girls Club soccer teams and works as the employment
specialist and donations manager at the Agency for New Americans,
the refugee resettlement agency that sponsored his family during
their resettlement. All of Joshua’s surviving siblings still live in Boise.
Unfortunately, his oldest sister died in November 2016. She had been
shot in the head during the massacre, and her injuries left her
paralyzed on the left side of her body. She had gotten married after
the family arrived in Boise and left six children behind when she died.
Joshua says the family misses her very much.
Story provided by Agency for New Americans, Boise, Idaho

Human Behavior: Individual and Collective

As eventful as it has been, Joshua’s story is still unfolding. As a social

worker, you will become a part of many unfolding life stories, and you
will want to have useful ways to think about those stories and
effective ways to be helpful to people like Joshua, his family, and
other refugees from the DRC, as well as the many other people you
will encounter in your social work journey. This book and its
companion volume, Dimensions of Human Behavior: The Changing
Life Course, provide ways for you to think about the nature and
complexities of human behavior—the people and situations at the
center of social work practice. To begin to do that, we must first clarify
the purpose of social work and the approach it takes to individual and
collective human behavior. This is laid out in the 2022 Educational
Policy and Accreditation Standards of the Council on Social Work
Education (CSWE):

The purpose of the social work profession is to promote human

and community well-being. Guided by a person-in-environment
framework, a global perspective, respect for human diversity, and
knowledge based on scientific inquiry, the purpose of social work
is actualized through its quest for social, racial, economic, and
environmental justice, the creation of conditions that facilitate the
realization of human rights, the elimination of poverty, and the
enhancement of life for all people, locally and globally. (CSWE,
2022, p. 14)

Let’s put that statement into some historical context. The CSWE was
formed in 1952 to bring the accreditation of social work education
under a single body, bringing together separate accrediting bodies for
medical social work, psychiatric social work, and generalist practice
to accredit both undergraduate and graduate social work education
programs. Three years later, in 1955, the National Association of
Social Workers (NASW) was formed by consolidating seven existing
organizations, the American Association of Social Work plus
specialized associations of psychiatric social workers, medical social
workers, school social workers, group workers, community organizing
social workers, and social work researchers. Both the newly formed
CSWE and NASW were dedicated to identifying what was common to
all social work practice. The CSWE immediately set to work to
develop curriculum policy and accreditation standards for a social
work education that could prepare students for all practice settings
and social work roles.

In these early efforts to identify the common base of social work,

presenters of one workshop at the 1952 meeting of the American
Association of Schools of Social Work, a forerunner of CSWE, argued
that “knowledge and understanding of human behavior is considered
an indispensable base for social work education and for all social
work activity” (Social Welfare History Archives, 1952, p. 1). I agree
wholeheartedly with that statement. Whether we are concerned about

how an individual can recognize the role of emotions and

cognitive biases shaping their behavior;
how a family can improve its communication patterns;
how a group can become more cohesive;
how a community can become empowered to solve problems;
how to maximize the benefits of increasing diversity in an
organization;
or the most effective ways to organize efforts to advance human
rights and social, racial, economic, and environmental justice;

we are concerned about human behavior.

In 1958, in the first working definition of social work practice after the
formation of CSWE and NASW, Harriett Bartlett linked the person-in-
environment perspective on human behavior to the definition of social
work (Kondrat, 2008). That connection has endured for six decades.
In discussion of social work competencies, the CSWE 2022
Educational Policy and Accreditation Standards (EPAS) notes that
social workers “apply knowledge of human behavior and person-in-
environment, as well as interprofessional conceptual frameworks” to
engage with, assess, intervene with, and evaluate practice with
“individuals, families, groups, organizations, and communities”
(CSWE, 2022, pp.11–13).

It is important to recognize that the social work profession, like all

disciplines and professions, continues to change and evolve. In 2020,
in the midst of health disparities in a global pandemic and the high-
profile brutal murder of George Floyd by Minneapolis police officers,
social work—like other professions and disciplines—began to
reexamine its own history of racism and white supremacy (see
Aguilar & Counselman-Carpenter, 2021; Wright et al., 2021). In July
2021, the National Association of Social Workers (NASW, 2021a)
submitted a report to the profession on racial justice, noting some
ways that the social work profession had contributed to ongoing
discrimination and oppression of people of color. In this report, NASW
apologized for grave mistakes in the profession’s history and called
for a renewed effort to live up to its mission to pursue justice. Here
are some of the grave mistakes in the history of social work noted in
the report:

The white social reformers in the progressive era did not

welcome Black Americans into the programs developed for white
immigrants.
Many white social reformers of the progressive era supported the
eugenics movement and participated in involuntary sterilization
programs that targeted women of color and low-income women.
White suffragists, including some social work and social welfare
leaders, blocked efforts of Black women to vote in their efforts to
secure the right for white women to vote.
African American social reformers were not allowed to attend
most of the first schools of social work and were not included in
the telling of the history of social work until recent times.
Social workers played a role in the Indian boarding school
movement that separated Indigenous children from their families
and cultures.
New Deal safety net programs created during the Franklin
Roosevelt administration excluded people involved in domestic
work and farm labor, the two low-wage occupations open to
African Americans at that time.
 Poor Black men were recruited into the fraudulent Tuskegee
medical experiment by social workers.
Social workers were part of the intake teams at the internment
camps for Japanese American families during World War II.

The contributing authors and I applaud the reinvigorated effort to live

up to social work’s mission to pursue justice for all and have
attempted to revise the chapters of this book in a way that supports
that renewed mission. As social workers, we must recognize the roles
we play in existing systems of oppression, avoid interventions that
maintain those systems, and develop new interventions to challenge
those systems.

In this book, we use the language of “person and environment” rather

than “person-in-environment” because the emphasis is not always on
the individual person. Although the person-in-environment (person
and environment) construct noted in the CSWE educational policy is
an old idea in social work, it still is a very useful way to think about
human behavior—a way that can accommodate such contemporary
themes in human life as the emotional life of the brain, human–robot
relationships, social media, human rights, economic globalization, the
racialization process, and environmental justice. This book elaborates
and updates the person and environment construct that has guided
social work intervention since the earliest days of the profession. The
element of time is added to the person and environment construct to
call attention to the dynamic nature of both people and environments.
This is important in rapidly changing societies around the world. Early
social workers could not have imagined television and air travel,
much less cell phones, a plethora of social media platforms, remote
education, or instant communications across continents. And, no
doubt, the world 50 years from now would seem as foreign to us as
the United States seemed to Joshua and his family when they first
arrived here.

As you reflect about Joshua’s story, you may be thinking, as I am, not
only about Joshua but also about the different environments in which
he has lived and the ways in which both Joshua and his
environments have changed over time. As they live their lives in the
natural environment, humans join with other humans to develop
physical landscapes and structures, technologies, and social systems
that form the context of their lives. These landscapes, structures,
technologies, and social systems are developed by collective action,
by humans interacting with each other. Once developed, they then
come to shape the way humans interact with each other and with
their natural environments. Landscapes, structures, technologies, and
social systems can support or deter individual and collective well-
being. Usually, they benefit some individuals and groups while
causing harm to others. Social workers are concerned about both
individual and collective behavior and well-being; when we talk about
human behavior, we are referring to both the individual and collective
behavior of humans. Sometimes we focus on individual behavior, and
other times we are more concerned about the social systems created
by human interaction.

This book identifies multiple dimensions of both person and

environment and draws on ongoing scientific inquiry, both conceptual
and empirical, to examine the dynamic understanding of each
dimension. Special attention is paid to globalization; human rights
and social, racial, economic, and environmental justice; and anti-
racism, diversity, equity, and inclusion in examination of each
dimension. In this chapter, a multidimensional approach to person
and environment is presented, followed by discussion of human rights
and social, racial, economic, environmental justice; anti-oppressive
and anti-racist practice; diversity; and equity and inclusion. After a
brief discussion of the process by which professionals such as social
workers move from knowing to doing, the chapter ends with a
discussion of how scientific knowledge from theory and research
informs social work’s multidimensional understanding of human
behavior.

Organization of Book

In this book, Part I includes two stage-setting chapters that introduce

the framework for the book and provide a foundation for thinking
critically about the discussions of theory and research presented in
Parts II and III. Part II comprises four chapters that analyze the
multiple dimensions of persons—one chapter each on the biological
person, the psychological person (or the self), the psychosocial
person (or the self in relationship), and the spiritual person. The eight
chapters of Part III discuss environmental dimensions: the physical
environment, cultures, social structure and social institutions, families,
small groups, formal organizations, communities, and social
movements.

As noted earlier, presenting person and environmental dimensions

separately, as we do in Parts II and III, is a risky approach. We do not
wish to reinforce any tendency to think about human behavior in a
way that camouflages the inseparability of person and environment.
In our work as social workers, we engage in both analysis and
synthesis. Sometimes we need to think analytically, breaking down a
complex situation by thinking more critically about specific aspects
and dimensions of the situation, whether that is a biological system or
a pattern of family relationships. But we also need to be able to put
the puzzle pieces back together to see the whole story. That is
synthesis. We are always working back and forth between analysis
and synthesis. Each chapter in the book attempts to capture some of
the complexity of multiple interacting dimensions of behavior.

A Multidimensional Approach

Social work’s person and environment construct has historically

recognized both person and environment as complex and
multidimensional , that is, as having several identifiable dimensions.
A dimension refers to a feature that can be focused on separately but
that cannot be understood without also considering its
embeddedness with other features. This last piece is really important:
Although we can focus on one dimension of a human story to help us
think about that dimension more clearly, no one dimension can be
understood without considering other dimensions as well. We are
walking a treacherous path here by separating out the dimensions to
explore each in some depth. The fear is that by doing so, we will
reinforce the human tendency to think of these dimensions as things
that are separate and unrelated rather than recognizing how they are
all utterly intertwined. As neuroscientist Robert Sapolsky (2017, p. 5)
warns, “It’s human behavior. And, it is indeed a mess, a subject
involving brain chemistry, hormones, sensory cues, prenatal
environment, early experience, genes, both biological and cultural
evolution, and ecological pressures, among other things.” In a similar
vein, writing about child development, Arnold Sameroff (2010, p. 7)
writes that “it is both child and parent, but it is also neurons and
neighborhoods, synapses and schools, proteins and peers, and
genes and governments.” Throughout this book, we try to call
attention to how dimensions of human behavior are related to each
other and intertwine to influence specific behaviors. Think about
Joshua. What comes quickly to your mind as you think about the
factors that influence his current behavior?

If we were writing a book focusing on only one type of behavior, such

as aggression as Sapolsky (2017) writes about, we could
demonstrate how all the elements of person and environment are
intertwined to create that one type of behavior. Because, instead, we
are writing a book that covers the wide range of human behaviors,
both individual and collective behaviors, we organize the book around
various dimensions of person and environment and do our best to
illustrate how those dimensions are related to each other. For
example, the chapter on cultures includes discussion of the
neuroscience of prejudice as well as discussion of gene–culture co-
evolution. We encourage you to pay particular attention to these
discussions of the way in which different dimensions of person and
environment are intertwined.

With an explosion of behavioral science research across a number of

disciplines in the past few decades, the trend has been to expand the
range of dimensions of both person and environment folded into the
person and environment construct. Time too can be thought of as
multidimensional. Let’s look at some of the dimensions of person,
environment, and time in Joshua’s story.

If we focus on the person in Joshua’s story, we think about the

conditions in the refugee camp that threatened his biological systems
and how he survived while many others died in the camp, where
hygiene was poor and water and food were scarce. We also think
about the biological damage done to members of his family at the
time of the massacre and are reminded how humans often carry both
biological and psychological reminders of physically and emotionally
traumatic situations. Joshua appears to have emotional resilience
and good problem-solving skills, having had the discernment to run
from the massacre with his baby sister, the fortitude to survive the
perilous days while the family waited to be resettled in the United
States, and the flexibility to adapt to a new life once he arrived in the
United States. He was able to learn a new language and culture and
plan for the future. It appears that he has been able to build
meaningful interpersonal relationships at work and in the community.
The Christian faith has been a source of comfort for him and his
family as they adapted to a new environment.

If we focus on the environment, we see many influences on Joshua’s

story. Consider first the physical environment. Joshua lived a
comfortable life in the city of Uvira, where he spent his days in school
and was able to be outside playing soccer after chores were done.
From there, he took a short walk across the Burundi border to a
crowded and primitive refugee camp where he has memories of
being bothered by mosquitoes. After the massacre, he, his father, and
his siblings lived where they could—in camps, hospitals, and other
people’s homes. They were finally resettled in a city about the size of
his original city of Uvira but where the climate was much colder. They
were surrounded by mountains as they had been in Uvira. Joshua is
once again able to be outside playing soccer but for a shorter season.

Culture is a dimension of environment that exerts a powerful

influence in Joshua’s story. Ethnic culture clash was a large part of
the Congo civil war, and Joshua and his family were of the
Banyamulenge ethnic group that had been targets for ongoing
discrimination and exclusion since the colonial period. Such cultural
conflict is not new; historical analysis suggests that intercultural
violence has actually declined in recent times (Pinker, 2011), but it
continues to be a source of great international upheaval and the
driving force behind refugee resettlement. As is true in many parts of
the world, ethnic conflict is intertwined in the Congo with control over
a natural resource, in this case coltan, a metallic ore used in
electronics such as computers and cell phones (McMichael & Weber,
2021).

Joshua’s story has been powerfully influenced by the geopolitical

unrest that marked his young life in Africa. His relationships with
social institutions have changed over time, and he has had to adapt
his behavior to the changing situations. Even though his country was
engaged in civil war during much of his young life, it did not reach his
city until he was 10 years old. Before that, his family lived in relative
comfort and peace. His family was relieved to get to the United
Nations refugee camp, but life there was hard, and ultimately the war
followed them there, even though the camp was supposed to be
protected by the Burundi government. Once they arrived in the United
States, Joshua and his siblings were able to go to school again, to
make their way economically, and to work toward citizenship in their
adopted country.

Another dimension of the environment, family, is paramount to

Joshua. He has suffered family loss and endured time when
members of his family were separated before resettling in the United
States. He has been lucky, however, to have his father and surviving
siblings living nearby. Many refugee families end up spread across
several continents, and that may or may not be true for Joshua’s
extended family. Joshua now has a wife to count as family.

Small groups, organizations, and communities have been important

forces in Joshua’s life, but he has had little direct contact with social
movements. His soccer teams are important small groups in the life
he has created in Boise. He participates in small groups at church
and in the African community in Boise. He is a member of the small
staff group at the refugee resettlement agency.

Several organizations have been helpful to Joshua and his family

since they fled Uvira. The refugee camp was an organization that
brought initial safety but ultimately trauma and loss. Joshua’s
association with other organizations has been much more positive; he
did well in several school organizations and has returned to work for
the refugee resettlement agency that sponsored his family and
assisted them to make a successful resettlement. The African
Christian church where his father is a minister is a source of close
relationships, spiritual connectedness, and continuity with life in
Uvira.

Joshua and his family needed to adapt their behavior to live in

several different types of communities. In Uvira, they were
surrounded by extended family, long-term friends and neighbors, and
a church community. In the crowded refugee camp, disease and
despair were common, and Joshua was not able to go to school. That
community was split, with some being targeted for massacre while
others were not. After the massacre, Joshua and his family moved
about from camps and hospitals to strangers and family relatives in
Burundi, and even back to Uvira, always trying to find safety. Now he
lives in a city in southwestern Idaho in proximity to other refugees
from the DRC and worships with many of them.

We don’t know if Joshua is aware that the Gatumba Refugees

Survivors Foundation (Davey et al., 2022) has spearheaded a social
movement to undertake inquiry about the Gatumba massacre, seek
justice for the survivors of the Gatumba genocide, raise global
awareness of torture and genocide, organize memorial gatherings to
help survivors heal, reunite family members who were separated
during the evacuation of the camp, relocate survivors from unsafe
areas, and advocate for medical support for survivors. It is possible
that the Boise community of Banyamulenge refugees has benefited
from the work of the GRSF as they heal from the trauma of that
massacre.

Time is also an important part of Joshua’s story. His story, like all
human stories, is influenced by the human capacity to live not only in
the present time but also in past and future times. Escape, crowded
camps, massacre, family loss and separation, and resettlement are
past events in his family’s life and can be vividly recalled. There were
times in the family’s life when they needed to focus on future
possibilities with such questions as “Will our father get better?” and
“Will we be granted refugee status, and if so when and where will we
go?” This future thinking has had an enormous impact on the current
circumstances of the family’s lives. In the interview for this case study,
Joshua engaged in thinking about his past life in Uvira and the
refugee camp, as well as the massacre event, but for the most part
he lives largely in the present while imagining possibilities for the
future with his wife, siblings, and father.

Joshua’s story is also influenced by the historical times in which he

has lived and is living. He has lived in a time of violent ethnic discord
in his home country, and the civil strife continues in the DRC (Human
Rights Watch, 2021). He is lucky to have been resettled to the United
States in an era of international support for refugees. The times in
which we live shape our behaviors in many ways.

Another way to think about the role of time in human behavior is to

consider the way in which age, or life stage, influences behavior.
Joshua notes that although learning English was difficult for him, it
was much easier for him at age 13 than it was for his father. He finds
this stage of his life, with school behind him and a new marriage, to
be an exciting time with a future stretching out before him.

As suggested, social work has historically recognized human

behavior as an interaction of person with environment, although the
relative emphasis on different dimensions of person and environment
has changed over time. Today, a vast multidisciplinary literature is
available to help us in our social work efforts. The good news is that
the multifaceted nature of this literature provides a broad knowledge
base for the varied settings and roles involved in social work practice.
The bad news is that this literature is highly fragmented, scattered
across a large number of fields. What we need is a structure for
organizing our thinking about this multifaceted, multidisciplinary,
fragmented literature.

The multidimensional approach provided in this book should help.

This approach is built on the person–environment–time model
described earlier. Although in this book we focus on specific
dimensions of person and environment separately, including
information on how our understanding of these dimensions has
changed over time, keep in mind the earlier caution that dimension
refers to a feature that can be focused on separately but cannot be
understood without considering other features. The dimensions
identified in this book have largely been studied as detached or
semidetached realities, with one dimension characterized as causing
or leading to another. In recent years, however, behavioral science
scholars have collaborated across disciplines, leading to exciting new
ways of thinking about human behavior, which the contributing
authors and I share with you. We emphasize again that we do not
see the dimensions analyzed in this book as detached realities, and
we are not presenting a causal model. We want instead to show how
these dimensions work together, how they are interwoven with each
other, and how many possibilities are opened for social work practice
when we think about human behavior in a multidimensional way. We
are suggesting that humans engage in multidetermined behavior ,
that is, behavior that develops as a result of many causes. As
Sapolsky (2017, p. 8) says, “It is impossible to conclude that behavior
is caused by a gene, a hormone, a childhood trauma”—because all
these factors and many others interact in one individual to produce
unique results ... you have to think complexly about complex things”
like human behavior. Figure 1.1 is a graphic overview of the
dimensions of person, environment, and time discussed in this book.
Table 1.1 defines and gives examples of each dimension.
Description

Figure 1.1 Person, Environment, and Time Dimensions

Table 1.1
Critical Thinking Questions 1.1

What courses have you taken that added to your understanding of

human behavior? How does content from any of these courses help
you to understand Joshua’s story and how a social worker might have
been helpful to Joshua and his family at any time during their
resettlement? Do you agree that the person and environment
construct is still useful for social work? Explain your answer.

Personal Dimensions

Any story could be told from the perspective of any person in the
story. The story at the beginning of this chapter is told from Joshua’s
perspective, but it could have been told from the perspectives of a
variety of other persons, such as a member of a different ethnic group
in the DRC, Joshua’s father or one of his siblings, a staff member at
the Gatumba refugee camp, the family in Burundi who took Joshua
and his baby sister in, or the case manager at the refugee
resettlement agency. You will want to recognize the multiple
perspectives held by different persons involved in the stories of which
you become a part in your social work activities.

You also will want tools for thinking about the various dimensions of
the persons involved in these stories. In recent years, social work
scholars, like contemporary scholars in other disciplines, have taken
a biopsychosocial approach that recognizes human behavior as the
result of interactions of integrated biological, psychological, and social
systems (see Choy et al., 2015; Sapolsky, 2017; Yeager et al., 2016).
In this approach, psychology—personality, emotion, cognition, and
sense of self—is seen as inseparable from biology. Emotions and
cognitions affect the health of the body and are affected by it (D.
Banerjee et al., 2021; Smith et al., 2013; Yeager et al., 2016).
Neurobiologists are identifying the brain circuitry involved in thoughts
and emotions (Davidson & Begley, 2012; Sapolsky, 2017). They are
finding evidence that the human brain is wired for social life and
identifying the regions and circuitry of the “social brain” (Porcelli et al.,
2019). They are also finding that physical and social environments
have an impact on brain structure and processes and on body
systems and disorders (McEwen & Bulloch, 2019). Interpersonal
relationships are an important part of social environments. Two
concepts are important in this study of the connection between
physical and social environments and the human body: biological
embedding and epigenetics. Biological embedding occurs when life
experience changes the biological processes and affect later life
health and well-being (Nist et al., 2019; Sun et al., 2022). Epigenetics
is the study of how behaviors and environments can affect the way
genes work, changing how the body reads a DNA sequence without
changing the DNA (Li, 2021). Environments influence biology, but the
same environment acts on diverse genetic material. This can help us
understand how some people survived and some did not before the
massacre in the Gatumba refugee camp. Two people with the same
genetic makeup and biological characteristics can have very different
behavioral outcomes, and two people with very different genetic
makeup and biological characteristics can have the same or similar
behavioral outcomes. In addition, two people with the same or similar
experiences with the environment can have very different behavioral
outcomes, and two people with very different experiences with the
environment can have the same or similar behavioral outcomes
(Sameroff, 2010).

Social work scholars and those in the social and behavioral sciences
and medicine have argued for greater attention to the spiritual
dimension of persons as well (Bowles et al., 2017; Crisp, 2017;
Pandya, 2016; Pathan, 2016). Beginning in the late 20th century, a
group of U.S. medical faculty and practitioners initiated a movement
to reclaim medicine’s earlier spiritual roots (Fleenor et al., 2022), and
in 2014, Puchalski et al. reported that content on spirituality and
health was incorporated into the curricula of over 75% of U.S.
medical schools. Developments in neuroscience have generated new
explorations of the unity of the biological, psychological, and spiritual
dimensions of the person. For example, some research has focused
on the ways that emotions and thoughts, as well as spiritual states,
influence the immune system and some aspects of mental health
(Davidson & Begley, 2012; Dehghan et al., 2021; Holmes et al.,
2019). One national longitudinal study examined the role of spirituality
in physical and mental health after the collective trauma of the 9/11
attacks and found that high levels of spirituality were associated with
fewer infectious ailments, more positive emotions, and more
immediate processing of the traumatic event in the 3 years following
the attacks (D. McIntosh et al., 2011). Spirituality and religious
affiliation appear to be a source of resilience for Joshua, his family,
and the Boise African community. In this book, we give substantial
coverage to four personal dimensions: biological, psychological,
psychosocial, and spiritual.

Environmental Dimensions

As we think about Joshua’s story, we are aware of the important role

that the multidimensional environment has played in his life journey to
date. Social workers have always thought about the environment as
multidimensional. Several models for classifying dimensions of the
environment have been proposed over time. Social workers (see,
e.g., Ashford et al., 2018) have been influenced by Urie
Bronfenbrenner’s (2005) ecological perspective, which identifies the
five interdependent, nested categories or levels of systems presented
in Figure 1.2 . You might notice some similarities between
Bronfenbrenner’s model and the one presented in Figure 1.1 . By
adding chronosystems in his later work, Bronfenbrenner was
acknowledging the importance of time in person–environment
transactions, but this book presents a more fluid, less hierarchical
model of person and environment than presented by Bronfenbrenner.
Some social work models have included the physical environment
(natural and built environments) as a separate dimension (see
Norton, 2009). There is growing evidence of the impact of the
physical environment on human well-being and growing concern
about environmental justice issues in the physical environment.
Description

Figure 1.2 Five Categories or Levels of Systems as Presented by

Urie Bronfenbrenner

Sources: Adapted from How Children Develop (3rd ed.), by R. S.

Siegler, J. S. DeLoache, and N. Eisenberg, 2011, Sage. Based on
“The Bioecological Model of Human Development,” by U.
Bronfenbrenner and P. Morris, in W. Damon and R. Learner (Eds.),
Handbook of Child Psychology: Vol. 1. Theoretical Models of Human
Development (6th ed.), 2006, John Wiley.

Crudup et al. (2021) argue that the Bronfenbrenner ecological

framework needs to be revised for anti-racist practice. They note that
Bronfenbrenner’s model puts the individual at the center of nesting
systems and does not accurately portray the relationships, the
interactions among and between systems. They suggest that visual
representations like the one presented in Figure 1.2 put the focus and
responsibility on the individual to overcome years of historical trauma,
discrimination, and exclusion. They raise the question, “What would
happen if the community was at the center rather than the
individual?” (p. 657). These are important questions for social
workers to consider. See Figure 1.3 for the visual model for the
revised ecological systems framework proposed by Crudup et al.
(2021). The funnel approach presented in Figure 1.3 captures the
ongoing mix of history, systems of oppression (race and gender),
community, social networks, family, and individual. It is an important
addition to human behavior theory.
Description

Figure 1.3 Crudup et al. Revised Ecological Systems Framework

Source: “De-centering Whiteness Through Revisualizing Theory in

Social Work Education, Practice, and Scholarship,” by C. Crudup, C.
Fike, and C. McLoone, 2021, Advances in Social Work, 21(3), pp.
654–671.

To have an up-to-date understanding of the multidimensional

environment, I recommend that social workers have knowledge about
the eight dimensions of environment described in Table 1.1 and
presented as chapters in this book: the physical environment,
cultures, social structure and social institutions, families, small
groups, formal organizations, communities, and social movements.
We also need knowledge about dyadic relationships—those between
two people, the most basic social relationship. Dyadic relationships
receive attention throughout the book and are emphasized in Chapter
5, which focuses on the psychosocial person. Simultaneous
consideration of multiple environmental dimensions provides new
possibilities for action, perhaps even new or revised approaches to
social work practice.

These dimensions are neither mutually exclusive nor hierarchically

ordered. For example, family is sometimes referred to as a social
institution, families can also be considered small groups or dyads,
and family theorists write about family culture. Remember,
dimensions are useful ways of thinking about person–environment
configurations, but we should not think of them as detached realities.

Time Dimensions

Time is an important part of Joshua’s story. He spent 10 years in his

native land of the Democratic Republic of Congo, followed by 4 years
of seeking safety in various places, and has now lived 15 years in
Boise, Idaho, in the United States. He graduated from high school in
2011, from community college in 2013, and from university in 2017,
the same year he received U.S. citizenship and married. The situation
for Joshua and his family is very different from that of many DRC
refugees resettled in the United States in more recent years, many of
whom spent 10 to 20 years in refugee camps in Tanzania, Uganda,
Kenya, Burundi, Rwanda, or Zambia before being resettled in the
United States (Mahoney et al., 2020). Think about how those long
years in refugee camps may affect their resettlement experience.

When I was a doctoral student in a social work practice course,

Professor Max Siporin began his discussion of social work
assessment with this comment: “The date is the most important
information on a written social work assessment.” This was Siporin’s
way of acknowledging the importance of time in human behavior, of
recognizing the ever-changing nature of both person and
environment. The importance of time in human behavior is reflected
in the finding that time is the most commonly used noun in print in the
English language; person is the second most common (English Club,
2022).
There are many ways to think about time. Physics is generally seen
as the lead discipline for studying time, and quantum physics has
challenged much about the way we think about time. Various aspects
of time are examined by other disciplines as well, and there are a
number of different ways to think about time. In this book and the
companion volume Dimensions of Human Behavior: The Changing
Life Course, we examine three dimensions of time that have been
studied by behavioral scientists as important to the understanding of
human behavior: linear time, historical era, and chronological age.

Linear time —time ordered like a straight line from the past through
the present and into the future—is the most common way that
humans think about time. Although it is known that people in some
cultures and groups think of time as stationary rather than moving
(Boroditsky et al., 2011), contemporary behavioral science
researchers are interested in what they call “mental time travel,” the
human ability to remember events from the past and to imagine and
plan for the future (Eacott & Easton, 2012). There is some evidence
that mental time travel is not human-specific but is better developed
in humans than in other primates, currently thought to be related to
evolutionary changes in the hippocampus (Benítez-Burraco, 2021).
The research on mental time travel has focused on the conscious
processes of reminiscence and anticipation, but there is also
considerable evidence that past events are stored as unconscious
material in the brain and the body and show up in our thoughts,
emotions, and behavior (see Davidson & Begley, 2012; Sapolsky,
2017; Prescott et al., 2019). Traces of past events also exist in the
natural and built environments, for example, in centuries-old buildings
or in piles of debris following a hurricane or tornado.

Sapolsky (2017) uses the perspective of linear time to demonstrate

how different dimensions of person and environment influence a
specific behavior. When a behavior occurs, we can think about the
multiple influences on that behavior in the context of time:

1. A second before the behavior: What went on in the person’s

brain a second before the behavior?
 2. Seconds to minutes before the behavior: What sensory input
reached the brain?
3. Hours to days before the behavior: What hormones acted hours
to days earlier to change how responsive the person was to a
particular sensory stimulus?
4. Days to months before the behavior: What features of the
environment in the days and months before the behavior
changed the structure and function of the person’s brain and thus
changed how it responded to hormones and environmental
stimuli?
5. Early development: What genetic codes were created at the time
of conception, and what elements of the fetal and early childhood
environment shaped the structure and function of the brain and
body and affected gene expression?
6. Centuries to millennia before the behavior: How has culture
shaped the behavior of people living in that individual’s group?
What ecological factors, including the physical environment,
helped shape that culture?

Linear time is measured by clocks and calendars. This approach to

time has been called clock time (Zimbardo & Boyd, 2008). However,
this approach to time is a relatively new invention, and many people
in the contemporary world have a very different approach to time. In
nonindustrialized countries, and in subcultures within industrialized
countries, people operate on event time, allowing scheduling to be
determined by events. For example, in agricultural societies, the most
successful farmers are those who can be responsive to natural
events—sunrise and sunset, rain, drought, temperature—rather than
to scheduled events (Zimbardo & Boyd, 2008). On his farm in rural
Tennessee, my grandfather operated with a combination of event
time and clock time.

Clock time cultures often use the concept of time orientation to

describe the extent to which individuals and collectivities are invested
in the three temporal zones—past, present, and future (see Figure
1.4). Research indicates that cultures differ in their time orientation. In
most cultures, however, some situations call for us to be totally
immersed in the present, others call for historical understanding of
the past and its impact on the present, and still others call for
attention to future consequences and possibilities. Psychologists
Philip Zimbardo and John Boyd (2008) have been studying time
orientation for more than 30 years and have identified the six most
common time perspectives held in the Western world.

Figure 1.4 Mental Time Travel/Time Orientation

Three dimensions of human behavior are captured in this photo—
person, environment, and time.

© John Foxx / Stockbyte / Thinkstock

past-positive: invested in the past, focused on its positive

aspects
past-negative: invested in the past, focused on its negative
aspects
present-hedonistic: invested in the present and getting as much
pleasure as possible from it
present-fatalistic: invested in the present, sees life as controlled
by fate
future: invested in the future, organizes life around goals
transcendental-future: invested in the future, focuses on new
time after death

Zimbardo and Boyd’s research using the Zimbardo Time Perspective

Inventory (ZTPI) in a number of Western societies indicates that
human well-being is maximized when people in these societies live
with a balance of past-positive, present-hedonistic, and future
perspectives. People with biases toward past-negative and present-
fatalistic perspectives are at greater risk of developing physical and
mental health problems. Zimbardo and Boyd’s (2008) book The Time
Paradox suggests ways to become more past-positive, present, and
future oriented to develop a more balanced time orientation. You
might want to visit www.thetimeparadox.com and complete the ZTPI
to investigate your own time orientation. It is important to remember
the important role that life experiences play in time orientation and
avoid pathologizing people who have developed past-negative time
orientations as a result of an accumulation of mistreatment and
marginalization.

Zimbardo and Boyd have carried out their research in Western

societies and acknowledge that the ZTPI may not accurately reflect
time orientation in other societies. They make particular note that
their description of present-hedonistic and present-fatalistic does not
adequately capture the way Eastern religions think about the present.
Western behavioral scientists have begun to incorporate Eastern
mindfulness practices of being more fully present in the current
moment (present orientation) to help people buffer the persistent
stresses of clock time and goal monitoring (future orientation).
Research also indicates age-related differences in time orientation,
with older adults tending to be more past oriented than younger age
groups (Yeung et al., 2012). Women have been found to be more
future oriented and men more present oriented (Zimbardo & Boyd,
2008). Researchers have observed that trauma survivors who
experienced the most severe loss are more likely than other trauma
survivors to be highly oriented to the past (see Zimbardo et al., 2012).
Zimbardo and colleagues (Zimbardo & Boyd, 2008; Zimbardo et al.,
2012) suggest that trauma survivors may need assistance to think in
different ways about past trauma and to enhance their capacity for
past-positive, present, and future thinking. With this goal in mind, they
have developed what they call time perspective therapy for working
with people with post-traumatic stress disorder (PTSD) (Sword et al.,
2014). Researchers have found time perspective therapy to be
effective in increasing psychological well-being in veterans with PTSD
(Malekiha & Moradi, 2019). This approach might be useful to some
members of the refugee community of which Joshua is a part. It is
something to keep in mind when we interact with refugees, military
veterans who have served in war zones, and other groups who have
an increased likelihood of having a history of trauma, including
racialized and other marginalized groups. It is also important for
social workers to be aware of the meaning of time for the individuals
and communities they serve.
Time is one of the three elements outlined in this text for studying
human behavior. It recognizes that people and environments are ever
changing, dynamic, and flowing.

© Comstock/Thinkstock

Two other dimensions of time have been identified as important to the

understanding of human behavior. Both dimensions are aspects of
linear time but have been separated out for special study by
behavioral scientists. The first, historical era, refers to the specific
block or period of time in which individual and collective lives are
enacted. The historical era in which we live shapes our environments.
The economies, physical environments, institutions, technologies,
and geopolitical circumstances of a specific era provide both options
for and constraints on human behavior. We can see what impact the
historical era in which Joshua spent his childhood has had on his life
trajectory. In an earlier time, he might have continued to live
peacefully in Uvira. How would his life have been different or the
same? Historical era has influenced Joshua’s story in another way.
His family resettled in the United States in 2007, a historical era in
which large refugee admissions programs existed in the United
States. If his family had wanted to resettle in the United States
between 2016 and 2020, they might have met the plight of many
DRC refugees who were denied an opportunity to settle here during a
time when federal funds for resettlement service organizations were
slashed (Mahoney et al., 2020). Researchers who study the impact of
external migration across national lines (also known as international
migration) on health point out that external migrants face different
social, political, and economic contexts during different historical eras
as conditions change in both their sending and receiving countries. In
addition, shifting immigration policies and shifting attitudes toward
particular migrant groups change the landscape for external migrants
over different historical eras (see Torres & Young, 2016).

The second time dimension, chronological age, seems to be an

important variable in every society. How people change at different
ages and life stages as they pass from conception to death has been
one of the most enduring ways of studying human behavior. Historical
era is examined throughout this book and its companion book
Dimensions of Human Behavior: The Changing Life Course, and
chronological age is the organizing framework for The Changing Life
Course.

Critical Thinking Questions 1.2

How would our understanding of Joshua’s story change if we had no

knowledge of his prior life experiences in the DRC and the Gatumba
refugee camp—if we only assessed his situation based on his current
functioning? What personal and environmental dimensions would we
note in his current functioning?

Advancing Human Rights and Social, Racial, Economic, and Environmental

Justice: A Global Perspective

The CSWE’s statement of the purpose of social work indicates that

social work practice is guided by a global perspective (CSWE, 2022).
What exactly does it mean, and why is it valued? We are increasingly
aware that we are part of an interconnected world, and Joshua’s story
is one reminder of this. Here are some aspects of what it means to
take a global perspective:

To be aware that my view of the world is not universally shared,

and others may have a view of the world that is profoundly
different from mine
To have a growing awareness of the diversity of ideas and
cultural practices found in human societies around the world
To be curious about conditions in other parts of the world and
how they relate to conditions in our own society
To understand where I fit in the global social structure and social
institutions
To have a growing awareness of how people in other societies
view my society
To have a growing understanding of how the world works, with
special attention to systems and mechanisms of privilege,
inequality, and oppression around the world
We have always been connected to other peoples of the world, but
those connections are being intensified by globalization , a process
by which the world’s people are becoming more interconnected
economically, politically, environmentally, and culturally. It is a process
of increased connectedness and interdependence that began at least
5 centuries ago but has intensified in recent times and is affecting
people around the world (Mann, 2011; Sernau, 2020). This increasing
connectedness is, of course, aided by rapid advancements in
communication technology. There is much debate about whether
globalization is a good thing or a bad thing, a conversation that is
picked up in Chapter 9 as we consider the globalization of social
institutions. What is important to note here is that globalization is
increasing our experiences with social diversity and raising new
questions about racism, diversity, equity, and inclusion.

As we strive to provide a global context, we encounter current

controversies about appropriate language to describe different
sectors of the world. Following World War II, a distinction was made
between First World, Second World, and Third World nations, with
First World referring to the Western capitalist nations, Second World
referring to the countries belonging to the socialist bloc led by the
Soviet Union, and Third World referring to a set of countries that were
primarily former colonies of the First World. More recently, many
scholars have used the language of First World, Second World, and
Third World to define global sectors in a slightly different way. First
World has been used to describe the nations that were the first to
industrialize, urbanize, and modernize. Second World has been used
to describe nations that have industrialized but have not yet become
central to the world economy. Third World has been used to refer to
nonindustrialized nations that are considered expendable in the
global economy. This approach has lost favor in recent years
because it is thought to suggest some ranking of the value of the
world’s societies. Immanuel Wallerstein (1974, 1979) uses different
language but makes a similar distinction; he refers to wealthy core
countries, newly industrialized semiperiphery countries, and the
poorest periphery countries. Wallerstein is looking not to rank the
value of societies but to emphasize the ways that some societies
(core) exploit other societies (periphery).
Other writers divide the world into developed and developing
countries (McMichael & Weber, 2021), referring to the level of
industrialization, urbanization, and modernization. Although scholars
who use those terms are not necessarily using them to rank the value
of different societies, the terms are sometimes used that way. Still
other scholars divide the world into the Global North and the Global
South, calling attention to a history in which the Global North
colonized and exploited the people and resources of the Global
South. This system of categorization focuses specifically on how
some societies exploit other societies. And, finally, some writers talk
about the West versus the East, where the distinctions are largely
cultural. We recognize that such categories carry great symbolic
meaning and can either mask or expose systems of power and
exploitation. Different researchers have used different language and
different characteristics to describe categories of nations, and when
reporting on their findings, we have used their own language to avoid
misrepresenting their findings—with some critique of the language
and measures used.

Human Rights and Social, Racial, Economic, and Environmental Justice

In its statement of social work competencies, the CSWE (2022, p. 9)

identifies the following two interrelated competencies “advance
human rights and social, racial, economic, and environmental justice”
and “engage anti-racism, diversity, equity, and inclusion.” In the
following section we begin with a discussion of human rights and
social, racial, economic, and environmental justice and move to a
discussion of anti-oppressive and anti-racist practice, diversity, and
equity and social inclusion (ADEI) in practice. Before examining the
different concepts presented in these two competencies, it is
important to note that social, racial, economic, and environmental
justice are intertwined, integrated in major social institutions. That will
be the topic of Chapter 9, Social Structure and Social Institutions.

Let’s look first at human rights. The CSWE (2022) states that “social
workers understand that every person regardless of position in
society has fundamental human rights” and “engage in practices that
advance human rights to promote social, racial, economic, and
environmental justice” (p. 9). As social workers have expanded the
conversation about social justice to include global social justice, they
have more and more drawn on the concept of human rights to
organize thinking about social justice (see Mapp, 2021; Wronka,
2017). In the aftermath of World War II, the newly formed United
Nations (1948) created a Universal Declaration of Human Rights
(UDHR) that spelled out the rights to which all humans were entitled,
regardless of their place in the world, and this document has become
a point of reference for subsequent definitions of human rights. Cox
and Pawar (2013) identify eight philosophical values suggested by
the UDHR: life (human and nonhuman); freedom and liberty; equality
and nondiscrimination; justice; solidarity; social responsibility;
evolution, peace, and nonviolence; and relationships between
humankind and nature. This listing of human rights values reminds us
of the many ways that basic human rights were denied to Joshua and
his Banyamulenge ethnic group. It is important for social workers who
work in refugee resettlement organizations to recognize the history of
human right violations faced by the refugee families they meet and to
ensure human rights protections in their resettlement work.

The idea that every human has certain basic rights is a relatively new
idea and is not equally shared around the world today. Slavery was a
universal institution in ancient and medieval times and still exists in
some places, and the limitation of human rights of some was a
feature of colonialization and continues today (Moore, 2020).
Joshua’s story is one example of the ways that human rights as we
now think of them continue to be violated around the world. One of
the issues that arises when we think of human rights is whether
reparations should be made for human rights violations. The UDHR
declaration on human rights claims that victims of human rights
violations are entitled to compensation (United Nations, 1948).
Transitional justice is an approach to systematic and massive
violations of human rights that calls for both accountability of the
perpetrators and redress for victims. It includes such measures as
criminal prosecutions, truth commissions, reparation programs, and
institutional reforms (Seul, 2019). Growing numbers of such
measures are being implemented in the United States and around the
world.

Now, let’s look at the concept of social justice. Several theories of

social justice have been proposed. Probably the most frequently cited
theory of social justice in the social work literature is John Rawls’s
(1971, 2001) theory of justice as fairness which focuses on the fair
distribution of primary social goods. In the past decade or so, some
social work scholars (M. Banerjee & Canda, 2012; Carlson et al.,
2016; Navratilova et al., 2021) have recommended the capabilities
approach to social justice as an alternative to Rawls’s theory of
justice as fairness. The capabilities approach was originally proposed
by Amartya Sen (1992, 2009) and revised by Martha Nussbaum
(2011). The capabilities approach draws on both Western and non-
Western thinking. In this approach, capabilities are, in simplest terms,
opportunities and freedoms to be or do what we view as worthwhile;
justice is served when people have such opportunities and freedoms.
Nussbaum carries the capabilities approach a step further and
identifies 10 core capabilities that all people in all societies must have
to lead a dignified life. She asserts that promotion of social justice
involves supporting the capabilities of people who are denied
opportunities and freedoms related to any of the core capabilities:

Life. To live to the end of a normal life course

Bodily health. To have good physical health and adequate
nourishment and shelter
Bodily integrity. To exercise freedom of movement, freedom from
assault, and reproductive choices
Senses, imagination, and thought. To have pleasant sensory
experiences, pain avoidance, adequate education, imagination,
free self-expression, and religious freedom
Emotion. To experience a full range of emotions and to love and
be loved
Practical reason. To think critically and make wise decisions
Affiliation. To live with others with empathy and compassion,
without discrimination
Concern for other species. To show concern for animals, plants,
and other aspects of nature
 Play. To laugh and play and enjoy recreational activities
Control over one’s political and material environment. To
participate freely in the political process and have equal access
to employment and property

In contrast with Nussbaum, Sen argues that no list of core capabilities

can be arbitrarily delineated because of the great diversity of people
and environments in the world. He thinks that individuals should be
left to decide which capabilities they choose to enhance or neglect.

Social workers also value the advancement of racial justice, which is

the systemic fair treatment of all people and equitable opportunities
for everyone. The identity of the United States is rooted in the political
ideals of liberty, equality under the law, dignity, and individual rights,
an identity juxtaposed with a history of racial injustices such as
slavery, Jim Crow, racial terror, stolen property, discrimination in many
forms, and genocide and cultural annihilation of Indigenous people, a
history that has created pervasive structural inequality. Heather Cox
Richardson (2020) writes that the history of the United States is built
on paradox and contradictions. The very men who wrote the founding
documents that declared “all men” equal were slave owners. When
thinking of racial justice, the first question that arises is how does a
society make the transition from a long history of racial injustice that
has accumulated over time to become a society characterized by
racial justice? Is transitional justice necessary and, if so, what
measures are needed? There are some examples of reparation
compensations in the United States: payments to Japanese
Americans interned during World War II, survivors of police abuse in
Chicago, victims of forced sterilization, and Black residents of a
Florida town that was burned by a murderous mob. In 2021, Virginia
legislators passed a law that requires five public universities to make
reparations to descendants of enslaved workers who built their
institutions, using such measures as scholarships, community-based
economic development, and memorial programs (Perry & Barr, 2021).

The future of transitional racial justice in the United States is unclear,

but social workers can participate in two types of reforms to advance
racial justice in the United States and other countries. First, the
truthful racial history must be told. In the United States there are
many attempts to prevent the true telling of racial history in public
primary and secondary schools. Recently, this resistance to racial
truth-telling in public schools has appeared in the form of state and
local laws prohibiting the teaching of critical race theory (discussed in
Chapter 2). Social workers should join in the effort to promote truth-
telling about race in public school curricula. Second, every major
social institution must be examined for ways it perpetuates systemic
racism and the necessary institutional reforms must be pursued.
Social workers must put a critical eye to the systemic racism in the
organizations in which they are employed and the ones with which
they have collaborative relationships. In addition, themes of white
superiority in interpersonal interactions must be recognized,
challenged, and disrupted.

Advancing economic justice is a goal of social work both

internationally and in the United States (CSWE, 2022; International
Federation of Social Workers [IFSW], 2020). And yet there is no
agreed-on definition of economic justice. The Boston University
School of Public Health (2017) defines economic justice as “a set of
moral principles for building economic institutions, the ultimate goal of
which is to create an opportunity for each person to create a sufficient
material foundation upon which to have a dignified, productive, and
creative life beyond economics” (para. 3). This definition focuses on
economic justice as the provision of the necessary economic
resources for social inclusion, a topic to be covered shortly. As I am
sure you have observed, there are many conflicting ideas about what
constitutes a fair distribution of income, wealth, and economic
opportunity. Economic justice includes issues of fair price in the
economic market, fair wage, and just profit.

Writing about economic justice and social work, Simmons (2021)

defines six realms of economic justice for social work consideration:

1. Issues of the interplay of economic inequality with racial and

gender inequalities
2. Workplace rights, including the right to organize
3. Wage levels
 4. Immigrant worker rights
5. Community-labor partnerships
6. Expansion of social programs, such as assistance to
unemployed, underemployed, and never-employed people;
expanding unemployment insurance; expanding nutritional
assistance; and so on

In its statement of the grand challenges for social work, the American
Academy of Social Work and Social Welfare (AASWSW, 2021)
includes two economic justice issues: (1) building financial capability
and assets for all, and (2) reducing extreme economic inequality. As
discussed in Chapter 9, Social Structure and Social Institutions,
economic inequality has been growing around the world, and
especially in the United States, under the political theory of
neoliberalism and the rate of growth accelerated during the COVID-
19 pandemic.

Social work has recently committed to advancing environmental

justice, which involves equitable access to clean and healthy
environments for all people, the same degree of protection from
environmental hazards or degradation across demographic groups or
communities, and equal inclusion in decision-making about how to
create healthy communities. Issues of environmental justice will be
discussed in Chapter 7, The Physical Environment.

Anti-oppressive and Anti-racist Practice

In the case study at the beginning of the chapter, Joshua’s ethnicity,

but not his race, opened him to human rights violations in the DRC.
He has been surprised to learn the extent of racial bias and
discrimination in the United States. The CSWE (2022) states that
“social workers demonstrate anti-racist and anti-oppressive social
work practice” at all levels of practice (p. 10). Let’s look first at the
broader idea, anti-oppressive practice. Oppression is the act of
disempowering, marginalizing, silencing, or otherwise subordinating a
social group or category. It may include observable actions but more
typically refers to complex, covert, interconnected processes and
practices (such as discriminating, devaluing, and exploiting a group of
individuals). To practice anti-oppressive social work, social workers
must recognize and disrupt a variety of mechanisms of oppression.

Suzanne Pharr (1988) provides some useful conceptual tools that

can help us recognize oppression and injustice when we see it. She
identifies a set of mechanisms of oppression, whereby the everyday
arrangements of social life systematically block opportunities for
some groups and inhibit their power to exercise self-determination.
Table 1.2 provides an overview of these mechanisms of oppression.
As you review the list, you may recognize some that are familiar to
you, such as stereotyping and perhaps blaming the victim. There may
be others that you have not previously given much thought to. You
may also recognize, as I do each time I look at the list, that although
some of these mechanisms of oppression are sometimes used quite
intentionally, others are not so intentional but occur as we do
business as usual. For example, when you walk into your classroom
or other public room, do you give much thought to the person who
cleans that room, what wage this person is paid, their financial
security during the COVID-19 pandemic, whether this is the only job
this person holds, and what opportunities and barriers this person has
experienced in life? Most likely the room is cleaned in the evening
after it has been vacated, and the person who cleans it, like many
people who provide services that make our lives more pleasant, is
invisible to us. Giving serious thought to common mechanisms of
oppression can help us to recognize oppression and social injustice
and think about ways to challenge it.

Table 1.2
Source: Adapted from Homophobia: A Weapon of Sexism, by S.
Pharr, 1988, Chardon Press.

One form of anti-oppressive practice is anti-racist practice. Anti-

racism is a process of actively identifying and opposing racism.
Racialized groups and racialized communities are terms frequently
used to refer to all people who are not considered white in the
processes of categorizing and marginalizing people according to race
for the purpose of maintaining white supremacy and social exclusion.
In the United States, racialized groups are also referred to as BIPOC
(Black, Indigenous, and People of Color), often with the intent of
centering their experiences in a racialized world. In this book, both
racialized group and BIPOC are used to refer to the same group of
people. At times, researchers study only one racialized group, such
as Black or African American or Indigenous, and in those situations,
the specific group will be noted using the researcher’s language.

Although social work has long had a stated commitment to social

justice, both social work education and the practice of social work
have too often reflected white supremacy. The telling of the history of
the profession has focused on white women leaders such as Jane
Addams and Mary Richmond and been silent on the early leadership
of the many BIPOC social work pioneers such as Ida B. Wells-
Barnett, Eugene Kinckle Jones, Dorothy Height, W. E. B. Du Bois,
Frederick Douglass, and many other hidden BIPOC social reform
leaders (Wright et al., 2021). The profession has too often thought of
BIPOC people as receivers, not providers, of service and used
theories and diagnostic systems of trauma that do not consider the
cumulative trauma faced by racialized groups (Riquino et al., 2021). It
has too often failed to recognize the natural helping networks of
Indigenous and other racialized groups (McCleary & Simard, 2021).
Human behavior and practice theories that center white culture have
been used, and educational institutions and service organizations
have too often been unwelcoming, even hostile, spaces for members
of racialized groups. The issue of culture-bound human behavior
theories will be explored in Chapter 2 of this book. Social workers
dedicated to anti-oppressive, anti-racist practice can benefit from
learning the methods for identifying and opposing racism presented in
Sue and colleagues’ book Microintervention Strategies (Sue et al.,
2021).

Diversity

The CSWE (2022) states that

Social workers understand how diversity and intersectionality

shape human experiences and identity development and affect
equity and inclusion. The dimensions of diversity are understood
as the intersectionality of factors including but not limited to age,
caste, color, culture, disability and ability, ethnicity, gender,
gender identity and expression, generational status, immigration
status, legal status, marital status, political ideology, race,
nationality, religion and spirituality, sex, sexual orientation, and
tribal sovereign status. (p. 9)

To understand who Joshua (case study at the beginning of the

chapter) is, we would want to think of him in relation to some of these
factors.

Diversity has always been a part of the social reality in the United
States. Even before the Europeans came, the Indigenous people
were divided into about 200 distinct societies with about 200 different
languages (Parrillo, 2013). Since the inception of the United States of
America, many waves of immigration have created the multiethnic,
multicultural character of the country. There have always been
tensions about how we as a nation handle diversity. Are we a melting
pot where all are melted into one indistinguishable model of
citizenship, or are we a pluralist society in which groups have
separate identities, cultures, and ways of organizing but work
together in mutual respect? Pluralism is consistent with social work’s
concern for human rights.

Even though diversity has always been present in the United States,
it is accurate to say that some of the diversity in our national social
life is new. There is increasing racial, ethnic, and religious diversity in
the United States, and the mix in the population stream has become
much more complex in recent years. The United States was 87%
white in 1925, 80% white in 1950, and 72% white in 2000; by 2045, it
is projected that we will be about 49.7% white (Frey, 2018; Taylor &
Cohn, 2012). Figure 1.5 shows the projected racial profile of the
United States for 2045. It is important to note, as you will read in
Chapter 8, Cultures, that the meaning of white has been and
continues to be a moving target in the United States. But why is this
demographic change happening at this time? A major driving force is
the demographic reality that native-born white people are no longer
reproducing at replacement level in the wealthy postindustrial nations,
which, if it continues, will lead to a declining population skewed
toward advanced age. One solution used by some countries,
including the United States, is to change immigration policy to allow
new streams of cross-national migration. The current rate of foreign-
born persons in the United States is lower than it has been
throughout most of the past 150 years, but foreign-born persons are
less likely to be white than when immigration policy, prior to 1965,
strictly limited entry for persons of color. With the recent influx of
immigrants from around the globe, the United States has become one
of many ethnically and racially diverse nations in the world today. In
many wealthy postindustrial countries, including the United States,
there is much anti-immigrant sentiment, even though the economies
of these countries are dependent on such migration. Waves of
immigration have historically been accompanied by anti-immigrant
sentiment. There appear to be many reasons for anti-immigrant
sentiment, including fear that new immigrants will dilute the “purity” of
the native culture, racial and religious bias, and fear of economic
competition. Wilkerson (2020) proposes that fear of no longer being
the majority race is fueling a rise in white nationalism in the United
States and is the motive behind such political phenomena as calls for
restricted immigration, gerrymandered congressional districts, and
voter suppression laws. As this chapter is being written, a “great
replacement” conspiracy theory is circulating, claiming that there is an
ongoing active but covert effort to replace white populations in
countries that are currently white majority (Southern Poverty Law
Center, 2022).
Description

Figure 1.5 Racial Profile of U.S. Population, 2045

Source: The US Will Become “Minority White” in 2045, Census

Projects: Youth Minorities Are the Engine of Future Growth, by W.
Frey, 2018, Brookings. Retrieved from
https://www.brookings.edu/blog/the-avenue/2018/03/14/the-us-will-
become-minority-white-in-2045-census-projects/.

On the other hand, some of the diversity in our social life is not new
but simply newly recognized. In the contemporary era, we have been
developing a heightened consciousness of human differences—
gender, gender identity, and gender expression differences; racial and
ethnic differences; cultural differences; religious differences;
differences in sexual orientation; differences in abilities and
disabilities; differences in family forms; and so on. It is important for
social workers to respect diversity of human experiences and
recognize differences within groups as well as between groups.

As we seek to honor differences, we make a distinction between

heterogeneity and diversity. We use heterogeneity to refer to
individual-level variations—differences among individuals. For
example, as a social worker who came in contact with Joshua’s family
at the time they were resettled in Boise, you would want to recognize
the ways in which they are different from you and from other people
you know, and different from other people of Banyamulenge heritage.
An understanding of heterogeneity allows us to recognize the
uniqueness of each person and situation. Diversity , on the other
hand, is used to refer to patterns of group differences. Diversity refers
to social groups, groups of people who share a range of physical,
cultural, or social characteristics within a category of social identity.
Knowledge of diversity helps us to provide culturally sensitive
services.

When we think about human diversity, it is important to think in terms

of intersectionality , a theory of group-based social identity that
recognizes that all of us are simultaneously members of a number of
socially constructed identity groups, such as those based on gender,
gender identity, race, ethnicity, social class, sexual orientation, age,
religion, geographical location, disability/ability, and so on (Crenshaw,
2021; Guittar & Guittar, 2015; Holman & Walker, 2021).
Intersectionality theory is rooted in the writings of U.S. Black feminists
who challenged the idea of a universal gendered experience (see
Collins, 2012; Collins & Bilge, 2020). For any one of us, our social
location (place in society) is at the intersection of our multiple identity
groups. We must recognize how our own particular social location
shapes how we see the world, what we notice, and how we interpret
what we “see.” Intersectionality theory emphasizes that either
advantage or disadvantage is associated with identity groups, and
when considering the life journey of any one individual, it is important
to consider the multiple identity groups of which they are a part
(Brown, 2018).

Attending to diversity involves recognition of the power relations and

the patterns of opportunities and constraints for social groups. If we
are interested in the Banyamulenge community in our city, for
example, we will want to note, among other things, the
neighborhoods where they live, the access to community resources
and quality of the housing stock in those neighborhoods, the
comparative educational attainment in the community, the
occupational profile of the community, the comparative income levels,
and so on. When we attend to diversity, we not only note the
differences between groups but also how socially constructed
hierarchies of power are superimposed on these differences.

Recent U.S. scholarship in the social sciences has emphasized the

ways in which three types of categorizations—gender, race, and class
—are used to develop hierarchical social structures that influence
social identities and life chances (Rothenberg, 2016; Sernau, 2020).
This literature suggests that these social categorizations create
privilege , or unearned advantage, for some groups and disadvantage
for other groups. In a much-cited article, Peggy McIntosh (2016) has
pointed out the mundane daily advantages of white privilege that are
not available to members of groups of color, such as assurances “that
my children will be given curricular materials that testify to the
existence of their race,” and “Whether I use checks, credit cards, or
cash, I can count on my skin color not to work against the
appearance of financial reliability.” We could also generate lists of
advantages of male privilege, age privilege, economic privilege,
heterosexual privilege, ability privilege, religious privilege, and so on.
McIntosh argues that members of privileged groups benefit from their
privilege but have not been taught to think of themselves as
privileged. They take for granted that their advantages are normal
and universal and are often resistant to attempts to point out the
privilege of their social locations. For survival, members of
nonprivileged groups must learn a lot about the lives of groups with
privilege, but groups with privileged status are not similarly compelled
to learn about the lives of members of nonprivileged groups.
Michael Schwalbe (2006) argues that those of us who live in the
United States also carry “American privilege,” which comes from our
dominant position in the world. (I would prefer to call this “U.S.
privilege,” because people living in Canada, Ecuador, and Brazil also
live in America.) According to Schwalbe, among other things,
American privilege means that we don’t have to bother to learn about
other countries or about the impact of our foreign policy on people
living in those countries. For example, we don’t have to learn about
how our society’s romance with computers and cell phones helps to
drive conflict over the natural resource of coltan in the Congo.
American privilege also means that we have access to cheap goods
that are produced by poorly paid workers in impoverished countries.
As Chapter 9 shows, the income and wealth gap between nations is
mind-boggling. In 2020, the average per capita income in the DRC
was $544.00 in U.S. dollars, compared with $63,593.40 in the United
States (World Bank, 2020). The DRC is rich in natural resources
wanted by the United States and other wealthy nations, but the
country’s economic conditions have been hurt by a colonial history
followed by continuous war (Sernau, 2020). It is becoming
increasingly difficult to deny the costs of exercising American privilege
by remaining ignorant about the rest of the world and the impact our
actions have on other nations.

This is a good place to interject some words about the language of

diversity as used in this book. In their study of human diversity,
human behavior researchers continuously struggle to find respectful
language to define different identity groups. You have probably
noticed that the language used to describe identity groups is ever-
changing and that not every member of a given identity group
embraces the same language at a given point in time. For example,
there is much controversy over the use of the term Latinx to describe
people from Latin America (Newport, 2022). There are personal,
generational, regional, and other types of variations in preferred
diversity language. We have also found that different researchers
define and measure identity groups in different ways—and the U.S.
Census Bureau and other governmental agencies use their own,
sometimes peculiar, language to describe and measure identity
groups. In this book, when we report on human behavior research,
we use the language of the researcher so as not to distort their work.
Likewise, when we report on census data, research based on census
data, or data from other governmental agencies, we use the language
of those agencies. That means that different terms are used at
different points to describe the same identity group. We are also
guided by copyediting style manuals regarding bias-free language.
We hope that you will recognize that the ever-changing language of
diversity has both constructive potential to find creative ways to affirm
diversity and destructive potential to dichotomize diversity into the
norm and the other.

Critical Thinking Questions 1.3

What impact is globalization having on your own life? Do you see it

as having a positive or negative impact on your life? What about for
Joshua? Do you think globalization is having a positive or negative
impact on his life? Do you agree with Martha Nussbaum that it is
important for all people to have opportunities and freedoms in relation
to the 10 core capabilities she identifies? How do you see Joshua in
relation to these core capabilities?

Equity and Social Inclusion

When Joshua and his siblings entered public school in Boise, Idaho,
their lack of knowledge of the English language meant they were not
on a level playing field with native English speakers. Joshua and his
siblings were among the one in five students in the United States who
speak a language other than English at home (New America, 2022).
Special assistance to English learners in the school system is
essential to level the playing field for these students, to allow them to
pursue learning and be included in the social life of the school.

As social workers participate in advancing social, racial, economic,

and environmental justice, we focus on two important interrelated
goals: equity and social inclusion. Equity is an ethical norm that
proposes that existing social, racial, economic, political, and
environmental inequalities require policies and practices that aim to
level the playing field for those in disadvantaged position, recognizing
that not all people are starting from the same place. As demonstrated
in Figure 1.6, the principle of equity recognizes that equal treatment
may be unfair, and measures must be taken to ensure that those with
fewer resources have equal access to social inclusion. Although it
has not been fully realized, equity was the goal of the Americans with
Disabilities Act (ADA), which became law in the United States in 1990
(Pappas, 2020). It required reasonable accommodations to allow
people with disabilities to be included in all sectors of society.

Description

Figure 1.6 Inequality, Equality, Equity, and Justice

Social inclusion is a multidimensional process to ensure that people

at risk of being left out gain the opportunities and resources needed
to participate fully in all aspects of life, including civic, social,
economic, political, and cultural life. It involves creating environments
where individuals and groups are respected, valued, and supported
and eliminating policies, practices, and behaviors that result in the
marginalization and exclusion of some. Social inclusion involves
removing both structural and interpersonal barriers to the full
participation by excluded groups. It recognizes that some groups
have been excluded not only by social policies and social institutions
but also by stigmatizing attitudes, beliefs, and behaviors. Berger and
Sarnyai (2015) report that chronic exposure to social exclusion
affects the brain in such a way to lead to social defeat, a sense that
one has no power to affect the course of one’s life and may contribute
to the development of mental illness.

Figure 1.6 demonstrates that social inclusion and justice require

changing social systems where possible to offer equal access to
resources and opportunities. Social inclusion also requires that
people have a voice in decisions that affect their lives. This idea has
been captured in the phrase “nothing about me without me,” a phrase
that has been used to mean that medical decisions should not be
made without consulting the patient. It has also been stated as
“nothing about us without us” to communicate that no social policy
should be decided without the full and direct participation of members
of the group(s) affected by that policy. Social workers have an
important role to play to ensure that all people have a voice in
decisions that affect their lives.

The U.S. social welfare institution has, historically, put primary

emphasis on promoting independence and preventing dependence.
In contrast, the European social welfare states have put more
emphasis on promoting social inclusion and using the social welfare
institution as an investment to protect the health of the society, which
they refer to as social protection (European Commission:
Employment, Social Affairs & Inclusion, 2022). Some policy analysts
in the United States argue that social inclusion should be the goal of
U.S. social welfare policy (Boushey et al., 2007), and this should be a
goal of legislative advocacy by U.S. social workers.

Knowing and Doing

Social workers, like other professional practitioners, must find a way
to move from knowing to doing, from “knowing about” and “knowing
that” to “knowing how to” (for fuller discussion of this issue, see
Hutchison et al., 2007). Social workers know about human behavior
for the purpose of doing. Like architects, engineers, physicians, and
teachers, social workers are faced with complex problems and case
situations that are unique and uncertain. You no doubt will find that
social work education, social work practice, and even this book will
stretch your capacity to tolerate ambiguity and uncertainty. That is
important because, as Carol Meyer (1993) suggested, “There are no
easy or simple [social work] cases, only simplistic perceptions” (p.
63). There are four important ingredients of “knowing how” to do
social work: knowledge about the case, knowledge about the self,
values and ethics, and scientific knowledge. These four ingredients
are intertwined in the process of doing social work. The focus of this
book is on scientific knowledge, but all four ingredients are essential
in social work practice. Before moving to a discussion of scientific
knowledge, let’s take a brief look at the other three ingredients.

Knowledge About the Case

In this context, case is used to mean the situation at hand, a situation

that has become problematic for some person or group of people,
resulting in a social work intervention. Our first task as social workers
is to develop as good an understanding of the situation as possible:
Who is involved in the situation, and how are they involved? What is
the nature of the relationships of the people involved? What are the
physical, societal, cultural, organizational, and community contexts of
the situation? What are the contextual constraints as well as the
contextual resources for bringing change to the situation? What
elements of the case are maintaining the problematic situation? How
have people tried to cope with the situation? What preferences do the
involved people have about the types of intervention to use? What is
the purpose, culture, and social resources of the social agency to
whose attention the situation is brought? You might begin to think
about how you would answer some of these questions in relation to
Joshua’s family when they arrived in Boise and were assisted by the
refugee resettlement agency.

It is important to note that knowledge about the case is influenced by

the quality of the relationship between the social worker and client(s).
There is good evidence that people are likely to reveal more aspects
of their situation if they are approached with commitment, an open
mind, warmth, empathic attunement, authentic responsiveness, and
mutuality (Hepworth et al., 2017). For example, as Joshua became
comfortable in the interview, feeling validated by the interviewer, he
began to engage in deeper reflection about what happened in the
DRC and Burundi. He had never put the story together in this way
before. This can be an important part of his grieving and adjustment
process. The integrity of knowledge about the case is related to the
quality of the relationship, and the capacity for relationship is related
to knowledge about the self.

But knowledge about the case requires more than simply gathering
information. We must select and order the information at hand and
decide if further information is needed. This involves making a series
of decisions about what is relevant and what is not. It also involves
searching for recurring themes as well as contradictions in the
information. For example, family loss is a consistent theme
throughout Joshua’s story, as is his strength and commitment to
move forward to adjust to new situations. Listening to his story, you
notice that the Gatumba massacre is mentioned very early in the
story telling, and this alerts us to the possibility that other
Banyamulenge refugees may need to reflect on the Gatumba
massacre.

To assist you in moving between knowledge about the case and

scientific knowledge, each chapter in this book begins as this one
does with one or more case studies. Most of the case studies change
names and other identifying information to protect confidentiality.
Each of these unique stories suggests what scientific knowledge is
needed. For example, to work effectively with Banyamulenge
refugees like Joshua, you will want to understand some things about
the DRC, the Banyamulenge ethnic group, grief reactions, the
acculturation process, challenges facing immigrant families, and
cross-cultural communication. Throughout the chapters, the stories
are woven together with relevant scientific knowledge. Keep in mind
that scientific knowledge is necessary, but you will not be an effective
practitioner unless you take the time to learn about the unique
situation of each person or collectivity you serve. It is the unique
situation that guides what scientific knowledge is needed.

Knowledge About the Self

In his book The Spiritual Life of Children, Robert Coles (1990) wrote
about the struggles of a 10-year-old Hopi girl to have her Anglo
teacher understand Hopi spirituality. Coles suggested to the girl that
perhaps she could try to explain her tribal nation’s spiritual beliefs to
the teacher. The girl answered, “But they don’t listen to hear us; they
listen to hear themselves” (p. 25, emphasis in the original). This
young girl has captured, in a profound way, a major challenge to our
everyday personal and professional communications: the tendency to
approach the world with preconceived notions that we seek to
validate by attending to some information while ignoring other
information (Kahneman, 2011). The capacity to understand oneself is
necessary to tame this very human tendency.

Three types of self-knowledge are essential for social workers:

understanding of one’s own thinking processes, understanding of
one’s own emotions, and understanding of one’s own social location.
We must be able to think about our thinking, a process called
metacognition. We all have biases that lead to thinking errors, and it
is very difficult to get control of our biases. In addition, both anger and
stress can lead us to think less critically and make erroneous
judgments (Sapolsky, 2017). As Daniel Kahneman (2011) suggests in
his book Thinking Fast and Slow, constant questioning of our own
thinking can become tedious and immobilize us. The best we can do,
therefore, is to understand the types of situations in which we are
likely to make mistakes and slow down and use multiple sources of
information to help correct for our biases. We also must be able to
recognize what emotions get aroused in us when we hear stories like
Joshua’s and when we contemplate the challenges of a given
situation, and we must find a way to use those emotions in ways that
are helpful and avoid using them in ways that are harmful. Although
writing about physicians, Gunnar Biorck (1977) said it well when he
commented that practitioners make “a tremendous number of
judgments each day, based on inadequate, often ambiguous data,
and under pressure of time, and carrying out this task with the
outward appearance of calmness, dedication and interpersonal
warmth” (p. 146).

In terms of social location, social workers must identify and reflect on

where they fit in a system of social identities, such as race, ethnicity,
gender and gender identity, social class, sexual orientation, religion,
ability/disability, age, and so on. A strong personal identity in relation
to important societal categories, and an understanding of the impact
of those identities on other people, is essential for successful social
work intervention across cultural lines. This type of self-knowledge
requires reflecting on where one fits in systems of privilege and
disadvantage.

Values and Ethics

The CSWE (2022) indicates the importance of values and ethics for
social work practice by making it number one in its identification of
social work competencies: Competency 1: Demonstrate Ethical and
Professional Behavior (p. 4). Knowledge about the self is critical to
ethical and professional social work practice. To engage in such
practice, we must recognize the difference between personal and
professional values and use reflection and self-regulation to manage
our personal values and our very human cognitive biases and
emotional reactions. That is why the first learning objective for each
chapter in this book and the companion volume Dimensions of
Human Behavior: The Changing Life Course is to recognize one’s
own cognitive and emotional reactions to the case studies that
introduce the chapter. Doing this kind of self-reflection is an important
part of ethical social work practice.
The process of developing knowledge about the case is a dialogue
between the social worker and client system, and social workers have
a well-defined value base to guide the dialogue. Six core values of
the profession have been set out in a preamble to the Code of Ethics
established by the National Association of Social Workers (NASW) in
1996 and revised in 2021 (NASW, 2021b). These values are service,
social justice, dignity and worth of the person, importance of human
relationships, integrity, and competence. The value of social justice
was discussed earlier in the chapter. The Code of Ethics articulates
an ethical principle for each of the core values:

1. Service. Social workers’ primary goal is to help people in need

and to address social problems.
2. Social justice. Social workers challenge social injustice.
3. Dignity and worth of the person. Social workers respect the
inherent dignity and worth of the person.
4. Importance of human relationships. Social workers recognize the
central importance of human relationships.
5. Integrity. Social workers behave in a trustworthy manner.
6. Competence. Social workers practice within their areas of
competence and develop and enhance their professional
expertise.

Value 6, competence, requires that we recognize the science

available to inform our work. It requires understanding the limitations
of the available science for considering the situation at hand but also
that we use the strongest available evidence to make practice
decisions. This is where scientific knowledge comes into the picture.

Critical Thinking Questions 1.4

If you were the social worker at Joshua’s refugee resettlement

program when he first arrived in the United States, what knowledge
about the case would you like to have? What information would you
find most important? What emotional reactions did you have to
reading Joshua’s story? What did you find yourself thinking about his
story? Where do you see Joshua fitting in systems of privilege and
disadvantage? Where do you see yourself fitting? How might any of
this impact your ability to be helpful to Joshua and his family?

Scientific Knowledge: Theory and Research

The CSWE (2022) notes that social work practice is guided by

“knowledge based on scientific inquiry” (p. 14). Ethical social workers
are always searching for or recalling what is known about the
situations they encounter, turning to the social and behavioral
sciences for this information. Scientific knowledge serves as a screen
against which the knowledge about the case is considered. It
suggests hypotheses, or tentative statements, to be explored and
tested, not facts to be applied, in transactions with a person or social
group. Because of the breadth and complexity of social work practice,
usable knowledge must be culled from diverse sources and a number
of scientific disciplines. Science is a systematically organized body of
knowledge on a particular subject. Scientific knowledge is the
knowledge produced by scientific inquiry. Two interrelated
approaches to knowledge building, theory and empirical research, fit
the scientific criteria of being logical, systematic, and documented for
the public. Together, they create the base of knowledge that social
workers need to understand human behavior. In your coursework on
social work research, you will be learning much more about these
concepts, so only a brief description is provided here to help you
understand how this book draws on theory and research.

Theory

As we discuss in Chapter 2, the CSWE (2022) notes that “social

workers understand theories of human behavior and person-in-
environment and critically evaluate and apply this knowledge” (p. 11).
Social workers use theory to help organize and make sense of the
situations they encounter. A theory is a system of ideas that helps us
make sense of interrelated phenomena. Human behavior theories
help us think about and understand the complexities of human
behavior, both individual behavior and collective behavior. As Elaine
Leeder (2020) so aptly put it, “To have a theory is to have a way of
explaining the world” (p. 8). Thus, theory gives us a framework for
engaging with, assessing, and intervening with client systems. It
seems to be human nature to develop theories to make sense of the
world. As social workers we put our personal theories of the world to
the test by studying theories proposed by serious scholars of human
behavior. Theories allow us to organize our thinking, but theories are
not “fact” or “truth.” They can provide a window on human behavior
but if taken as fact or truth they can put us in a box that does not
allow us to see alternative views of human behavior.

Other terms that you will often encounter in discussions of theories

are model, paradigm, and perspective. Model usually is used to refer
to a visual representation of the relationships between concepts,
paradigm most often means a way of seeing the world, and
perspective is an emphasis, view, or lens through which we look.
Paradigms and perspectives are broader and more general than
theory. But different scholars use these terms in different ways, and
sometimes interchangeably.

If you are to make good use of theory, you should know something
about how it is constructed. Concepts are the building blocks of
theory. They are symbols, or mental images, that summarize
observations, feelings, or ideas. Concepts allow us to communicate
about the phenomena of interest. Some relevant concepts in
Joshua’s story are culture, cultural conflict, refugee, resettlement,
acculturation, trauma, loss, and grief. Theoretical concepts are put
together to form propositions, or assertions about the relationships
among concepts. For example, loss and grief theory proposes that
the loss of a person, object, or ideal leads to a grief reaction. This
proposition, which asserts a particular relationship between the
concepts of loss and grief, may help a refugee resettlement social
worker understand some of the sadness, and sometimes despair, that
they see in work with refugee families. They have lived with an
accumulation of losses—loss of land, loss of livelihood, loss of roles,
loss of status, loss of family members, loss of familiar language and
rituals, and many more. It is important to remember that theory is
about likelihood, not certainty. Not all who experience loss will grieve
and not all grief reactions are the same.
Social and behavioral science theories are based on assumptions, or
beliefs held to be true without testing or proof, about the nature of
human social life. Human behavioral theoretical assumptions have
raised a number of controversies, three of which are worth
introducing at this point.

1. Do the dimensions of human behavior have an objective reality

that exists outside a person’s consciousness, or is all reality
based on personal perception ( subjective reality )?
2. Is human behavior determined by forces beyond the control of
the person ( determinism ), or are people free and proactive
agents in the creation of their behavior ( voluntarism )?
3. Are the patterned interactions among people characterized by
harmony, unity, and social cohesion or by conflict, domination,
coercion, and exploitation?

It is important to consider the assumptions a theory makes as you

think about its usefulness for social work practice. The nature of the
controversies noted above will become more apparent in Chapter 2
and other chapters. The contributing authors and I take a middle
ground on all of them: We assume that reality has both objective and
subjective aspects, that human behavior is partially constrained and
partially free, and that social life is marked by both cohesion and
conflict.

Empirical Research

Traditionally, science is equated with empirical research, which is

widely held as the most rigorous and systematic way to understand
human behavior. Research is typically viewed, in simple terms, as a
problem-solving process, or a method of seeking answers to
questions. If something is empirical, we experience it through our
senses, as opposed to something we experience purely in our minds.
The process of empirical research includes a careful, purposeful, and
systematic observation of events with the intent to note and record
them in terms of their attributes, to look for patterns in those events,
and to make our methods and observations public. Each empirical
research project is likely to raise new questions, often producing
more questions than answers. The new questions become grist for
future research. Like theory, empirical research is a key tool for social
workers. The CSWE (2022) specifies that social workers “apply
research findings to inform and improve practice, policy, and
programs” (p. 10). It is important to understand, however, that
empirical research, like theory, informs us about probabilities, not
certainties (Firestein, 2012). For example, research can tell us what
percentage of parents who were abused as children will become
abusive toward their own children, but it cannot tell us whether a
specific parent who was abused as a child will become abusive
toward their children. Social workers, of course, must make decisions
about specific parents, recognizing the probabilities found in research
as well as considering the knowledge about the case.

We must recognize both the benefits and limitations of empirical

research. Human behavior is complex, and human observers have
limitations in their ability to capture that complexity. Neuroscientist
Stuart Firestein (2012) reminds us that we must learn to live with
“unknowable unknowns” (p. 30) and become capable of working with
uncertainties. The lack of available research on a novel coronavirus
produced much uncertainty during the early days of the COVID-19
pandemic, and the uncertainties paved the way for the politicization of
the pandemic. Nevertheless, research remains the most rigorous and
systematic way to understand human behavior.

Research can serve a number of purposes; it can be used to define

and describe social phenomena (descriptive research), explore what
is going on with a population or situation about which little is known
(exploratory research), identify causes and effects of social
phenomena and predict future occurrences (explanatory research),
and evaluate programs and practices (evaluation research). For
example, descriptive research could be used to gather facts about the
Banyamulenge refugees in Boise, such as their ages, their English
proficiency, their educational level, and their medical needs.
Exploratory research could be used to study what it has been like to
be resettled in Boise, perhaps with narrative methods that capture
stories of refugee experiences. Explanatory research could be used
to understand the connection between accumulated losses and
mental and physical health. Evaluation research could be used to
evaluate the effectiveness of specific resettlement interventions with
this population.

Different methods of research are used for different purposes of

research. No single research method can adequately capture the
whole, the complexity of human behavior. The CSWE (2022)
indicates that “Social workers demonstrate knowledge and skills
regarding qualitative and quantitative research methods and analysis,
and they interpret data derived from these methods” (p. 10).
Qualitative methods of research are methods such as participant
observation, intensive interviewing, and focus groups that are
designed to understand the lives of the participants in their own
words rather than in categories predetermined by the researcher.
These methods usually involve exploratory research questions and
seek the meanings participants attach to events in their lives. The
findings are reported in words. Quantitative methods of research are
methods such as surveys and experiments that record variation in
human behavior and social life in categories that are predetermined
by the researcher. These methods use quantifiable measures of
concepts, standardize the collection of data, attend only to
preselected variables, and use statistical measures to look for
patterns and associations (Hilton et al., 2020). Some researchers
combine qualitative methods and quantitative methods in the same
study, an approach known as mixed methods. Mixed methods
research can provide a fuller picture of the phenomena under study
by utilizing the strengths of both methods.

Recently, researchers have used narrative and other qualitative

research approaches to tell the stories of members of racialized and
other marginalized groups to develop deeper understanding of the
role racism and other forms of oppression have played in their lives.
Examples of this research include examination of forms of racism
faced at different life course stages (Breheny et al., 2021); life course
trajectories of African American centenarians, the changing nature of
racism they faced, the survival skills they used, and the support
systems that sustained them (Heinz et al., 2021); and how different
cohorts of Black parents have prepared their sons for racial bias and
discrimination (DiAquoi, 2018). Other researchers have examined the
impact of chronic physical and mental health conditions on life
trajectories (Jetha et al., 2018; Müller et al., 2011); the career
trajectories of gay men (MacCharles & Melton, 2021); and the
experiences of transgender, nonbinary, and gender diverse people
(Hereth, 2021; Tasker & Gato, 2020). Use of qualitative exploratory
research is essential for telling the stories of members of racialized
and other marginalized groups in their own words, filling an important
gap in available research. Researchers are also developing
measures for anti-oppressive, anti-racist quantitative research (see
Knowles & Hawkman, 2019), such as the Everyday Discrimination
Scale (EDS; Williams et al., 1997) and the Gender Minority Stress
and Resilience Measure (Testa et al.; 2015).

Critical Use of Theory and Research

You may already know that social and behavioral science theory and
research have been growing at a fast pace in modern times, and you
will often feel, as McAvoy (1999) aptly put it, that you are “drowning in
a swamp of information” (p. 19), both case information and scientific
information. Ironically, as you are drowning in a swamp of information,
you will also be discovering that the available scientific information is
incomplete. You will also encounter contradictory theoretical
propositions and research results that must be held simultaneously
and, where possible, coordinated to develop an integrated picture of
the situation at hand. That is, as you might guess, not a simple
project. It involves weighing available evidence and analyzing its
relevance to the situation at hand. That requires critical thinking.
Critical thinking is a thoughtful process of questioning and reflecting
on knowledge and information that is presented; it involves thinking
about your own thinking and the influences on that thinking, as well
as a willingness to change your mind. It also involves careful analysis
of assumptions and evidence. Critical thinkers also ask, “What is left
out of this conceptualization or research?” “What new questions are
raised by this research finding?” Throughout the book, we call out
critical thinking questions to support your efforts to think critically.
As you read this book and other sources of scientific knowledge,
begin to think critically about the theory and research they present.
Give careful thought to the credibility of the claims made. Let’s look
first at theory. It is important to remember that although theorists may
try to put checks on their biases, they write from their own cultural
frame of reference, from a particular location in the social structure of
their society, and from life experiences. As we work in a highly
diversified world, we need to be attentive to the possibilities of biases
related to race and ethnicity, gender and gender identity, culture,
religion, sexual orientation, abilities/disabilities, social class, and so
on. One particular concern is that such biases can lead us to think of
marginalized members of society as pathological or deficient, rather
than focusing on the systemic and interpersonal mechanisms that
marginalize them.

Social and behavioral science scholars disagree about the criteria for
evaluating theory and research. However, we recommend the criteria
presented in Table 1.3 because they are consistent with the
multidimensional approach of this book and with the value base of the
social work profession. (The five criteria for evaluating theory
presented in Table 1.3 are also used in Chapter 2 to evaluate seven
theoretical perspectives relevant to social work.) There is agreement
in the social and behavioral sciences that theory should be evaluated
for coherence and conceptual clarity as well as for testability and
evidence of empirical support. The criterion of comprehensiveness is
specifically related to the multidimensional approach of this book. We
do not expect all theories to be multidimensional, but critical analysis
of a theory should help us identify deterministic and unidimensional
thinking where they exist. The criterion of consistency with emphasis
on anti-racism, diversity, equity, and inclusion examines the utility of
the theory for a profession that places high value on social justice,
and the criterion of usefulness for practice is essential for a
profession.

Table 1.3
Theories and research about human behavior are boundless and
constantly growing. Active readers must question what they read.

© iStockphoto.com/Udo Weber

Now let’s look at research. The CSWE (2022) calls for social workers
to “use ethical, culturally informed, anti-racist, and anti-oppressive
approaches in conducting research and building knowledge . . . and
evaluate design, analysis, and interpretation using an anti-racist and
anti-oppressive perspective” (p. 10). Just as theory may be biased
toward the experiences of members of dominant groups, so too may
research be biased. The results may be misleading, and the
interpretation of results may lead to false conclusions about members
of marginalized groups. Bias can occur at all stages of the research
process.

Funding sources, governmental agencies, and other vested

interests have a strong influence on which problems are selected
for research attention. For example, for more than 20 years,
between 1996 and 2017, the U.S. Centers for Disease Control
and Prevention stopped funding research into firearm injuries
and deaths. The result was that public health funding for this
issue almost totally dried up (Frankel, 2017). Taffe and Gilpin
(2021) report that grant applications submitted by African
American or Black researchers to the U.S. National Institutes of
Health are less likely to be funded than applications submitted by
white researchers.
Bias can occur in the choice and definition of variables for study.
For example, although epidemiological research has consistently
found racial disparities in physical and mental health, it is only in
recent years that epidemiologists have begun to explore the role
racism, both structural and interpersonal, plays in the consistent
finding that African Americans have poorer health, more disease,
than their white peers (Bailey et al., 2017; Garcia, 2022; Goosby
et al., 2018; Paradies et al., 2015). When studying marginalized
social groups, it is essential to examine the oppressive contexts
of their lives. In addition, it is important that questions posed to
research participants are culturally appropriate.
Bias can occur in choosing the sample to be studied. Because
there are fewer of them, members of underrepresented groups
may not be included in sufficient numbers to demonstrate the
variability within a particular identity group. Or a biased sample of
an underrepresented group may be used (e.g., it is not
uncommon to make Black/white comparisons on a sample that
includes middle-class whites and low-income Blacks). Analysis of
articles in the major behavioral science journals indicates that
most of the samples are drawn almost exclusively from Western,
educated, industrialized, and democratic (WEIRD) societies
(Henrich et al., 2010). This same analysis concludes that these
research participants are different from most other people of the
world in important ways. We need to keep this in mind as we
review available empirical research.
Bias can occur in data collection. The validity and reliability of
most standardized measuring instruments have been evaluated
by using them with white, non-Hispanic male respondents, and
their cultural relevance with members of racialized groups,
 women, impoverished persons, or members of other groups is
questionable. Language and literacy difficulties may arise with
both written survey instruments and interviews. Some groups
may be reluctant to participate in research because they don’t
trust the motives of the researchers. Researchers should keep in
mind that interview responses are influenced by similarities and
differences in characteristics of the interviewer and the
respondent (Hilton et al., 2020).
Bias can occur in interpretation of the data because empirical
research typically fails to produce uncontestable results
(Firestein, 2012). It is important to consider the social locations of
the researchers making the interpretation.

As with theory evaluation, there is no universally agreed-upon set of

criteria for evaluating research. We recommend the nine criteria
presented in Table 1.3 for considering the credibility of a research
report. These criteria can be applied to either quantitative or
qualitative research. The contributing authors and I want you to know
that in preparation of this book, we have collectively reviewed
hundreds of research reports. Ideally, we would share with you our
evaluation of each research report used in our analysis, but that
would make for a book of immense length. Please know, however,
that we make every effort to think critically about the research cited;
on occasion we will call your attention to problematic issues in the
research. One major problem in existing research is that it has too
often studied racialized and other marginalized groups without
studying the oppressive social structures and interactions that frame
their lives. That has led to a deficit approach to such groups,
providing individual-level explanations and interpretations (Kornbluh
et al., 2021). Such research asks, “what is wrong with marginalized
people?” rather than “what is wrong with the oppressive social
structures and social systems within which marginalized people live?”
In this seventh edition of the book, we have made renewed effort to
seek out anti-oppressive, anti-racist research to frame our
understanding of human behavior.

Critical Thinking Questions 1.5

If I drew a line on the floor with objective reality at one end and
subjective reality at the other end, where would you place yourself on
the line to demonstrate your own understanding of human behavior?

Objective Reality ___________________ Subjective Reality

And if I drew another line with determinism at one end and

voluntarism at the other end, where would you place yourself on this
line?

Determinism ____________________ Voluntarism

And if I drew a third line with harmony, unity, and social cohesion on
one end and conflict, domination, coercion, and exploitation at the
other end, where would you place yourself on this line to demonstrate
your theory about what happens in human social interaction?

Implications for Social Work Practice

The multidimensional approach outlined in this chapter suggests

several principles for social work engagement, assessment,
intervention, and evaluation—for both prevention and remediation
services.

Be aware of your own implicit and explicit biases as you work to

improve your capacity for anti-oppressive, anti-racist social
workers.
For successful social work engagement, allow people to tell their
own stories and pay attention to how they describe the pattern
and flow of their person–environment configurations.
In the assessment process, collect information about all the
critical dimensions of the changing configuration of person and
environment.
 In the assessment process, attempt to see the situation from a
variety of perspectives. Use multiple data sources, including the
person(s), significant others, and direct observations.
Use the multidimensional database of information about critical
dimensions of the situation to develop a dynamic picture of the
person–environment configuration.
Link intervention strategies to the dimensions of the assessment.
In general, expect more effective outcomes from interventions
that are multidimensional, because the situation itself is
multidimensional.
Pay particular attention to the impact of human rights violations
and social, racial, economic, and environmental injustice.
Learn methods for disrupting racism and other forms of
oppression in social structures and interpersonal relationships.
Develop and use practice methods that promote equity and
social inclusion.
Allow the unique stories of people and situations to direct the
choice of theory and research to be used.
Use scientific knowledge to suggest tentative hypotheses to be
explored in the unique situation.
Give attention to multiple dimensions of person–environment
configurations in practice evaluation.

Chapter Review

Key Terms

Anti-racism
Biological embedding
Critical thinking
Dimension
Diversity
Empirical research
Epigenetics
Equity
Globalization
Intersectionality
 Lineartime
Multidetermined behavior
Multidimensional
Oppression
Privilege
Qualitative methods of research
Quantitative methods of research
Racialized groups
Science
Social inclusion
Theory
Time orientation

Active Learning

1. We have used multiple dimensions of person, environment, and

time to think about Joshua’s story. If you were the social worker
at the refugee resettlement agency that sponsored his family’s
resettlement, you would bring your own unfolding person–
environment–time story to that encounter. With the graphic in
Figure 1.1 as your guide, write your own multidimensional story.
What personal dimensions are important? What environmental
dimensions? What time dimensions? What might happen when
these two stories encounter each other?
2. Select a social issue that interests you, such as child abuse or
youth gangs. List five things you “know” about this issue. Think
about how you know what you know. How would you go about
confirming or disproving your current state of knowledge on this
topic?

Descriptions of Images and Figures

Back to Figure

The infographic is described as follows.

Time: Linear time, historical era, chronological age.

Environment: Social movements, communities, formal organizations,
small groups, physical environments, cultures, social structure and
social institutions, dyads, families.

Person: Biological, psychological, psychosocial, spiritual.

Back to Figure

The concentric circles from innermost to outermost are described as

follows.

The innermost circle is the microsystem. It comprises of the child,

family, church, synagogue, doctor's office, peers, childcare center,
school, neighborhood play area.

The next circle is the mesosystem. It is a link between the

microsystem and the exosystem.

The next circle is the exosystem. It comprises of Extended family,

neighbors, government agencies, school board, parents, social
services, and heath care, workplace, mass media, friends of family.

The outermost circle is the macrosystem. It consists of attitudes,

customs, ideology of the culture.

The Chronosystem denotes the linear passage of time. It represents

the environmental changes and transitions over the life span.

Back to Figure

The infographic is described as follows.

The base of the inverted pyramid has History/Social

Construction/Systems of White Supremacy.

The next layer: Race and Gender.

The next layers: Community, Social Networks, Family.

The apex: Individual.

Back to Figure

The pie chart reads as follows.

Total: 3,81,390; One Race: 3,63,105; White: 2,71,249; Non-Hispanic

White: 1,89,671; Black or African American: 54,814; American Indian
and Alaska Native: 5,199; Asian: 30,806; Native Hawaiian and Other
Pacific Islander: 1,038; Two or More Races: 18,285; Hispanic or
Latino: 93,826.

Back to Figure

The chart reads as follows.

Inequality: Unequal access to opportunities. A tree having two people

on either side leans towards the right, and the person on that side
gets the fruits; the person on the left doesn’t.

Equality? Evenly distributed tools and assistance. A tree having two

people on either side leans towards the right, both people have equal
footstools, and the person on that side gets the fruits; the person on
the left doesn’t.

Equity: Custom tools that identify and address inequality. A tree

having two people on either side leans towards the right, both people
have footstools with the one on the left higher than the other, and
both people get the fruits.

Justice: Fixing the system to offer equal access to both the tools and
the opportunities. A tree having two people on either side leans
towards the right but is corrected to remain in the center. Both people
have equal footstools and both people get the fruits.
2 Theoretical Perspectives on Human Behavior

Elizabeth D. Hutchison, Leanne Wood Charlesworth, and Cory

Cummings

Learning Objectives

2.1 Recognize one’s own cognitive and emotional reactions to a

case study.
2.2 Identify the major themes of seven perspectives on human
behavior: systems, critical, social constructionist,
psychodynamic, developmental, learning, and humanistic-
existential.
2.3 Analyze the merits of each theoretical perspective as well as
a multitheoretical approach to human behavior and practice.
2.4 Apply knowledge of seven theoretical perspectives on human
behavior to recommend guidelines for social work engagement,
assessment, intervention, and evaluation.

A Case Study About Human Behavior Theory

Case Study 2.1: COVID-19 in the Family

Mariana Rodriguez took a job in the laundry at the nursing home in

her small California town in October 2019 soon after her 52nd
birthday. She had been working part-time at an assisted-living facility,
but her husband Daniel, age 57, was unable to work after a recent
heart attack and the family needed the health insurance provided to
staff at the nursing home. She and Daniel lived in a 1,300-square-foot
house with three bedrooms and one bathroom, along with two of their
children, Sofia and Mateo. Sofia was in the second year at
community college and Mateo was in the 10th grade. Another
daughter, Camila, lives with her husband, Juan, in an apartment a
few blocks away. Mariana’s pay at the nursing home was much less
than what Daniel had received in his landscaping job and money was
tight. They were trying not to dip into the small savings account that
they had carefully built.

When the first cases of COVID-19 were confirmed in California in late

January 2020, Mariana was not sure what to think of it. She heard so
many stories, and some of her friends and relatives were convinced
the media and some politicians were exaggerating the situation.
When a statewide stay-at-home order was issued, Camila and Juan,
both hair stylists, were not able to work. Sofia and Mateo had to
quickly find a way to stay involved with their educational programs
from home, and Sofia was no longer able to work part-time at the
salon where Camila and Juan worked. Daniel and the children
begged Mariana to quit her job, where she was considered an
essential worker. Mariana said, “I must work; the family depends on
my $13.50/hour paycheck. Don’t worry. I won’t get sick.”

There was confusion at the nursing home about what precautions the
staff needed to take. Masks and other protective equipment were
scarce, and some administrators and a number of the staff were not
convinced of the necessity for them. In early May 2020, Mariana
became so fatigued at work one day that she couldn’t deliver laundry
to the resident rooms. She tested positive for COVID-19 and was
sent home. Over a few hours, she developed a high fever and a
harsh cough and stayed in bed. She tried to stay separate from the
rest of the family, but social distancing was hard to do in a small
house with one bathroom. Over the next week, Daniel, Sofia, and
Mateo also tested positive. Daniel was transported to the hospital
with a severe breathing problem and needed to be on a ventilator.
Mariana was hospitalized two days later but she responded well to
treatment. Sofia and Mateo had milder symptoms and were able to
stay at home, with Camila, neighbors, relatives, and friends delivering
food to the front door.

Mariana was filled with guilt that she had brought COVID-19 into the
house and was despondent that she could not visit Daniel or take
care of Sofia and Mateo. The medical team kept her informed about
Daniel’s condition, and the news was not good. From discussions she
had with Daniel after his heart attack, she knew that he did not fear
death but was concerned about what would happen to her and their
children if he died. Mariana was able to leave the hospital after 10
days of treatment and before she left the medical team brought her a
hospital iPad so that she could say goodbye to Daniel before she left.
When she returned home, she asked Sofia, Mateo, and Camila to
make FaceTime calls to their father. Daniel died 5 days after Mariana
was discharged from the hospital. The family turned to the parish
priest to see what type of funeral rituals could be planned during the
pandemic and were advised that the traditional gathered community
ritual was not possible.

They were all overcome with grief and yet had some concrete
problems to solve. Because Mariana had not been at her job for a full
year before becoming ill, she was not eligible for sick leave. The last
of the savings went to pay the mortgage and utilities. Mariana’s
sisters volunteered to feed the family until the small life insurance
policy on Daniel paid out. The landscaping company where Daniel
was employed for many years loaned the family money for Daniel’s
burial, which they were able to repay in 2022 after the federal
government began a program that reimbursed eligible families for
COVID funerals. Camila, Juan, and Sofia were able to contribute a
little to the expenses of Mariana’s household.

Mariana, still fatigued and grieving, returned to work 10 days after

Daniel died. When she pulled into the parking lot at the nursing home,
she felt her heart racing and was lightheaded when she got out of the
car. She felt fearful at work for the next month and tried to stay away
from other people as much as possible. At first she thought her
physical symptoms were caused by COVID-19, but upon reflection,
she realized they did not occur anywhere but at work. When she told
her supervisor that she got dizzy, had trouble breathing, and trembled
every time she had to go near the resident room where she thought
she had contracted COVID, the supervisor agreed not to send her to
that section of the nursing home for a while. As the nursing home
administration became more careful about worker safety, Mariana
began to feel less fear at work and the symptoms gradually
disappeared.
On August 21, 2020, California hair salons were able to reopen with
some health precautions. Camila and Juan were able to return to
work, and Sofia was able to resume her part-time work at the salon.
Mateo struggled with remote learning, but with the help of Sofia and a
cousin he was able to get back on track. He was happy when outdoor
sports were once again allowed and he could resume playing with the
high school soccer team. He was sad, however, because his dad had
always been his soccer mentor and had never missed one of his
games. Juan made an effort to fill in for Daniel in that role.

The financial situation stabilized a bit when Sofia increased her hours
working at the salon and Mateo was able to work full-time in the
summer and part-time during the school year at the landscaping
company where Daniel had worked. The family was learning to get by
without Daniel, but Mariana continued to feel guilty about bringing
COVID-19 home and became worried that her deep sadness was
lasting so long. She didn’t want to burden the children with her
sadness, so in early September 2021, after talking with the nursing
home social worker, she began to meet with a grief support group at
the hospital. In those conversations, Mariana talked about her guilt
and sadness and recalled that when she was a child her grandmother
had contracted influenza from her and died. This was something that
she had never given conscious thought to, but she realized that she
had always carried some guilt about that. After a few sessions with
the support group, Mariana decided to talk with the parish priest
about planning a Día de los Muertos celebration for all the people
who had died from COVID-19 in their largely Mexican American
parish. She knew that she had never had the chance to fully grieve
the loss of Daniel or to celebrate his life with a loving community.

Multiple Theoretical Perspectives for a Multidimensional Approach

As you think about the details of the unfolding story of Mariana

Rodriguez and her family, you may discover that you have some
informal theory or theories of your own about what they have been
through and how they are coping now. If we asked you what caught
your attention as you read the story, we would begin to learn
something about your theory or theories of human behavior as you
have developed it or them so far. There is much information in the
case material as presented, but the case may have raised questions
for you as well and left you wanting more information. What you see
as gaps in the information might also tell us something about your
theory or theories. Theories help us organize vast and multifaceted
information. The purposes of this chapter are twofold: first, to help
you identify and refine your own theory or theories of human behavior
and, second, to help you think critically about commonly used formal
theories of human behavior that have been developed by behavioral
science scholars and used to guide social work practice.

As noted in Chapter 1, social work has a long tradition of being

guided by a person and environment construct for understanding
human behavior. Different theories have been considered essential to
understanding person and environment in different time periods, but
theory has always been an important resource for social work
practice in all settings. In its 2022 Educational Policy Statement, the
Council on Social Work Education (CSWE) reiterated the important
role that theory plays in social work practice, noting the way that
theory supports the development of four social work competencies. It
states that “social workers understand theories of human behavior
and person-in-environment and critically evaluate and apply this
knowledge” to facilitate

engagement with (Competency 6),

assessment of (Competency 7),
intervention with (Competency 8), and
evaluation of practice with (Competency 9)

“individuals, families, groups, organizations, and communities”

(CSWE, 2022, pp. 11–13).

Although different theories have been considered essential

knowledge for social workers in different periods of time, there is
general agreement that contemporary social workers must use a
range of theories that draw on a number of disciplines to help us
understand the practice situations we encounter and to see the
possibilities for change. As we have come more and more to
recognize that human behavior is multidimensional, we have also
recognized the need for multiple disciplines and a multitheoretical
framework to understand it (Berzoff et al., 2022; Sapolsky, 2017).
There are many theories from which to draw: general theories of
human behavior, as well as theories designed to understand specific
dimensions of person and environment covered in this book. There
are also a number of ways of grouping existing theories into
categories or perspectives. We have organized them into seven
broad perspectives: systems perspective, critical perspective, social
constructionist perspective, psychodynamic perspective,
developmental perspective, learning perspective, and humanistic-
existential perspective. An overview of the big ideas, major concepts,
and related theories of each perspective is presented in Table 2.1 .
This table can be helpful to review as you continue to learn more
about human behavior.

Table 2.1
We have selected these seven perspectives for a number of reasons.
Each has a wide range of applications across dimensions of human
behavior and is used in empirical research. Each has been
reconceptualized and extended over time to keep current with rapid
knowledge development. Each paid little attention to diversity, and
most paid little attention to issues of oppression, equity, and inclusion
in early versions, but all have evolved over time to address diversity,
human rights, injustice, and the pursuit of justice. Since the last
edition of this book, each of the perspectives has taken a much more
critical approach to understanding societal arrangements and
become much more intentional in addressing issues of racism and
other forms of oppression. This is a much more rapid theoretical
revision than we have seen at any time since we first began to work
on these books in the mid-1990s. Each of the perspectives was
developed by European or American theorists, but in recent years
have begun to be influenced by thinking in other regions of the world.
Some of the perspectives had multidisciplinary roots in their early
versions, and each has benefited by collaboration across disciplines
in more recent refinement and elaboration. Some blurring of the lines
between perspectives has been occurring for some time. Theorists
are increasingly being influenced by each other as well as by societal
changes and have begun to borrow ideas from each other and to
build new theory by combining aspects of existing theory. As you can
see, theory, like other aspects of human behavior, is ever-changing.

Each of the perspectives presented in this chapter comprises a

number of diverse theories. We present the important principles of
each perspective and not a detailed discussion of the various theories
within the perspective. Although we trace the development of each
perspective over time, we pay particular attention to some of the
recent extensions of the perspectives that seem most useful in
contemporary times. We draw special attention to instances where
new research is supporting premises of the early root theories as well
as recent theoretical revisions. If you are interested in a more in-
depth look at these theoretical perspectives, there are many
resources to help you do this. We introduce the perspectives in this
chapter, and you will see variations of them throughout subsequent
chapters, where theory and research about specific dimensions of
person and environment are explored.

In this chapter, in addition to presenting an overview of ideas, we

analyze the scientific merit of the perspectives and their usefulness
for social work practice. The five criteria for critical understanding of
theory identified in Chapter 1 provide the framework for our critical
analyses of the perspectives: coherence and conceptual clarity;
testability and empirical support; comprehensiveness; consistency
with social work’s emphasis on anti-racism, diversity, equity, and
inclusion; and usefulness for social work practice.

Systems Perspective

When you read the case study at the beginning of this chapter, you
may have thought of it as a story about a family system—a story
about Mariana Rodriguez, her husband Daniel, and their three
children, Camila, Sofia, and Mateo—even though Mariana appears
as a central figure in the story telling. You may have noted how
intertwined the lives of Mariana, Daniel, Camila, Juan, Sofia, and
Mateo are and the impact each had and is having on the overall well-
being of the family. They are also connected to people far beyond
their immediate family, connected in a global pandemic. Prominent in
the story is how COVID-19 spread rapidly in their small house,
crossing the boundary from Mariana’s work system into the family
system. We see the way the family interacted with a number of other
institutions and social systems as they coped with the challenges
COVID-19 brought to their family: a hospital system, school systems,
employing organizations, government assistance programs, and a
network of neighbors, relatives, and friends. The Catholic parish of
which they are members has served as a spiritual resource to the
family and also provided some concrete services such as meal
delivery and funeral planning. We also are aware of the important role
that nonhumans play in the story of Mariana Rodriguez and her
family: the SARS-CoV-2 virus, masks and other protective equipment,
diagnostic tests, medical treatments, and electronic communication
devices. These are some of the ideas that the systems perspective
suggests for understanding what has happened and is happening
with Mariana Rodriguez and her family.

The systems perspective sees human behavior as the outcome of

interactions within and among systems of interrelated parts. It
focuses on the interconnectedness of elements of the social and
physical worlds. The roots of the systems perspective are very
interdisciplinary, and there are many theoretical variations. The
perspective has been influenced by contributions from biology,
cultural anthropology, economics, engineering, mathematics, physics,
political science, psychology, and sociology. Figure 2.1 provides a
visual representation of the systems perspective, and Table 2.1 lists
the important principles, major concepts, and related theories of the
perspective.

Description

Figure 2.1 Systems Perspective

Social workers were attracted to the systems perspective in the
1960s, and general systems theory was the dominant theoretical
perspective in the social work literature during the 1960s and 1970s.
This theory was based primarily on the work of biologist Ludwig von
Bertalanffy, who defined systems as “sets of elements standing in
interrelation” (von Bertalanffy, 1969, p. 38). von Bertalanffy proposed
that any element is best understood by considering its interactions
with its constituent parts as well as its interactions with larger systems
of which it is a part. For example, Mariana Rodriguez and members
of her family are best understood by considering the interactions
among the family members as well as the interactions the family has
with other systems. von Bertalanffy identified two types of systems:
closed systems and open systems. A closed system is isolated from
other systems in its environment. An open system is in constant
interaction with other systems. He emphasized that feedback
mechanisms—processes by which elements of the system affect
each other in a reciprocal way—produce both stability (homeostasis)
and change within and across systems. Socially and geographically
isolated families and communities could be considered examples of
relatively closed systems. Some Internet-based social networks are
examples of comparatively open systems. The family of Mariana
Rodriguez seems to be a comparatively open system that was able to
receive the resources needed to manage their COVID-19 crisis.

In the 1980s, ecological theory, also known as ecosystems theory,

became popular across several disciplines, including social work.
This theory comes from the field of ecology, which focuses on the
relationships and interactions between living organisms and their
environments. Interdependence and mutual influence are
emphasized. The environment exerts influence on an individual,
family, or social group, but individuals, families, and groups can also
have an impact on external systems. Social workers who promoted
the ecological perspective called for a holistic view of practice
situations that considers the multiple environmental influences
involved (Germain & Gitterman, 1996). The ecological perspective
extended general systems theory by considering the important role of
physical environments in human behavior and recent systems
theorizing has expanded upon this idea.
More recently, social workers have drawn on an extension of Urie
Bronfenbrenner’s bioecological perspective, which was revised to pay
more attention to biomedical factors, to understand individual
behavior (Bronfenbrenner, 2005). As it evolves, the bioecological
approach includes many and varied attempts to incorporate ongoing
neuroscience research into theorizing about the ways that biological
factors are intertwined with psychological and sociocultural factors in
the creation of human behavior. This approach considers gene–
environment interactions, the impact of the environment on brain
development, and the intertwined nature of biology, cognition, and
emotion. One theoretical approach often used in social work is risk,
protection, and resilience theory, which is an extension of the
ecological perspective. It uses concepts from epidemiology and
public health to explain the complexity of influences on human
behavior. This theory proposes risk factors and protective factors in
both the person and the environment. Risk factors are conditions and
circumstances that increase the likelihood of a harmful outcome of
person and environment interactions, and protective factors are
conditions and circumstances that support a positive outcome (see
Jenson & Fraser, 2016). In the past decade or so, biomedical
researchers have expanded on the ecological risk, protection, and
resilience model to propose a theory that views human behavior as
developing from the biological embedding of conditions in the social
and physical environments (Nist et al., 2019; Sun et al., 2022). While
most of the research on risk, protection, and resilience has focused
on individual well-being, the approach has also been used at the
community level to examine health equity (Plough, 2021).

Social network theory is a systems theory that focuses on the ties

between actors in social networks connected either directly or
indirectly by interpersonal relationships, social interactions, and an
exchange of resources (Borgatti et al., 2018; Cook, 1987). Yang and
Horak (2019) note that the Korean word for network is inmaek, which
“literally means people entangled like vines” (p. 397). The actors in
networks may be individuals but they may also be groups,
communities, or organizations. Social networks are typically
presented visually, with members of the network—individuals, groups,
or organizations—represented as points. Lines are drawn between
pairs of points to demonstrate a relationship between them. Arrows
are often used to show the flow of exchanges in a relationship. These
graphic displays illuminate such issues as network size, density of
relationships, strength of relationships, reciprocity of relationships,
and access to power and influence. Social capital theory is an
outgrowth of social network theory. Social networks provide social
capital , both direct and indirect connections to others who are
potential sources of a number of types of resources (Horak et al.,
2019). Social network theory has stimulated considerable empirical
research.

Social network theory focuses on relationships between and among

human actors. In contrast, influenced by scientific inquiry in a number
of disciplines, recent systems theorizing emphasizes the nonhuman
elements involved in human behavior and broadens understanding of
the complexity of interactions from which human behavior emerges.
Taken as a whole, these new theories are attempting to explain the
complexity of contemporary life, acknowledging the roles that
nonhuman animals, technology, and the natural world play in human
behavior. The following discussion highlights two of these recent
system theories, actor–network theory and theories of the
Anthropocene as well as another recent systems theory that takes a
different approach to understanding systems boundaries, Luhmann’s
systems theory.

Actor–network theory (ANT; Haraway, 2008, 2016; Latour, 2007,

2017) extends social network theory to look beyond human
relationships. The basic premise of this theory is that societies are not
made up of humans alone. Societies are networks made up of both
human and nonhuman actors, including such things as animals,
viruses, plants, electrons, gravity, climate, and computers. Social life
includes collaborations between humans and nonhuman entities.
ANT refers to all of these entities as actants, who exert force on other
actants and have the capacity to modify, even transform, one another.
ANT theorists suggest that our study of networks should decenter
humans and recognize the important roles that other entities play in
network exchanges. They decry the humanistic assumption that
humans have more value than other actants. They call attention to
the important role that material entities—such as keyboards,
computer screens, websites, and medical technologies—play in
human relationships, suggesting that these entities are more than
resources for humans; they are also important actants in network
interactions. Ritzer and Stepnisky (2022) note that ANT can be used
to understand the influence that the virus SARS-COV-2 and the
related disease COVID-19 exerted on societies around the world. It
was an actant that changed everyday face-to-face relationships,
prompting such innovations in human behavior as the wearing of
masks and staying 6 feet apart. Government, medical and scientific
professions, and the pharmaceutical industry were important actants
in the global response to COVID-19.

Social network theorist Donna Haraway (1991, 2016) challenges the

idea that there are clear boundaries between humans, technology,
and the natural world and introduces the term cyborg to refer to a
cybernetic organism that is a hybrid of human and machine.
Technology of many types is so pervasively used to extend human
abilities—to travel, communicate, fight wars, learn, do business, and
live in comfort—that we are all effectively cyborgs. Actants such as
Siri, Alexa, self-driving cars, assistive robots, and computer
algorithms act with an autonomy once thought possible only of
humans. Haraway (1991, 2008, 2016) suggests that humans are put
together in bits and pieces over time through relationships with
technology and other nonhuman elements such as companion
animals and aspects of the natural world such as sunlight. This idea
is taken up again in Chapter 3 of this book.

In recent years, interdisciplinary theories of the Anthropocene have

received considerable attention (see Chernilo, 2017; Ellis, 2018). The
Anthropocene is described as the current geological era in which
collective human activity has become the dominant influence on
climate and the natural environment. Like ANT, theories of the
Anthropocene decenter humans and argue that humans must
abandon the self-important idea that human societies can be
separated from nature. These theories take a more global
perspective than ANT. They emphasize the way that human societies
are embedded in and dependent on the natural environment and
focus on the global problem of human-caused changes to the
planetary ecosystem. They call attention to the great acceleration of
population growth and the capitalistic economic system that depends
upon endless growth in consumerism and take a critical view of how
these circumstances are damaging the natural world and benefitting
wealthy members of European and North American societies while
passing the risks on to economically marginalized groups,
communities, and countries. They argue that we need new theories
that help us understand nature on its own terms and where humans
fit in the ecosystem. They recommend a world ecological perspective
that examines how societies shape and are shaped by the natural
environment. Theories of the Anthropocene call for social workers to
consider whether it is possible to promote human and community
well-being without working to protect the well-being of the planetary
system in which human lives are embedded (M. D. Allen, 2020).

Actor–network theory and theories of the Anthropocene challenge the

idea that there are clear boundaries between humans, nonhuman
animals, technology, and the natural world. In this way, they can be
seen as proposing very open systems with highly permeable
boundaries. In contrast, German sociologist Niklas Luhmann (2011)
proposes a systems theory that suggests that in highly complex
societies, systems must find a way to reduce complexity to make life
more manageable. They do this by developing cultures and
structures that clearly differentiate one system from other systems.
Systems are open to interaction with other systems, but they are
operatively closed, meaning that system behavior is influenced only
by the system’s operations—its language, culture, and processes—
and not by the language, culture, and processes of other systems.
The environment can affect the system only by causing it irritations or
disruptions, but the system will have its own conditions for responding
to these irritations. Luhmann argues that systems are autopoietic,
meaning they are self-created and reproduced. For example, think
about social workers who work in child welfare services. They assess
child safety issues in the context of their social work knowledge of
child development and family dynamics, and in the process, they
often interact with medical professionals and the court system. When
interacting with those two systems, they must recognize that those
systems use their own often different language, culture, and
processes to think about child safety. Luhmann has made some good
observations about how human social systems try to manage
complexity and, when working across social system boundaries,
social workers will need to understand the language, cultures, and
processes of these other professional systems. At the same time, it is
important for social workers to recognize the nonhuman elements
involved in human behavior and consider the permeable boundaries
of human, nonhuman animals, technology, and the natural
environment.
The pieces of this globe come together to form a unified whole—each
part interacts with and influences the other parts—but the pieces are
interdependent, as suggested by the systems perspective.

© iStockphoto.com/Vipin Babu

Critical Analysis of the Systems Perspective

In terms of coherence and conceptual clarity, some concepts
associated with the systems perspective have been criticized as
vague and somewhat ambiguous. While the concepts in some
versions of the perspective continue to be highly abstract, overall
recent systems theorizing has coherence and conceptual clarity.
Considering testability and empirical support, a long tradition of
research supporting a systems perspective can be found in
anthropology and sociology. The systems perspective has been
greatly strengthened in recent years with research in neuroscience,
epidemiology, and environmental science. Social network analysis is
used to analyze many types of networks and has research evidence
supporting its validity (see Ahmed et al., 2020; Falcone et al., 2020).

The systems perspective is clearly devoted to the ideal of

comprehensiveness. Different versions of the perspective address
different system elements, and some versions are more
comprehensive than others. Bioecological theories and research are
shedding light on the complex interactions of various biological
systems with each other and with psychosocial processes. Both the
bioecological theories and theories of the Anthropocene include time
dimensions. Actor–network theory makes an important contribution
by calling attention to the nonhuman elements—technology and the
natural world—involved in human behavior, and theories of the
Anthropocene focus on the planetary ecosystem. Anti-racism,
diversity, equity, and inclusion are not the explicit focus of systems
theorizing. However, bioecological research contributes to
understanding of human diversity, and the risk, protection, and
resilience research has begun to explore racism and other forms of
oppression as a risk factor for racialized and other oppressed groups
(see Z. Bailey et al., 2017; Goosby et al., 2018). Social network
analysis has great potential for exploring patterns of social inclusion
and exclusion (Young et al., 2020). Theories of the Anthropocene
give some attention to social, economic, and environmental justice
(see Langemeyer & Connolly, 2020).

As noted in Chapter 1 in this book, social work has been guided by

an ecological person-in-environment framework for over 6 decades.
This attests to the perspective’s usefulness for social work practice.
Systems thinking is consistent with the National Association of Social
Workers (NASW, 2021) ethical principle “Social workers recognize
the central importance of human relationships.” That said, the
systems perspective is perhaps more useful for assessment and
practice evaluation than for directing social work engagement and
interventions. The greatest value of the systems perspective is that it
can be used at any level of practice, including individual, family,
group, organization, community, or society. It also has merit because
it surpasses other perspectives in suggesting that we should widen
the scope of assessment and intervention and expect better
outcomes from multidimensional interventions. Bioecological theory
and research cue social workers to the neurological and other
biological mechanisms involved in human behavior. Social network
theory provides tools for analyzing the social networks of individuals,
families, groups, organizations, and communities. Actor–network
theory breaks ground for social workers by recommending attention
to nonhuman actants—such as technology, companion animals, and
the natural environment—in the situations they encounter in practice.
Luhmann’s autopoetic systems theory is helpful when social workers
are engaged in advocacy; it reminds us that to be effective
advocates, we must make the effort to understand the language,
culture, and processes of the social systems we target with our
advocacy efforts.

Critical Thinking Questions 2.1

As you read the story of the COVID-19 crisis faced by Mariana

Rodriguez and her family, what aspects of their situation caught your
attention? What would the systems perspective draw your attention
to? What more would you like to know? How would you explain their
story to someone else? What types of social capital were available to
Mariana Rodriguez and her family from the social networks of which
they were a part? The systems perspective focuses on the
interconnectedness of nonhuman and human intertwined elements of
the physical and social world. How did the COVID-19 pandemic help
you to think about that interconnectedness?
Critical Perspective

When we think about Mariana Rodriguez and her family, we note the
precarious financial and health situations they faced during the worst
of the COVID-19 epidemic. A pandemic like COVID-19 is a universal
problem across geography, race, gender, and class, but not all are
affected equally. The pandemic story of Mariana Rodriguez and her
family is a story of the intersection of race, gender, and economic
inequality. During the first wave of the pandemic, people of color
suffered more job loss than white workers and were more likely to be
among “essential” workers whose work could not be carried out
remotely. Like Mariana Rodriguez, nearly half of Black or Hispanic
health care workers earn less than $15/hour. One in five Black and 1
in 6 Hispanic workers could work remotely from home, compared to 1
in 3 white workers (Tiako et al., 2021; Powell, 2021). People of color
were more likely to work in jobs that required interacting with the
public, which presented more exposure to the virus, especially if they
were working in health care settings. They were hospitalized at a rate
of about 4 times the rate of white workers. One in every 3 jobs held
by women was deemed “essential,” and women like Mariana
Rodriguez were overrepresented among low-wage “essential”
workers, many of whom did not have sick leave or health insurance.
While wealthy families could escape highly contagious areas or, when
infected, quarantine in separate spaces of large homes, families like
Mariana’s live in smaller spaces with no such luxury. In the early days
of the pandemic, the federal government was weak in enforcing
worker safety and slow to promote availability of personal protective
equipment (Tiako et al., 2021; Powell, 2021). These are some of the
observations suggested by the critical perspective about the
experiences of Mariana Rodriguez and her family with COVID-19.

The critical perspective focuses on injustice and the pursuit of justice.

There are many versions of the critical perspective; in this section we
introduce Marxian and neo-Marxian theories, feminist theories,
postcolonial theories, and theories of race and racism. Figure 2.2
provides a visual representation of the critical perspective, and Table
2.1 lists the important principles, major concepts, and related theories
of the perspective. The roots of contemporary critical theories are
usually traced to the works of Karl Marx (1887/1967; 1932/1964),
which focused on exploitation and domination of workers as central
ingredients in the capitalist economic system. For Marx, exploitation
and domination lead to a perversion of human relationships and to
workers becoming alienated from their own work and from their true
nature. Marx proposed, however, that workers are capable of
recognizing the exploitation and achieving class consciousness—
awareness of one’s place in a system of social classes—but
capitalists are incapable of recognizing the exploitation inherent in the
system.

Description

Figure 2.2 Critical Perspective

Karl Marx

© Mark Ralston/AFP/Getty Images

Marxist theory evolved over time, and newer versions are often
referred to as neo-Marxist theory. Neo-Marxist theorizing includes
some theorists who criticize the economic determinism proposed by
Marx. Jürgen Habermas (1984, 1987) and other critical theorists
argued that as capitalism underwent change, people were more likely
to be controlled by culture and their consumer role than by their work
position. They argue that human lives have become dominated by the
culture industry, which is controlled by mass media. Critical theorists
suggest that the culture industry plays a major role in turning workers
into consumers, calling attention to the role of the advertising industry
in exploiting consumers. Other neo-Marxists continue to focus on the
economic system, calling attention to the exploitation and domination
in the globalized capitalist economy. Wallerstein (2004) argues that
the core geographical area (North America and Western Europe)
dominates the capitalist world economy and exploits the rest of the
global capitalist system. Sassen (2014) contends that global
capitalism is now based on “predatory formations” that are producing
a brutal form of inequality based on expulsion and exclusion. Some
communities stand in the way of extraction of natural resources and
the production of profit, and these communities are expelled and
excluded from contemporary social and economic systems.
Economists Banerjee and Duflo (2019) call these “left behind”
communities. Left behind communities exist in Africa, Latin America,
and central Asia but also in increasingly isolated rural and urban
communities in North America and Europe. Sassen (2014) names six
forms of contemporary expulsion: poverty, outmigration, foreclosures,
unemployment, displacement, and imprisonment.

Feminist theories originated during an era of binary gender

conceptualization; such theories focus on male domination of the
major social institutions and present a vision of a just world based on
gender equity. As feminist theories have evolved over time, they have
raised several basic questions about the organization of social life
and the answers to these questions have produced different varieties
of feminist theory. Lengermann and Niebrugge (2022) trace the
development of feminist theory, suggesting that it has moved through
the following sequence of questions being raised:

1. And what about the women? Where are the women in any
situation being reported? What are their contributions to the
situation? If they are not present in the situation, why not? This is
a question about inclusion.
2. Why is women’s situation the way it is? What social forces are
involved in the marginalized way women are situated in the
world?
3. What about the differences among women? Feminist and critical
race theorists have developed intersectionality theory , which
recognizes numerous vectors of oppression and privilege,
including not only gender but also class, race, physical
disabilities, global location, sexual orientation, and age (see
Crenshaw, 2021).
4. How can we change and improve the social world so as to make
it a more just place for all people?
5. How and why does gender inequality persist in the modern
world?
6. What is really being understood by the category “gender”? This
question has arisen as the concept of gender as binary has been
problematized.

Postcolonial theories focus on the ongoing impact of 18th- and 19th-

century colonialism on the social, cultural, political, and economic
development of both the colonizing and colonized nations.
Colonialism was a process by which European nations and the
United States created empires and occupied and dominated
overseas nations, sometimes by administrative rule from a distance
and sometimes by establishing permanent settlements in colonies.
The colonizers stripped the colonized territories of political and
economic sovereignty and constructed a hierarchy in which colonized
people were treated as inferior in legal, social, and cultural terms
(Steinmetz, 2014). To maintain dominance, the colonizers racialized
people they were colonizing as nonwhite and therefore inferior people
who, in their minds, rightfully belonged at the bottom of the social
hierarchy. This perspective observes that Western societies have
created an image of themselves grounded in their encounter with
colonized people, an image that nourishes and sustains Western
privilege and power. The end of the colonial era did not destroy the
power structures established by colonialism. Many postcolonial
theorists argue that we now live in a neocolonial world in which a
philosophy of neoliberalism puts great faith in the rationality of a free
market and opposes any form of collectivism, state planning, or
safety net for those who are economically disadvantaged, using the
argument that any governmental involvement would hurt economic
growth. Neoliberalism became prominent at the end of the colonial
era, ensuring that those who held power during the colonial era were
well situated to continue to hold power (see Go, 2013).

Southern theory, one version of postcolonial theory, has been

developed in the Global South to critique existing social and
behavioral theory and research, arguing that Southern societies have
been studied using Global North concepts and research methods and
this has led to a colonizing of knowledge (Connell, 2007; Connell et
al., 2017). These theorists argue that Indigenous knowledge has
been discounted as primitive and irrational. Southern theory has
called for alternative theoretical concepts and a respect for
Indigenous knowledge. Some Southern theorists are synthesizing
Northern theories and Indigenous philosophy to form new theory. An
example of that will be presented in the discussion of the humanistic-
existential perspective.

Because of the historical relationship between colonialism and the

social construction of race, theories of race and racism call attention
to the postcolonial perpetuation of racial domination as well as to
ongoing resistance to that domination. Critical race theory (CRT) is
the best-known theory of race and racism, largely because it has
been targeted in recent years by the political right in the United States
as a theory that should be eliminated from public school curricula
(even though it was seldom, if ever, taught in public school curricula).
CRT was developed in the 1980s by a group of legal scholars who
concluded that racism is a permanent part of U.S. society, and law is
not a neutral tool that can end it (Bell, 2021). CRT has been
summarized as having six basic tenets (Bell, 2021; Delgado, 2017):

Race is a social construction, not a biological phenomenon. It

“represents a perceived set of shared phenotypical
characteristics that are assigned meaning and value by society”
(Bell, 2021, p. 109).
Racism is a regular part of U.S. society and racial hierarchy was
codified in the founding documents of the country.
The racial hierarchy places whites at the top and Blacks at the
bottom, with other people of color falling between whites and
Blacks. Whites receive both psychological and material benefit
from their whiteness.
There is not one “Black experience.” Black individuals live their
lives at the intersection of multiple identities (intersectionality),
such as those related to class and gender.
People of color have a unique and valuable perspective on their
lives, but most of the science about race has been written from a
white, Eurocentric perspective.
Scholarship on race and racism should use “personal stories,
allegories, metaphors, analogies, and other related methods of
storytelling” (Bell, 2021, p. 111).

Scholars from racialized groups other than Black and African

American have proposed variations of CRT to consider the distinct
ways that these groups are racialized. These variations include
AsianCrit (Qin et al., 2022), LatCrit (Solorzano & Bernal, 2001), and
TribalCrit (Brayboy, 2005). Proponents of AsianCrit, LatCrit, and
TribalCrit agree that race is a social construction and see their
theories as supplementary and complementary to CRT. AsianCrit,
also known as Asianization, emphasizes the way Asian Americans
are cast as a monolithic group of “overachieving model minorities,
perpetual foreigners, and threatening yellow perils” (Museus, 2014, p.
23). LatCrit theory calls attention to language, immigration, and
ethnicity in the racialization of Latinx people and also to the
intersection of racism, sexism, and classism (Solorzano & Bernal,
2001). TribalCrit highlights the way that colonization processes
continue to privilege European American knowledge and power
structures, and it argues that material gain for white people and
assimilation of Indigenous people are driving goals.

Omi and Winant (2015, 2021) present a theory of racial formation that
proposes that race and racism are central organizing features of
social life in the United States. Race is a dominant category that
shapes history, culture, and social structure. Like CRT, Omi and
Winant note that race is a social construction, not a biological reality.
Race is connected to racial identity at the micro level and is
embedded in the economic, cultural, and political institutions at the
macro level. People do not have race but rather are racialized.
Racialization is the process of assigning meaning and value to
perceived phenotypical characteristics. The process of racialization
that began with colonialism gives superior value to whiteness and
inferior value to people of color. Race is both stable and unstable. It is
a constant dominant category and yet different groups have been
cast as Black at some historical times and white at other times. Omi
and Winant propose that racist racial projects create and reproduce
structures of racial domination. Antiracist racial projects challenge
and resist structures of racial domination. They argue that racial
conflict is persistent at the macro and micro levels but passes through
periods of both rapid change and inertia. Racism can be challenged
through social movements and racial identity can be a foundation for
demands for equity and inclusion.

Amico et al. (2021) propose a theory of white privilege (discussed in

Chapter 1 in this book), which examines what whites are
experiencing as people of color are experiencing racism. They argue
that racism cannot be understood without understanding whiteness,
the power bestowed on those considered white. Being white means
to be advantaged in relation to those not considered white. Lipsitz
(2006) argues that white people are possessive of their white status
and manipulate people of color to compete for white approval. Amico
et al. (2021) suggest that an important aspect of whiteness is a lack
of awareness of the role that race plays in societal power
arrangements. They suggest that the important elements of white
privilege are the invisible opportunities received, presumption of white
innocence, white ethnocentric educational curricula, residential and
social isolation of whites from people of color, and enforcement of
privilege through social structure and social institutions.

Sue (2010) presents a theory that calls attention to how

microaggressions —brief, everyday exchanges that send denigrating
messages and insults to people of color or members of any other
marginalized identity group—create alienation for members of the
marginalized group. Microaggressions are a form of covert racism
and oppression that is often difficult to detect. Sue and colleagues
(2021) also identify microintervention strategies for disarming and
dismantling individual and systemic racism. Recent critical theories of
race and racism have incorporated the work of cognitive
psychologists who examine implicit bias, a concept examined in the
section on the learning perspective in this chapter and also in
Chapter 8, Cultures.

North American Indigenous scholars are ambivalent about existing

theories of human behavior, considering them inherently connected to
Western imperialism (Simpson & Smith, 2014). They are modifying
Western concepts to better reflect Indigenous perspectives. The work
of Glen Coulthard (2014) is one example of such scholarship. The
basic premise of Coulthard’s theory is that settler colonialism
subjected and continues to subject Indigenous North Americans to
enormous physical and cultural violence: plagues, stolen lands,
forced relocation, cultural and language destruction, and removal of
children from communities. Coulthard insists that concepts such as
cultural recognition, reconciliation, and multiculturalism do not liberate
Indigenous people from colonialism but instead serve to obscure
Western government efforts to maintain settler–colonial systems of
domination. Like the Southern theorists, Coulthard calls for a
resurgence of theorizing based on Indigenous knowledge not only of
cultural symbols but also of land and nature. One example of work
that weaves together Indigenous knowledge and Western scientific
knowledge is Kimmerer’s 2013 book Braiding Sweetgrass:
Indigenous Wisdom, Scientific Knowledge, and the Teachings of
Plants.

Critical Analysis of the Critical Perspective

In terms of coherence and conceptual clarity, most concepts of the
critical perspective are straightforward—injustice, exploitation,
alienation, domination, inequality, exclusion—at least at the abstract
level. Like all theoretical concepts, however, they become less
straightforward when we begin to define them for the purpose of
measurement. In general, theories in the critical tradition are
expressed in language that is relatively accessible and clear, but like
any theoretical perspective they introduce new concepts that must be
learned. Considering testability and empirical support, critical theories
have developed, in the main, through attempts to codify persistent
themes in history. A preferred research method is empirical research
that looks at large-scale patterns of history. As with other methods of
research, critics have attacked some interpretations of historical data
from the critical perspective, but historical analyses are some of the
most influential works in contemporary sociology. All versions of the
critical perspective encourage storytelling and other qualitative forms
of empirical investigation and are providing new understanding of the
lives of members of oppressed and marginalized groups.

In terms of comprehensiveness, the greatest contribution of the

critical perspective is that it addresses dimensions of human behavior
not found in other perspectives. Many versions of the critical
perspective focus on large-scale social institutions and social
structures, such as economic and political institutions, even global
ones. In the contemporary era, critical theorists integrate processes
at the societal level with those at the community, small-group, and
family levels. They suggest that we should recognize exploitation,
domination, and conflict as a central process in social life at all levels.
In terms of individual psychology, critical theories propose that
oppression of nondominant groups leads to a sense of alienation
rather than belonging. Most critical theories do consider dimensions
of time involved in ongoing systems of oppression. They are
particularly noteworthy for recommending that the current behavior of
members of marginalized groups should be put in historical context.

With the critical perspective’s focus on injustice and the pursuit of

justice, it more than any other perspective presented in this chapter
helps us think about anti-racism, diversity, equity, and inclusion.
Intersectionality theory, which recognizes that individuals have
overlapping memberships in a variety of status groups, is particularly
useful for considering human diversity. The critical perspective is
strong in usefulness for social work practice. It is essential to the
social justice mission of social work and has been instrumental in
recommending practice strategies for confronting microaggressions,
elevating the voices of marginalized members of society, and
challenging interpersonal and systemic racism. It shines a spotlight
on how domination and oppression affect human behavior; it
illuminates processes by which people become estranged and
discouraged. A major strength of the critical perspective is that it
discourages taking a deficit approach to members of racialized and
other marginalized groups, recognizing the historical, cultural,
economic, and political context of behavior. It encourages social
workers to consider the meaning of their power relationships with
clients, particularly nonvoluntary clients. Empowerment approaches
to practice at the individual and group level are recommended to
connect “social and economic injustice and individual pain and
suffering” (J. Lee & Hudson, 2017, p. 146). Social movement theories
(see Chapter 14), which are based in the critical perspective, have
implications for the mobilization of historically marginalized groups.

Social Constructionist Perspective

When a novel virus hits the world population, it is expected that

people will be confused about what it will mean for them. In the early
days of the pandemic, Mariana Rodriguez recognized that not all the
people she knew shared the same meaning about the newly
identified virus. Her husband and children were concerned about her
health and safety and encouraged her to leave the job where she was
vulnerable to exposure to the disease. On the other hand, some of
her relatives, neighbors, friends, and coworkers thought the media
and some politicians were exaggerating the dangers of the novel
virus. As the pandemic hit her own community, Mariana was
surprised at the deep divide that had developed about its meaning for
social life. Masks became symbols of that divide. Mariana knew that
she had been classified as an “essential” worker, a classification that
was socially constructed, and like many essential workers she
struggled to understand what it means to be essential and yet
undervalued, even disposable. As she struggled to reconstruct a life
without Daniel, Mariana realized that her grief process had been
short-circuited by the inability to participate in shared traditional death
rituals. These are some ideas observed by the social constructionist
perspective about the COVID-19 experience of Mariana Rodriguez
and her family.

To understand human behavior, the social constructionist perspective

proposes that social reality is constructed and constantly
reconstructed as humans interact with each other. People construct
meaning, a sense of self, and a social world through their interactions
with each other. They learn, through their interactions with each other,
to think about the world and their place in it. People interact with each
other and the physical world based on shared meanings or shared
understandings about the world. This perspective asserts that people
develop their understandings of the world and themselves from social
interaction, and these understandings shape their subsequent social
interactions. A visual representation of this way of thinking about
human behavior is presented in Figure 2.3, and Table 2.1 lists the big
ideas, major concepts, and related theories of the perspective.
Description

Figure 2.3 Social Constructionist Perspective

The early roots of the social constructionist perspective come from

symbolic interaction theory , which proposes that as humans interact,
they develop symbols to which they attach meaning. Words are
symbols, but so are actions, tattoos, masks, national flags,
confederate monuments, crosses, rosaries, clothing and fashion
styles, and the types of homes we build. Symbols can carry very
different meanings for different people, and conflicts can arise about
the meaning they carry. In the United States, conflicts have arisen
about the meaning of confederate monuments and the act of standing
during the national anthem. A mask came to symbolize safety and
respect to some people and unnecessary loss of freedom to other
people. The symbolic interactionist would be interested in how
ideological differences developed about the meaning of the COVID-
19 pandemic. For the symbolic interactionist, society is constructed
by human beings engaging in (symbolic) interaction, and the self is
constructed through interactions situated in historical and social
contexts (Mead, 1934/1962). Individuals have multiple and dynamic
selves created by their interactions with multiple groups in multiple
settings (McVeigh, 2016).

Social constructionists disagree about how constraining the

environment is. Some see individual actors in social interactions as
essentially free, active, and creative (Gergen, 1985). Others suggest
that individual actors are always performing for their social audiences,
based on their understanding of community standards for human
behavior (Berger & Luckmann, 1966; Goffman, 1959). Although this
idea of human behavior as performance has been around for a while,
it is taking on new meaning in the current world of proliferating
communication technology, which provides us with many modalities
for performing for our audiences, for engaging in what Goffman refers
to as impression management. The dominant social constructionist
position is probably the one represented by Schutz’s (1967)
phenomenological sociology. While arguing that people shape social
reality, Schutz also suggests that individuals and groups are
constrained by the preexisting social and cultural arrangements
constructed by their predecessors.

The social constructionist perspective and its central concept “social

construction” gained prominence with sociologists Berger and
Luckmann’s 1966 book The Social Construction of Reality. The
concept of social construction was quickly diffused through a number
of academic disciplines, but it also gained popular usage outside of
academic settings. In the section on the critical perspective, we saw
that both critical race theory and racial formation theory focus on the
social construction of race. Racial formation theory proposes that
although race is a stable social construction in U.S. society,
assignment to racial groups has been flexible over time with some
groups, such as Jews and immigrants from Finland, Italy, and Ireland,
being categorized as not-white at some points and white at others,
depending on the needs of people in power. This is consistent with
the symbolic interactionist proposal that reality is constantly being
constructed and reconstructed. As evidence of popular usage of the
social construction concept, Knoblauch and Wilke (2016, p. 56) report
that a December 17, 2015, Google search of the term “social
construction of reality” yielded almost 10,000,000 hits.

Some social constructionists focus on the important role of language,

one type of symbol, in the social construction of reality. Language is
used to label our experiences and to develop classification systems
of behaviors and categories of social identities. Social
constructionists differ in their analysis of how constraining language is
on human behavior. Structuralism theory argues that meanings, the
mind, and the social world are shaped by the structure of language.
They call attention to the influence of the use of binary oppositions in
language structures, where one thing is understood by comparing it
to its binary opposite: bad-good, female-male, life-death, us-them
(Layton, 2006). The structuralists believe that human cognition favors
the simplicity of binary conceptualizations. In contrast,
poststructuralist theorists believe that language cannot constrain
people. Derrida (1998) proposes that language is disorderly and
unstable, taking on different meaning in different contexts. Consistent
with poststructuralist theory, scholars in the Global South argue that
language has been colonized and represents the interests of cultural
elites in the Global North. They contend that language is embedded
in economic, political, and cultural systems; is never neutral; is often
alienating and oppressive; and is resisted (Deumert, 2021; Rudwick &
Makoni, 2021; Useem, 2020). Deumert (2021) argues that language
can be used to imagine alternative futures, that “language is key to
political freedom and liberation” (p. 109).

Poststructuralist theorists also challenge the structuralist contention

that binary opposition is an essential characteristic of social reality.
They propose that in the West reality has been constructed through
linguistic binaries, with one element in the binary structure always
viewed as inferior to the other. Binary opposition is an example of
how language produces social hierarchy. Binary oppositions are used
by people with power to reinforce the existing power structure and
preserve their own status. In this way, poststructuralism is consistent
with the critical perspective. Poststructuralists also argue that binary
opposition is an oversimplification of social reality and masks the
complexity of social life and human behavior.

In the poststructuralist tradition, queer theory, one of the most

influential social theories of the past two decades, proposes that
sexuality and gender are linguistic creations rather than natural
realities (Piontek, 2006). They are constructed, experienced, and
performed in language. Queer theory pushes for a move away from
the binary male/female, homosexual/heterosexual binaries, arguing
that sexuality and gender are not fixed and stable and do not
determine who we are. They are social constructions that create
power and inequality, but they are fluid and always open to
transformation. Butler (2004) argues that linguistic binaries of
sexuality and gender overlook the many identities that are
constructed through mixing and remixing linguistic binary categories.
Although queer theory focuses on the social construction of sexuality
and gender, theorists in this tradition challenge all categories of
socially constructed identities and the hierarchies built on them.
Queer theory proposes that no area of social life is immune from the
influence of sexuality and gender; therefore, queer theory is not just a
theory of sexuality and gender but a theory of social life.

Both neuroscience research and cognitive psychology research (see

Kahneman, 2011; Sapolsky, 2017) indicate that categorizing and
identity building are an inherent part of human cognition, but the
importance of queer theory is that it reminds us of the critical role that
culture and power relations play in shaping these cognitions.

Postmodern theories, like closely related poststructuralism, are

skeptical of theoretical explanations that claim to be valid for all
groups and all cultures and call attention to the multiple social
realities created by culture and other social systems. Two adaptations
of postmodern theory are discussed here: standpoint theory and
affect theory. Standpoint theory argues that what people know and
believe is shaped by where they “stand” in society, their geographies,
cultures, socioeconomic statuses, races, genders, and so on. No two
people have exactly the same standpoint and we must recognize our
own standpoints, be reflective about them, and be curious and open
to learn about the unique standpoints of others. At the core of
standpoint theory is the belief that not all standpoints are equally
valued and that marginalized people must live with a bifurcation of
consciousness (from one’s own perspective as well as the
perspective of dominant standpoints) while dominant group members
often enjoy the privilege of remaining oblivious to nondominant
standpoints. Like poststructuralism, standpoint theory is a blend of
the social constructionist and critical perspectives. It was first
developed as feminist standpoint theory, but Dorothy Smith (2005)
began to focus not only on gender but also on the exclusion and
oppression of other standpoints, such as those based on class, race,
sexual orientation, and able-bodiedness.

Affect theory is a significant departure from other postmodern theory

because it calls attention to the independent role that biology and
matter play in the construction of reality (see Blackman & Venn,
2010). It calls for breaking down the artificial boundaries between the
natural and social sciences, noting that both biology and social
processes play important roles in creating human reality. In affect
theory, affect refers to a nonconscious, automatic form of emotion.
Emotion is what happens to affect once it undergoes the social
processes that make it conscious. Affect theorists are interested in
the way that human bodies affect each other as they interact, calling
attention to a process of entrainment identified by neurologists—a
process in which the nervous and hormonal systems of interacting
people are brought into alignment (Brennan, 2004). Some
psychodynamically oriented social workers have written about how
the disembodiment involved in remote communications during
COVID-19 interfered with the process of entrainment (Hershberg &
Sandmeyer, 2021). Like the ANT discussed earlier as a systems
theory, affect theory takes seriously the important role of nature and
other nonhuman elements in human behavior.

Critical Analysis of the Social Constructionist Perspective

In terms of coherence and conceptual clarity, social constructionism,

both the original phenomenological and symbolic interactional
concepts as well as the contemporary poststructuralist and
postmodern conceptualizations, is often criticized as vague and
unclear. And, yet, the rapid diffusion of the concept of social
construction across academic disciplines and its popular use outside
of academic settings suggest that it is intelligible to both scholars and
the general public. Over the past few decades, a great diversity of
theorizing has been done within this broad theoretical perspective,
and there is much fragmentation of ideas. In recent theorizing, social
theorists in the critical and social constructionist perspectives have
borrowed ideas from each other and blurred the boundaries between
these two perspectives. There is inconsistency among the various
streams of the constructionist perspective about how constraining
history and social structures are on human interaction and how free
humans are to reconstruct their social interactions.

Considering testability and empirical support, the social

constructionist perspective has made a great contribution to scientific
inquiry by calling attention to the limitations of positivist research
methods to explain all of human behavior and for pointing out the
possibilities for bias in those research methods. Social
constructionists propose alternative research methodology that
focuses more on narrative and storytelling. Social constructionism
has stimulated a trend in the behavioral sciences to use a mix of
quantitative and qualitative research methodologies to accommodate
both objective and subjective reality. This is providing a richer picture
of human behavior. Affect theory, the newest theory discussed here,
has incorporated findings from the natural sciences, and many ideas
of the theory are well supported by empirical research.

Looking at the range of theories in the social constructionist

perspective, it gets relatively high marks in comprehensiveness. Until
the development of affect theory, social constructionism had paid little
attention to the role of biology in human behavior. In some versions of
social constructionism, cognitive processes are central, and the social
construction of emotions is considered in others. With the emphasis
on meaning making, social constructionism is open to the role of
religion and spirituality in human behavior. With its emphasis on
social interaction, the social constructionist perspective is strong in
attention to the social environment. Unlike earlier social
constructionist theories, poststructural theories, queer theory, and
standpoint theory call attention to the macro world of social
institutions and social structure. Time, and the role of history, is
respected in the social constructionist perspective, with many authors
drawing attention to the historical era in which behavior is
constructed.

Recent versions of the constructionist perspective have much to offer

for understanding anti-racism, diversity, equity, and inclusion. The
emphasis on multiple social realities is useful for considering the
diverse variations in human behavior. Critical race theories consider
the history of the social construction of race and its relationship to
contemporary racism. Poststructuralism, queer theory, and standpoint
theory are strong in their understanding of the processes of social
exclusion and inclusion, particularly in the use of language to build
hierarchies and social exclusion.

Although the social constructionist perspective does not provide

direct guidelines for intervention, the perspective does have
usefulness for social work practice. In the social constructionist
perspective, the social work relationship begins with developing an
understanding of the meaning the client—individual, family, small
group, community, or organization—makes of the situation and how
that meaning has been developed in social interactions over time. It is
highly relevant for engagement and assessment, but it is also useful
for social work intervention. The social construction of meaning and
identity can be interrogated to inform such interventions as cognitive
behavioral therapy, narrative therapy, and solution-focused therapy.
The perspective suggests that a goal of practice is to help clients see
more realities in their story lines, with other possible interpretations of
events. The social constructionist thesis that self, meaning, and
reality are constantly reconstructed and even transformed through
social interaction makes it a particularly useful approach for work with
families, small groups, communities, and organizations.
Poststructuralism and queer theory are useful for encouraging both
social worker and client to think critically about prominent social
categories, particularly linguistic binary categories. At the level of
families, groups, communities, and organizations, the social
constructionist perspective recommends engaging discordant groups
in sincere discussion of their disparate constructions of reality and to
negotiate lines of action. This is the goal of restorative justice
projects.

Critical Thinking Questions 2.2

What do theories in the critical perspective add to your understanding

of the story of Mariana Rodriguez and her family? Do you think it
helps to think about the family in this way? Why or why not? Do you
think it helps to think about events like COVID-19 in this way? Why or
why not? How does the social constructionist perspective help you to
think about the great division that occurred in meaning making about
COVID-19 safety guidelines and vaccinations—a divide that occurred
in local communities, the nation, and around the world? What
influenced the meaning you made of safety guidelines and
vaccinations?

Psychodynamic Perspective

Mariana Rodriguez and her family faced a highly stressful situation

involving a novel viral pandemic. Like most families during the
pandemic, they needed to quickly make many adaptations to their
daily routines, and they faced changes in their physical and social
environments. They faced financial hardship and the loss of husband
and father roles in their family system while also worrying about their
personal safety. Their lives were impacted by environmental forces as
well as by biological and psychological forces. It appears Mariana
and her children were motivated by survival and adaptation instincts
as well as a strong drive to maintain their attachment relationships
with each other. Each member of the family developed new
capacities as they adjusted to life without Daniel. We take note of
Mariana’s physiological symptoms of anxiety when she returns to
work and consider how she feels unsafe in that setting. We might
wonder about the defense mechanisms used by each family member
to cope with Daniel’s death and the anxieties stirred by the loss of
such an important attachment figure. In the grief support group,
Mariana became aware of guilt she had carried about her
grandmother’s death, something she had never given conscious
thought to before. These are some of the observations that come to
mind when we think of Mariana Rodriguez and her family from a
psychodynamic perspective.

The psychodynamic perspective focuses on how internal processes

such as needs, drives, emotions, and mental states motivate human
behavior. The perspective has evolved over the years, moving from
the classical psychodynamic emphasis on innate drives and
unconscious processes toward greater emphasis on the adaptive
capacities of individuals and their interactions with the environment.
The origins of all psychodynamic theories are in the work of Sigmund
Freud. More recent formulations of the perspective include ego
psychology, object relations theories, self psychology, and relational
and intersubjective theories. Figure 2.4 presents a visual
representation of the psychodynamic perspective, and Table 2.1 lists
the important principles, major concepts, and related theories of the
perspective.
Description

Figure 2.4 Psychodynamic Perspective

To trace the evolution of the psychodynamic perspective, it is

essential to begin with its Freudian roots. Sigmund Freud proposed
that human behavior is driven by strong biological instinctual forces
that operate largely outside of awareness. Freud looked at the human
personality from a number of interrelated points of view; the most
notable are his drive or instinct theory, topographical theory, structural
theory, and psychosexual stage theory. Freud revised each of these
approaches to understanding human personality over time, and
different followers of Freud have attended to different aspects of his
theoretical works, further revising each of them over time.

Drive or instinct theory. This theory proposes that human

behavior is motivated by two basic instincts: thanatos , the drive
 for aggression or destruction, and eros , the drive for life (through
sexual gratification).
Topographical theory of the mind. Topographical theory proposes
three states of mind: conscious mental activities of which we are
fully aware; preconscious thoughts and feelings that can be
easily brought to mind; and unconscious thoughts, feelings, and
desires of which we are not aware but which have a powerful
influence on our behavior.
Structural model of the mind. This model proposes that
personality is structured around three parts: the id , which is
unconscious and strives for satisfaction of basic instincts; the
superego , which is made up of conscience and ideals and is the
censor of the id; and the ego , which is the rational part of
personality that mediates between the id and the superego.
Psychosexual stage theory. This theory proposes a five-stage
model of child development, based on sexual instincts. Freud
emphasized the importance of childhood experiences on
personality development.

Let’s turn now to some of the roads the psychodynamic perspective

has taken from its Freudian roots. Ego psychology focuses on
unfolding human capacities as individuals interact with social and
physical environments (Schamess & Shilkret, 2022). Ego
psychologists see a bigger influence of external forces on human
behavior than proposed by Freud. Although they see a large
contribution of conscious activity to human behavior, they emphasize
the ego’s use of unconscious defense mechanisms to keep
intolerable threats from conscious awareness. White (1959) proposes
that humans are driven as much by an instinct for mastery as by
sexual and aggression instincts. Control-mastery theory suggests that
adaptation and survival instincts are the primary motivations for
human behavior (Silberschatz, 2005). Erik Erikson, who will be
discussed in the section on the developmental perspective, is
considered an ego psychologist.

Object relations theories study the relationships and interactions

individuals have with other people (objects) and are particularly
concerned with the mental representations of the self and the other
that are developed from these relationships and interactions
(Flanagan, 2022a). More specifically, they are interested in how
others become a part of the self. In object relations theories,
attachment relationships with others are absolute human needs
(Bowlby, 1969). Some object relations theorists stress the need for
humans to balance attachment to others with the ability to be
separate (Winnicott, 1958, 1960). Object relations theorists are
interested in the defenses used to cope with anxieties that arise in
relationships.

Self psychology focuses on the kinds of life experiences that

contribute to a mature self (Flanagan, 2022b). Heinz Kohut (1978)
proposed a tripolar self who must have three needs met to develop a
healthy, cohesive self. First, the grandiose self needs to be validated
and made to feel special. Second, the developing self needs to have
a strong admirable person whom they can idealize and with whom
they can merge and feel safe. Third, the developing self needs to feel
that there are others who are similar to oneself, a need that Kohut
called twinship. Kohut (1978) was interested in disorders of the self
that develop when these needs are not met, disorders such as the
understimulated self, the overstimulated self, the fragmented self, and
the overburdened self.

Relational and intersubjective theories propose that the basic human

drive is for relationships with others. The self is understood to
develop and mature through emotional connectedness in mutually
empathic relationships. Human connectedness is emphasized,
human diversity acknowledged, and human difference is normalized
rather than pathologized (Berzoff, 2022). Influenced by postmodern
and queer theories, relational and intersubjective theories see the self
as fluid, multiple, discontinuous, and influenced by language—rather
than as fixed and singular as in self psychology. Multiple selves are
sometimes harmonious but often are not.

Recently, social workers who practice from a psychodynamic

perspective have taken a critical eye to issues of diversity, race, and
racism. Berzoff et al. (2022) recommend that an intersectionality lens
should be used to recognize the great diversity represented in social
work practice situations. Malamed (2021, p. 149) argues that “racism
is a pathology that resides in White people . . . borne of Whites’
narcissistic fragility.” This analysis is usually put in the context of
Melanie Klein’s theory of “splitting” as an object relations defense
mechanism (see Rasmussen & Garran, 2022; Woods, 2020). Splitting
is “the process by which the good and bad or positive and negative
aspects of the self and others are experienced as separate or kept
apart” (Flanagan, 2022b, p. 111). Hershberg and Sandmeyer (2021,
p. 439) suggest that in the United States African Americans are
stamped as “the devalued others.” Woods (2020) suggests that white
people often engage in a radical splitting of the idealized self from
degraded others and that issues of race can prompt such severe
anxiety in white people as to block the capacity to think. Malamed
(2021) proposes that white people project their fears and forbidden
desires on to people of color and argues that psychotherapy with
white people must interrogate the meaning of whiteness and
challenge the ethic of white supremacy. Malamed further argues that
awareness of social justice issues is necessary for emotional
maturation in white people. Self psychologist Walls (2006) proposes
that the constant othering and exclusion of people of color and other
marginalized groups denies their need to be validated, and such
ongoing invalidation requires a double consciousness that views
“oneself through the eyes of one’s oppressor” (p. 131).

From the early Freudian roots, the psychodynamic perspective was

embodied (Hershberg & Sandmeyer, 2021). Freud was a neurologist
who saw biological instinctual forces as the primary motivators of
human behavior. Freud recognized the reciprocal relationship
between body and mind, but he did not have the tools to study the
biological mechanisms involved with cognition and emotion, tools
later developed by neuroscientists and cognitive psychologists.
Recent research in these fields is giving credence to some of the
inclinations of both Freudian and neo-Freudian theory while filling in
the gaps related to biological mechanisms. Here are some examples
of that research. (Cognition and emotion are covered in more detail in
Chapter 4.)
First, both neuroscience and cognitive psychology research suggest
that Freud was correct to propose that much of human behavior is
based on unconscious emotional and cognitive processes. The limbic
systems are central to the emotions that fuel behavior (Rolls, 2019).
The limbic systems indirectly regulate autonomic bodily functioning
and hormone release, and autonomic and hormonal conditions feed
back to the brain to influence behavior, mostly unconsciously. Much
research of the limbic systems has focused on the amygdala, two
almond-shaped clusters of neurons that serve to rapidly appraise
stimuli and mobilize responses to stress. It is the brain region
involved in feeling afraid and anxious, and the region most involved in
generating aggression (Hoban et al., 2018). As any warning system
should, the amygdala works so fast that it responds in advance of a
conscious awareness of danger. Research by cognitive psychologists
indicates that much of human behavior is based on activity that is
outside of awareness; although they do not use this language, it
appears that they are suggesting both preconscious and unconscious
activity (Bursell & Olsson, 2021; Kahneman, 2011).

Second, ego psychologists were correct to recognize the role of both

unconscious and conscious processes and both emotion and
cognition in human behavior. Neuroscientist Robert Sapolsky (2017)
argues that the distinction between thought and feeling is a false
dichotomy. The cortex is the “gleaming, logical, analytical crown
jewel” of the brain (p. 28). Most sensory information flows into there
to be decoded, but some sensory information takes a shortcut,
bypassing the cortex and going straight to the amygdala. Lots of
axonal projections connect the cortex with the amygdala, and the
limbic systems and cortex stimulate as well as inhibit each other.
They collaborate and coordinate, and they also bicker and undermine
each other. This sounds very much like what Freud meant by ego.
Emotions filter what gets remembered. When the amygdala wants to
mobilize behavior, it seeks approval from the frontal cortex, which is
the site of working memory, executive functioning (which includes
organizing thoughts and actions, prioritizing tasks, and making
decisions), emotion regulation, and impulse control. However, if the
amygdala is sufficiently aroused by fear, it produces a faster but less
accurate response by bypassing the frontal cortex. It is situations like
this, when the amygdala is hijacked by fear, that a cell phone may be
seen as a gun. Sapolsky (2017) calls the frontal part of the cortex the
superego of the brain.

Third, neuroscientists identify the neurotransmitter dopamine as

central to understanding reward, pleasure, and particularly the pursuit
of pleasure (Speranza et al., 2021). It may be implicated in behaviors
that some psychodynamic theorists have thought of as id activity.

Fourth, the psychodynamic approach is correct in asserting that early

childhood experiences play an important role in behavior across the
life course. There is strong evidence from several disciplines that
early life experiences shape the structure and functions of the brain in
ways that influence behavior throughout the life course. One example
is the intersection of research on neurobiology, attachment, and
trauma (see Shapiro, 2022).

Fifth, proponents of the emerging polyvagal theory are investigating

how physiological states are associated with stress reactions (see R.
Bailey et al., 2020; Kolacz et al., 2019; Porges & Porges, 2022;
Sullivan et al., 2018). Polyvagal theory proposes that for survival,
humans need to feel safe and safely connected to others. The theory
identifies three distinct neural platforms in the autonomic nervous
system (ANS) that are involved in the perception of threat and safety:
the sympathetic system and two branches of the vagus nerve in the
parasympathetic system. When faced with perceived threat, the
sympathetic system responds with fight or flight, the dorsal vagal
responds by freezing and conserving resources, and the ventral vagal
responds by self-soothing and seeking connection with others.
Polyvagal theory proposes that neuroception, a neurophysiological
response that does not involve cognitive processing, plays a central
role in the ANS’s ability to assess danger in the environment.
Research on polyvagal theory is in the early stages, and recent
research focuses on the biological mechanisms that connect
traumatic stress to both gastrointestinal and psychiatric disorders
(Kolacz et al., 2019).

Critical Analysis of the Psychodynamic Perspective

In terms of coherence and conceptual clarity, Freud’s original
concepts and propositions were not entirely consistent; they evolved
over time. Ego psychology, object relations, self psychology, and
relational and intersubjective theorists strengthened the logical
consistency of the psychodynamic perspective by expanding and
clarifying definitions of major concepts. The different strains of the
perspective put different emphases on conscious and unconscious
activity and internal versus external influences on motivation.
Theories in the psychodynamic perspective are sometimes criticized
for the vague and abstract nature of their concepts but perhaps no
more than most other theoretical perspectives.

Considering testability and empirical support, much empirical work

has been based on the psychodynamic perspective, and research in
other disciplines provides support for some of the propositions of the
perspective. Recent long-term longitudinal studies support the
importance of childhood experiences but also indicate that personality
continues to develop throughout life. There is growing evidence of the
supremely important role that attachment plays in shaping
development over the life course. Neuroscience research is indicating
the important role of emotion in human behavior, explicating the brain
mechanisms involved in emotion and suggesting that both genetics
and life experiences shape the emotional brain (Davidson & Begley,
2012). Early life experiences are important in this process, but the
brain is “plastic” and can be changed by ongoing life experiences and
mental activity.

In terms of comprehensiveness, early psychodynamic theories were

primarily concerned with internal psychological processes. Freud
assumed that biology determines behavior, and recent
psychodynamic theorists have incorporated new developments in
neurological sciences into their formulations (see, e.g., Berzoff et al.,
2022). With the exception of Carl Jung, early psychodynamic
theorists were not interested in the spiritual aspects of human
behavior, but some psychodynamically oriented clinicians have made
attempts to include an examination of spirituality and religion in
psychodynamic clinical practice (see Nagai, 2007; Shafranske, 2009).
As for environments, close personal relationships play an important
role in most post-Freudian theorizing, but the economic, political, and
historical environments of human behavior receive little attention. As
for time, the early focus of the psychodynamic perspective was on
how people change across childhood. Theories in the psychodynamic
perspective continue to pay little attention to time in human behavior.

Until recently, psychodynamic theorists and clinicians paid little

attention to issues of anti-racism, diversity, equity, and inclusion.
Human diversity is a major theme in relational and intersubjectivity
theories, and as noted, psychodynamically oriented social workers
have recently been drawing on concepts from object relations
theories and self psychology to write about anti-racist social work
practice. This is an important contribution to psychodynamic
theorizing.

For the most part, theories in the psychodynamic perspective

developed as clinical theory and the perspective is strong in
usefulness for social work practice in clinical practice with individuals,
families, and groups. In general, however, the psychodynamic
perspective does not suggest practice principles at the level of
communities, organizations, and social institutions. In clinical
practice, theoretical concepts can be used for engagement,
assessment, intervention, and practice evaluation. Practice principles
common to all versions of the psychodynamic perspective include the
centrality of the professional–client relationship, the curative value of
expressing emotional conflicts and understanding past events, and
the goals of self-awareness and self-control. Several research
projects have found psychodynamic psychotherapy to be effective
and the benefits of such therapy to increase with time (see Shedler,
2010). Supported by recent neuroscience research, the
psychodynamic perspective reminds social workers that many
emotions and cognitions happen at the unconscious, automatic level
and are not easily accessed for conscious exploration. This is
especially true of traumatic memories. As psychodynamic theorists
embrace neuroscience research, the perspective continues to be
useful for understanding how trauma is stored and processed
(Basham, 2022). Given our commitment to evidence-based practice,
social workers should be aware of empirical evidence of the potential
benefits of a number of adjunct non-talking, somatic interventions for
trauma-related mental health disorders, including eye movement
desensitization and reprocessing (EMDR; Fereidouni et al., 2019;
Wilson et al., 2018), neurofeedback (Reiss et al., 2019; van der Kolk
et al., 2016), and yoga (Reinhardt et al., 2018). One systematic
review of the efficacy of creative arts therapies for post-traumatic
stress disorder (PTSD) found that art therapy and music therapy may
have potential for reducing the symptoms of PTSD (Baker et al.,
2018). Polyvagal theory is being used to develop both biological and
interpersonal interventions to stimulate and improve functioning in the
vagus nerve (see R. Bailey et al., 2020). Such interventions include
electrical stimulation of the vagus nerve (Yagi et al., 2020), yoga
(Sullivan et al., 2018), and group therapy (Flores & Porges, 2017).
Mindfulness meditation has been found to build better connections
between the amygdala and prefrontal cortex (see Davidson & Begley,
2012) and to improve stress reactivity and anxiety symptoms
associated with anxiety disorders (Blum et al., 2021). Not all of these
intervention methods are used by social workers, but social workers
can work collaboratively with practitioners who are trained in them.

Developmental Perspective

Another way to think about Mariana Rodriguez and her family is to

view their situation in terms of life stages, the developmental tasks
they face, and their roles and statuses. In middle age, Mariana
suddenly became the primary wage earner for her family. Her
husband, Daniel, developed a compromising health problem when he
was just at the peak of his earning power and hoping to consolidate
the family finances for a comfortable old age. He became very ill and
died before he could do that. Sofia and Mateo faced disruptions in
their educational and social lives at a time when identity, relationship
building, and developing skills for future careers were important parts
of their developmental process. Camila and Juan had their careers
temporarily disrupted as they were taking on adult roles. Daniel was
lost to the family at a time when they had expected he would still be
there to support and guide them. These are some aspects of the
story of Mariana Rodriguez and her family suggested by the
developmental perspective.

The focus of the developmental perspective is on how human

behavior unfolds across the life course, how people change and stay
the same over time. Human development is seen to occur in defined
stages based on a complex interaction of biological, psychological,
and social processes. Each new stage involves new tasks and brings
changes in social roles and statuses. A visual representation of these
ideas is presented in Figure 2.5, and Table 2.1 lists the important
principles, major concepts, and related theories of the perspective.

The developmental perspective focuses on how human behavior

unfolds across the life course.

© Brand X Pictures/Thinkstock
Description

Figure 2.5 Developmental Perspective

The developmental perspective is perhaps the oldest perspective

discussed in this chapter. Early ideas of life stages are found in
Eastern and Western religious philosophies, proposed in the Talmud
and by Sanskrit scholars. A great number of developmental theories
have been developed since the beginning of the 20th century, many
of which focus on a specific aspect of human behavior. Freud
proposed a theory of psychosexual stages, Jung a stages of life
theory, Piaget a theory of cognitive stages, Erikson a theory of
psychosocial stages, Kohlberg and Gilligan theories of stages of
moral development, and Fowler a theory of faith stages. In addition,
there are a vast number of related theories that use a developmental
framework to focus on one particular developmental phase.
Examples include theories of perspective taking in middle childhood,
theories of sexual identity development in adolescence, theories of
emerging adulthood, and other adult stages.

Early psychology-based developmental theories focused on the inner

life at age-graded stages, but recent multidisciplinary theories have
expanded the focus to put greater emphasis on the social forces
involved in life stage development. Early theories looked for universal
patterns in life stages, and more recent theorizing has paid more
attention to diversity in life stage development.

Erikson (1963) has been the most influential developmental theorist

to date because his model of life span development includes adult as
well as child stages of development. Erikson (1963) proposed an
epigenetic model of human development , in which the psychological
unfolding of personality takes place in sequences influenced by
biological, psychological, and social forces. Healthy development
depends on the mastery of life tasks at the appropriate time in the
sequence. Erikson divided the life cycle into eight stages, each with a
special psychosocial crisis, basic strength, and core pathology. Life
span or life cycle theory, based in psychology, has continued to build
on the work of Erikson’s psychosocial theory of development (see
Newman & Newman, 2018). Although life span theorists tend to
agree with the epigenetic principle, there is also growing agreement
that the stages are experienced in a more flexible way than Erikson
proposed, with cultural, economic, and personal circumstances
leading to some differences in timing and sequencing. More stages
have been added to life span theories as longevity increases in
wealthy nations.

Early life span theorists, including Erikson, saw their models of

development as universal, applying equally well to all groups of
people. This idea has been the target of much criticism, with
suggestions that the traditional models are based on the experiences
of European American, cisgender, heterosexual, middle-class men
and do not apply as well to members of other groups. This criticism
has led to a number of life cycle models for specific groups, such as
women (Borysenko, 1996); gay, lesbian, and bisexual persons (e.g.,
Cass, 1996; Troiden, 1989; Weinberg et al., 1994); and African
Americans (Cross et al., 1991). For example, Lev (2004) proposes a
six-stage model of transgender identity development:

Stage 1: Awareness
Stage 2: Seeking information/reaching out
 Stage 3: Disclosure to significant others
Stage 4: Exploring identity and transition
Stage 5: Exploration—transition issues/possible body
modification
Stage 6: Integration and pride

It is important to remember that the models noted in the previous

paragraph should be placed in the historical time in which they were
developed. Life span theories have been criticized for failing to deal
with historical time and the cohort effects on human behavior that
arise when groups of persons born in the same historical time share
cultural influences and historical events at the same period in their
lives.

The criticisms of life span theories for their failure to recognize

diversity in life course journeys and their failure to appreciate the
important role of changing historical times in human behavior have
helped to stimulate the development of the multidisciplinary life
course perspective (LCP). This relatively new perspective
conceptualizes the life course as a social, rather than psychological,
phenomenon that is nonetheless unique for each individual, with
some common life course markers or transitions related to shared
social and historical contexts. In its current state, there are six major
themes in this perspective:

Interplay of human lives and historical time. Individual and social

group development must be understood in historical context.
Timing of lives. Particular roles and behaviors are associated
with particular age groups, based on biological age,
psychological age, and social age.
Linked lives. Human lives are interdependent, and the family is
the primary arena for experiencing and interpreting wider
historical, cultural, and social phenomena.
Human capacity for choice making. The individual life course is
constructed by the individual choices made and actions taken
within the opportunities and constraints of history and social
circumstances.
 Diversity in life course trajectories. There is much diversity in life
course pathways as a result of cohort variations, individual
agency, social class, race, ethnicity, gender, ability and disability,
and so on.
Developmental risk and protection. Experiences with one life
transition or life event have an impact on subsequent transitions
and events and may either protect the life course trajectory or put
it at risk.

LCP research has explored many dimensions of human diversity and

their impact on life course trajectories. Although early LCP
researchers focused on large-scale longitudinal research projects,
recent LCP researchers have used narrative and other qualitative
research methods to develop deeper understanding of diverse groups
by recording their experiences in their own voices. LCP theorists
have begun to modify the perspective to extend its capacity to reflect
the experiences of members of marginalized groups. Two examples
are critical race life course perspective (DiAquoi, 2018) and feminist
life course theory (Calderone et al., 2020; Jones et al., 2018).

With its focus on developmental risk and protection, the LCP

emphasizes how advantage and disadvantage accumulate over time.
Cumulative advantage involves the accumulation of increasing
advantage as early advantage positions an individual for later
advantage. Cumulative disadvantage is the accumulation of
increasing disadvantage as early disadvantage positions an individual
for later disadvantage. The LCP proposes that social institutions and
societal structures develop mechanisms that ensure increasing
advantage for those with early life advantage and increasing
disadvantage for those who struggle (Ferraro & Shippee, 2009).
Researchers have applied the concepts of cumulative advantage and
cumulative disadvantage to study health disparities related to class
and race (Pais, 2014), financial assistance from midlife parents to
adult children (Padgett & Remle, 2016), the earnings trajectories of
individuals (Gabay-Egozi & Yaish, 2019), criminal career trajectories
(Mowen & Brent, 2016), the victimization trajectory of transgender
women (Hereth, 2021), and evolving patterns of inequality among
late-life adults (Crystal et al., 2016). The life course perspective is the
conceptual framework for the companion volume to this book,
Dimensions of Human Behavior: The Changing Life Course
(Hutchison & Wood Charlesworth, 2025).

Critical Analysis of the Developmental Perspective

In terms of coherence and conceptual clarity, classical developmental

theory’s notion of life stages is internally consistent and conceptually
clear. Theorists have been able to build on each other’s work in a
coherent manner. The life course perspective has developed
considerable coherence and clarity about the major concepts.
Considering testability and empirical support, many of Erikson’s ideas
have been employed and verified in empirical research. Social work
aspires to engage in evidence-informed practice, and the LCP was
developed from empirical research and continues to be refined by
ongoing research. Most of the early LCP research used large-scale
longitudinal research methods, following the same people over an
extended period of time. The benefit of longitudinal research is that it
clarifies whether differences between age groups are based on
developmental differences or whether they reflect cohort effects from
living in particular cultures at particular historical times. There is a
growing body of longitudinal research in the life course tradition that
suggests that age-graded differences in behavior reflect both
developmental factors and historical trends (see Elder & Giele, 2009).
The LCP is a leading perspective driving longitudinal study of
physical and mental health behaviors and outcomes. Life course
researchers have recently begun to use qualitative methods of
research to understand the meanings people attach to events in their
lives.

The developmental perspective gets relatively high marks for

comprehensiveness. Both the life span and the life course streams
recognize human behavior as an outcome of complex interactions of
biological, psychological, and social factors, although most theorists
in both streams pay little attention to the spiritual dimension. The
traditional life span approach pays limited attention to the political,
economic, and cultural environments of human behavior, and the life
course perspective pays less attention to psychological factors than
the psychologically based life span approach. Both approaches
attend to the dimension of time, in terms of linear time, but the life
course perspective attends to time in a more comprehensive manner
by emphasizing the role of historical time in human behavior. Indeed,
the developmental perspective is the only one of the seven
perspectives discussed here that makes time a primary focus.

As the developmental perspective evolved over time, it paid more

attention to racism, diversity, equity, and inclusion. The early life span
models were looking for universal stages of human development and
did not attend to issues of diversity. More recent life span models
have paid more attention to diversity, and diversity of pathways
through life is a major theme in the LCP. The LCP recognizes
patterns of advantage and disadvantage in life course trajectories,
and life course researchers have done considerable work on the
accumulation of advantage and disadvantage over the life course.
LCP research on cumulative advantage and cumulative disadvantage
shows that not all people start from the same place and reinforces the
idea that anti-racist, anti-oppressive social work must focus on equity
and inclusion. Critical race life course theory and feminist life course
theory move the LCP to more clearly articulate issues of racism and
other forms of oppression.

The developmental perspective gets relatively high marks for

usefulness for social work practice. It is often used for assessment
purposes in social work practice to evaluate biological, psychological,
and social development of individuals. The LCP suggests that
individuals must always be assessed within familial, cultural, social,
economic, and historical contexts. The developmental perspective
can also aid indirectly in the identification of potential personal and
social developmental resources. Developmental research provides
robust evidence that what happens throughout the life course is
strongly influenced by what happens in the early years. Societal
health is associated with public policies that support early
development, and social workers can play an important role in
promoting supportive public health and child and family policies. With
its emphasis on life stories that unfold over time, the LCP is a
particularly good fit with narrative approaches to practice. Narrative
approaches can be used with families, small groups, communities,
and organizations as well as with individuals. Overall, the
developmental perspective can be viewed as optimistic. Most people
face difficult transitions, life crises, and developmental or other
challenges at some point, and many people have been reassured to
hear that their struggle is “typical.” The developmental perspective is
particularly useful for suggesting how to engage people of specific life
phases, particularly children and adolescents and for indicating
stage-appropriate interventions. Because the developmental
perspective sees individuals as having the possibility to rework their
inner experiences as well as their relationships, clients may be
assisted in finding new strategies for getting their lives back on
course. Life course research also has abundant implications for social
policy and for practice evaluation.

Critical Thinking Questions 2.3

Both the psychodynamic and developmental perspectives provide

stage theories of human behavior, but they put different emphases on
the importance of childhood experiences. How important do you think
Mariana Rodriguez’s childhood experiences are to her current
situation? The psychodynamic perspective sees emotion as holding a
central place in human behavior. What emotions do you experience
as you read the story of Mariana Rodriguez and her family? Do you
think these emotions have any relationship to your own life course
experiences? Psychodynamically oriented social workers have
recently used concepts from object relations theories and self
psychology to think about anti-racist social work practice. What are
your reactions to their analyses as discussed in this chapter?

Learning Perspective

When Mariana Rodriguez returned to work after recovering from

COVID-19 and burying her husband, she had physical symptoms that
are associated with anxiety and panic. For the first few days back at
work, she thought that these symptoms meant that she was not fully
recovered from COVID-19 but upon reflection she realized that they
only occurred at work and became much more severe when she was
in the vicinity of a particular room. We can speculate that the
symptoms were learned responses, based on an association of
certain physical spaces and sensory stimuli with the COVID-19 crisis
her family had recently experienced. Another way to think about what
happened to Mariana when she returned to work is that her fast-
thinking system of cognitive learning led to automatic responses to
certain environmental cues, which she was able to override over time
with awareness, introspection, and analysis. It appears that Mariana
had a belief in her own personal competence to have her supervisor
understand the fears she was having at work, to find support in her
grief process, and to seek parish assistance to provide a collective
day of mourning and celebration of community members who died
with COVID-19. These are some ideas about Mariana Rodriguez’s
situation suggested by the learning perspective.

Theories in the learning perspective focus on how human behavior is

learned when individuals interact with their environments. There are
disagreements among the different streams of learning theory,
however, about the processes by which behavior is learned. Over
time, three major versions of learning theory—classical conditioning,
operant conditioning, and theories of cognitive learning—have been
presented, proposing different mechanisms by which learning occurs.
Recent research finds that learning often involves an integration of
conditioning and cognitive strategies (I.-S. Lee et al., 2021). The
general themes of the learning perspective are represented visually in
Figure 2.6, and Table 2.1 lists the important principles, major
concepts, and related theories of the perspective.
Figure 2.6 Learning Perspective
Classical conditioning is traced to an experiment Russian physiologist
Ivan Pavlov performed with dogs.

© Time & Life Pictures/Getty Images

Classical conditioning theory, also known as respondent conditioning,

sees behavior as learned through association, when a naturally
occurring stimulus (unconditioned stimulus) is paired with a neutral
stimulus (conditioned stimulus). This approach is usually traced to a
classic experiment by Russian physiologist Ivan Pavlov, who showed,
first, that dogs naturally salivate (unconditioned response) to meat
powder on the tongue (unconditioned stimulus). Then, a ringing bell
(conditioned stimulus) was paired with the meat powder a number of
times. Eventually, the dogs salivated (conditioned response) to the
ringing of the bell (conditioned stimulus) even when it was not paired
with the meat powder. In other words, an initially neutral stimulus
comes to produce a particular behavioral response after it is
repeatedly paired with another stimulus of significance. Biomedical
research indicates that many bodily functions and bodily responses
such as pain and placebo effects are affected by classical
conditioning (see Babel, 2019; I.-S. Lee et al., 2021). Neuroscience
research has found that fear responses in the amygdala and other
parts of the brain are trained through classical conditioning (Hwang et
al., 2022; Morriss et al., 2021; Sapolsky, 2017).

Research indicates that classical conditioning plays a role in

understanding many problems that social work clients experience.
For example, among people with substance abuse disorders, the
environmental contexts routinely associated with the alcohol or other
substance intake that preceded the pharmacological effects of the
substance can become cues for craving and relapse (Valyear et al.,
2017). These environmental contexts can include people, locations,
and sensory information such as smells. Although fear is central to
human survival, persistent pervasive fear interferes with human
functioning. Conditioned fear responses are involved in panic
disorder, phobias, social anxiety, and post-traumatic stress disorder
(PTSD) (Lebois et al., 2019). After a traumatic experience, the body
and the brain are conditioned to reexperience the traumatic situation
when exposed to sights, sounds, smells, and other sensory stimuli
associated with the original traumatic experience (van der Kolk,
2014). The classical conditioning approach looks for antecedents of
behavior—stimuli that precede behavior—as the mechanism for
learning. Classical conditioning ideas form the basis for exposure-
based psychotherapy and other attempts to inhibit and extinguish
pervasive fear responses. Because of research that indicates that
most people experience trauma in their lifetime but only a small
percentage (8–9%) experience PTSD, some researchers are
studying the factors involved in individual differences in responses to
classical conditioning (see M. T. Allen et al., 2019; Morriss et al.,
2021).

Operant conditioning theory, also known as instrumental conditioning,

sees behavior as learned through reinforcement. It is built on the
work of two American psychologists, John B. Watson and B. F.
Skinner. In operant conditioning, a behavior occurs and is reinforced
by the environment; the reinforcement increases the probability that
the behavior will occur again. A classic experiment demonstrated that
if a pigeon is given a food pellet each time it touches a lever, over
time, the pigeon learns to touch the lever to receive a food pellet. This
process is known as shaping, a process through which gross
approximations of a desired behavior are rewarded, followed by
rewards for successive approximations to shape the final behavior.
The operant conditioning approach looks for consequences—what
comes after the behavior—as the mechanism for learning behavior.
Positive reinforcers are positive consequences of the behavior, such
as food, water, sex, or social approval. We use positive reinforcers,
such as smiles or praise, to reward behaviors we find pleasing in
hopes of strengthening those behaviors. Negative reinforcers involve
the removal of an aversive consequence. For example, an adolescent
cleans their room to avoid parental complaints. Avoiding the
complaints reinforces the room-cleaning behavior. Operant
conditioning principles are applied in therapeutic attempts to
extinguish problematic behaviors such as smoking. It is not always
easy to determine which consequences are reinforcing for a particular
person, and research indicates that people vary in their sensitivity to
reinforcement (Cui et al., 2015).

A number of theories of cognitive learning have been proposed. We

have chosen four for this discussion: Bandura’s social cognitive
theory, social exchange and rational choice theories, cognitive load
theory, and dual process theory. Albert Bandura’s social cognitive
theory of learning suggests that humans have the flexibility to learn
by observation, modeling, rehearsing, beliefs, and expectations. In
this view, the learner is not passively manipulated by elements of the
environment but can use cognitive processes to learn behaviors.
Humans can observe behaviors of others and model their own
behavior on what they have observed, taking into account the
characteristics of the model and the consequences of the modeled
behavior. Observational learning has been found to play a central role
in the development of social skills and cultural knowledge. Social
work skills are often developed by observing a model, and social
work clients often use the social work practitioner as a model for
learning new skills. Neuroscience research indicates an important
role for the lateral prefrontal cortex in observational learning (Kang et
al., 2021).

Bandura (1977, 1986) proposes that beliefs and expectations are

driving forces for learning. He suggests that self-efficacy (a sense of
personal competence) and efficacy expectation (the expectation that
one can personally accomplish a goal) play an important role in
motivation to learn. Bandura (2001, 2002) has extended the theory of
self-efficacy to propose three models of agency (the capacity to
intentionally make things happen): personal agency of the individual
actor; proxy agency, in which people reach goals by influencing
others to act on their behalf; and collective agency, in which people
act cooperatively to reach a goal. Improvement in self-efficacy is
sometimes a goal of individual and group psychotherapy (Cusack et
al., 2019). Some practice situations call for social workers to act as
proxy agents (advocates), and collective action is the most effective
way to bring about change on a large scale.

Social exchange and rational choice theories integrate ideas from

operant conditioning and social cognitive theory. Exchange and
choice theories see human behavior as based on rational analysis of
the costs and benefits (rewards and punishments) of particular
actions and different relationships (Coleman, 1990; Homans, 1958).
Viewed through this theoretical lens, humans are rational actors who
make strategic decisions based on values, goals, expectations, and
the history of reinforcements.

Two theories developed by cognitive psychologists, cognitive load

theory and dual process theory, present a challenge to social
exchange and rational choice theories by proposing limits to the
rationality of human decision-making and learning. Cognitive load
theory proposes three parts of memory that are used in learning and
decision-making: sensory memory, long-term memory, and working
memory. Sensory memory and long-term memory hold information for
long periods of time for later recall. Working memory is where
processing of information happens, but only a limited amount of
information can be held in working memory at one time. People
experience cognitive overload when the demands for decision-
making exceed the capacity of working memory. Cognitive overload
interferes with problem solving and learning. It has been implicated in
medical errors and impasses in social policy negotiations (Harris &
Santhosh, 2022; Stone, 2012).

Dual process theory proposes that there are two systems of human
cognition, one system that is fast, automatic, unintentional, and
operates outside awareness and another system that is slow,
deliberate, analytical, and operates within awareness (Evans, 2008;
Kahneman, 2011). This theory receives support from neuroscience
research that finds different neural pathways for fast and slow
thinking (Bursell & Olsson, 2021). In dual process theory, the fast-
thinking system is known as implicit cognition. Implicit cognition is
influenced by language structures and based on memories of past
social experiences that are not remembered but have created
automatic associations, attitudes, and stereotypes. Explicit cognition
occurs in working memory and is accessible to awareness,
introspection, analysis, and control (Kahneman, 2011). Implicit bias is
an example of fast thinking and is an automatic, favorable, or
unfavorable mental representation of people belonging to a social
category. It is a social cognition operating outside of awareness,
based on attitudes and stereotypes learned over time that often
involve a preference for the in-group over an out-group (Banji et al.,
2021). Implicit biases persist even when they are discordant with
explicit biases. Implicit bias receives further attention in Chapter 8,
Cultures.

Critical Analysis of the Learning Perspective

In terms of coherence and conceptual clarity, the learning perspective

gets high marks for conceptual clarity; concepts are very clearly
defined in each of the streams. Although there are disagreements
about the mechanisms of learning among the various streams of the
behavioral perspective, within each stream, ideas are logically
developed in a consistent manner. Considering testability and
empirical support, learning concepts are easily measured for
empirical investigation because theorizing has been based, in very
large part, on laboratory research. This characteristic is also a
drawback of the learning perspective, however, because laboratory
experiments, by design, eliminate much of the complexity of person–
environment interactions. In general, however, all streams of the
learning perspective have attained a high degree of empirical
support.

Overall, the learning perspective sacrifices multidimensional

comprehensiveness to gain logical consistency and testability. Little
attention was paid to biology in early theorizing, but in his later work,
Bandura (2001, 2002) recognized the role of biology in human
behavior. Even so, biological research provides some of the best
evidence for the learning perspective. Cognition and emotion are not
included in theories of classical and operant conditioning, but they do
receive attention in social cognitive theory. Spiritual factors are
considered unmeasurable and irrelevant in classical and operant
conditioning theories. Although environment plays a large role in the
learning perspective, the view of the environment is quite limited in
classical and operant conditioning. Operant conditioning theories
search for the one environmental factor, or contingency, that has
reinforced or has the possibility of reinforcing one specific behavior.
The identified contingency is usually in the micro system (such as the
family) or sometimes in the meso system (e.g., a school classroom),
but these systems are not typically put in social, economic, political,
or historical contexts. Bandura’s cognitive social learning theory
acknowledges broad systemic influences on the development of
gender roles, and dual processing theory recognizes both micro and
macro influences on implicit cognition. In conditioning theories, time is
important only in terms of the juxtaposition of stimuli and
reinforcement. Social exchange and rational choice theories
recognize the history of reinforcements, and dual process theory
emphasizes the way implicit cognition is created over time.

Early theorizing in the learning perspective receives low marks for

addressing anti-racism, diversity, equity, and inclusion. Recent
theorizing about and empirical measures for implicit bias have made
an important contribution to the understanding of the persistence of
racist attitudes and stereotypes as well as unfavorable implicit biases
about other marginalized groups. It is important for social workers to
recognize that we all have implicit biases that are created over time
and operate outside of awareness, even when they conflict with
newly learned explicit cognition. The best antidote to harmful implicit
biases is to slow down and allow time for explicit cognition to kick in.
In terms of diversity, Sapolsky (2017) suggests that conditioning
theorists were often right about human behavior but were wrong in
one big way: They failed to acknowledge that we are not all born the
same and the same training will not produce the same results in all
humans. Researchers have begun to tackle this issue with empirical
investigation of individual differences in responses to classical
conditioning and sensitivity to reinforcement (M. T. Allen et al., 2019;
Cui et al., 2015; Morriss et al., 2021). Bandura’s (2002)
conceptualization of proxy agency and collective agency has
implications for social reform, equity, and inclusion. Operant
conditioning theory recommends rewards over punishment, but it
does not account for the coercion and oppression inherent in power
relationships at every system level. It is quite possible, therefore, for
the professional behavior modifier to be in service to oppressive
forces. On the other hand, Bandura (1986) notes that persons in
nondominant positions are particularly vulnerable to learned
helplessness , in which a person’s prior experience with
environmental forces has led to low self-efficacy and expectations of
efficacy. Maier and Seligman (2016) analyzed the neural circuitry of
learned helplessness.

A major strength of the learning perspective is the ease with which

learning principles can be extrapolated for intervention, giving it high
marks for usefulness for social work practice. Classical and operant
conditioning interventions are used to extinguish or modify
problematic behaviors. Parent training programs often teach parents
how to make more effective use of reinforcements to strengthen
positive behaviors and weaken negative behaviors in their children.
Cognitive theories of learning, with their attention to beliefs,
expectations, and fast and slow thinking, are useful for social work
engagement and assessment. Social workers often model how to
enact new behaviors for their clients. Cognitive behavior therapy
(CBT) has been found to produce lasting favorable results for many
human problems (Thomlison & Thomlison, 2017). Dual processing
theory can be used to assess the implicit and explicit cognitions
involved in depression and substance use disorders and to guide
cognitive behavioral interventions for these situations (see Haeffel et
al., 2007; Keough et al., 2016; Li & Dobson, 2021). Dialectical
behavior therapy involves the learning of adaptive coping related to
dysregulation in emotional, interpersonal, self, behavioral, and
cognitive dimensions (Cooper et al., 2022). Cognitive processing
therapy, which helps clients learn skills to challenge their trauma-
related beliefs and cognitive distortions, has been found to have long-
term benefits for reducing symptoms of PTSD (Cooper et al., 2022;
Iverson et al., 2015). Bandura’s (2002) conceptualization of proxy
agency and collective agency has implications for advocacy and
collective anti-racist, anti-oppressive action. The empowerment
approach to practice can be used for increasing client self-efficacy (J.
Lee & Hudson, 2017).

Humanistic-Existential Perspective

Like many families, Mariana Rodriguez and her family were motivated
by many needs during the early days of the COVID-19 pandemic.
Their basic physiological and safety needs were compromised when
they tested positive for the disease. During Mariana’s and Daniel’s
hospitalizations, the close-knit family was unable to provide each
other the kind of daily love and belongingness to which they had been
accustomed. However, they appreciated the compassion and support
from the medical community and from their Catholic parish. The
changes that needed to be made after Daniel’s death were painful
and frightening, but Mariana and her children found the courage, will,
and perseverance to make the necessary adjustments. When
Mariana experienced anxiety and panic at work, she had confidence
that her supervisor would respect her version of what was happening
and that they could work together to minimize the challenge. Mariana
was motivated to be a strength for her family and to take the steps
needed to take responsibility and accountability for her grief process.
She was fortified by the positive regard and empathic listening she
experienced in the grief support group and felt empowered to help
create a culture of collective grief and celebration of life for her
community. As she reflected on Daniel’s death, she revisited
conversations in which he had told her he was not afraid of death and
questioned her own death fears. These are some of the ideas the
humanistic-existential perspective suggests for understanding what
has happened and is happening with Mariana Rodriguez and her
family.

The humanistic-existential psychological perspective is often called

the “third force” of psychology, because it was developed in reaction
to the determinism found in early versions of both the psychodynamic
(behavior as intrapsychically determined) and learning (behavior as
externally determined) perspectives. It is a phenomenological
approach that focuses on human conscious experiences, how the
person experiences the world internally. It proposes that human
behavior is best understood from the internal frame of reference of
the person rather than from external evaluation. The humanistic-
existential perspective proposes that humans have the capacity to
make choices (human agency), search for meaning, and constantly
strive to become the best version of themselves that they can be.
This perspective asserts that each individual is unique, has worth,
and should be treated with dignity. The main ideas of the humanistic-
existential perspective are presented visually in Figure 2.7, and Table
2.1 lists the important principles, major concepts, and related theories
of the perspective.
Figure 2.7 Humanistic-Existential Perspective

The most influential early contributors to humanistic psychology are

Abraham Maslow (1950, 1970, 1971) and Carl Rogers (1973, 1978,
1986). Maslow proposed a theory of motivation. He considered
motivation to be complex, both conscious and unconscious or
unknown to the person. He acknowledged that some behavior is not
motivated but driven by such influences as conditioned reflexes,
maturation, and drugs. Maslow proposed that people are constantly
motivated by one need or another and presented a hierarchy of
needs in which higher level needs cannot emerge in full motivational
force until lower needs have been at least partially satisfied.
Physiological needs are at the bottom of the hierarchy, and the need
for self-actualization is at the top:
 Physiological needs: food, water, oxygen, maintenance of bodily
functions
Safety needs: physical security, stability, dependency, protection
Love and belongingness needs: affection, intimacy
Esteem needs: self-respect, confidence, competence, reputation
Self-actualization: self-fulfillment, realization of potential

Maslow (1950) was particularly interested in self-actualizing people

and was critical of the emphasis on psychopathology in
psychoanalytic theory. After engaging in a number of case studies,
Maslow identified some characteristics that self-actualizing people
possess. They can detect lack of authenticity in others; are less afraid
of the unknown than other people; accept themselves, others, and
nature; are spontaneous, simple, and natural; are interested in
problems outside of themselves; have a purpose for living; and can
find joy in solitude and privacy. Maslow is considered one of the
founders of transpersonal psychology (discussed in Chapter 6, The
Spiritual Person), which he labeled as the “fourth force” of
psychology.

Rogers (1973, 1978, 1986) proposed a person-centered theory.

Rogers believed that humans have vast internal resources for self-
understanding and self-directed behavior. The person-centered
theory has two basic assumptions: the formative tendency and the
actualizing tendency. The formative tendency assumes that all matter
has a tendency to evolve from simpler to more complex forms.
Human consciousness evolves from a primitive unconsciousness to a
highly developed awareness, including self-awareness. The
actualizing tendency assumes that organisms have a tendency to
move toward fulfillment of their potential. Rogers thought that the
actualizing tendency is not limited to humans; animals and plants also
have an inherent tendency to grow toward genetic potential. Rogers
also suggested that humans have a tendency to resist change, to
fight against new ideas, and find change painful and frightening.
However, humans are willing to learn and change when certain
interpersonal conditions are met to support the actualizing tendency.
The conditions that must be met are involvement with a partner who
is authentic and exhibits empathy and unconditional positive regard.
These are the ideal interpersonal conditions under which people
come to use their internal resources to become more fully functioning.
Rogers was particularly interested in the capacity of humans to
change in therapeutic relationships and presented a detailed theory
of client-centered psychotherapy that focused on the necessary and
sufficient conditions for therapeutic growth (authenticity, unconditional
positive regard, and empathic listening), stages of therapeutic
change, and the desired outcome of a higher level of positive regard.
Rogers emphasized the dignity and worth of each individual.

Existential psychological theory considers the balance between

freedom and responsibility in human lives, the human search for
meaning, and the uniqueness and value of each person. It posits that
the human essence is the power to continually redefine oneself
through the choices that are made. Personal growth results from
staying in the immediate moment, and each person is responsible for
who they are and become. An issue that sets existentialism apart
from other versions of humanistic theory is the suggestion that
suffering is a necessary part of human growth. Echoing Erich
Fromm’s (1947) humanistic psychoanalysis theory, Rollo May’s
(1967, 1981) existential psychology theory provides an example of
this focus on suffering. May emphasizes the human suffering that
comes from alienation and describes three types of alienation: losing
touch with the natural world (unwelt), lack of meaningful interpersonal
relations (mitwelt), and alienation from one’s authentic self
(eigenwelt). Healthy people adapt to the natural world, relate to
others as fellow humans, and have self-awareness about what their
experiences mean to them. May proposed that self-awareness must
include an awareness of one’s own mortality. Life becomes more
meaningful when we confront the eventuality of our death, and fear of
death often leads people to live defensively (May, 1958). The idea of
fear of death is the focus of contemporary terror management theory
(TMT) and related research. TMT proposes that human awareness of
death makes humans vulnerable to terrifying death anxiety (Harvell &
Nisbett, 2016).

Maslow is said to have coined the term positive psychology when he

used it as a chapter title in his 1954 book, Motivation and Personality.
As we know it today, positive psychology undertakes the scientific
study of people’s strengths and virtues and promotes optimal
functioning of individuals and communities (Lopez et al., 2019).
Martin Seligman (1998, 2002), one of the authors of the concept of
learned helplessness, has been at the forefront of positive
psychology, contributing the important concept of learned optimism ,
the idea that optimism, hope, and joy can be learned and cultivated.
Positive psychologists focus on prevention of mental illness and other
problems of living and suggest this is best accomplished by
enhancing human strength and competence. They have identified a
set of human strengths that promote well-being and buffer against
mental illness, including optimism, courage, hope, perseverance,
honesty, a work ethic, and interpersonal skills (Lopez et al., 2019).
The positive psychology approach is drawing on both Western and
Eastern worldviews. A large focus on hope is rooted in Western
thinking about individualism, whereas emphasis on balance,
compassion, and harmony comes more from Eastern collectivist
thinking. The strengths perspective and solution-focused approach to
social work are rooted in positive psychology, and Kam (2021)
proposes an empowerment-participation-strengths (EPS) model for
social work practice.

In recent decades, the humanistic-existential perspective has

received criticism on several fronts. Sociological posthumanists
criticize the perspective for putting humans at the center of the world
and elevating the importance of humans over nature and other
nonhuman elements. The perspective has also been criticized for its
individualistic nature, suggesting that it is not a good fit for non-
Western communal cultures. Another criticism is that the perspective
ignores the role of oppressive social structures in human
consciousness and behavior and has been used to make decisions
about who is worthy of being called human.

Currently, we are seeing a resurgence of the humanistic-existential

perspective in a more radical, critical form known as critical
humanism (Plummer, 2021). Critical humanism focuses attention on
the suffering and power imbalances in the world and calls for
acknowledgment of the suffering and active work to develop solutions
to alleviate it. It emphasizes the need to work toward reducing and
repairing suffering and alienation caused by all types of
dehumanization, exploitation, domination, and oppression embedded
in contemporary social life. It is interested in building connections to
the earth and all of the human and nonhuman beings that occupy it.
The approach to consciousness in critical humanism draws on
Freire’s (1970) theory of critical consciousness, which is the ability to
recognize and analyze economic, political, and social systems of
inequality and to commit to taking actions against these systems (see
Bañales et al., 2019; Conlin et al., 2021; Zaidi et al., 2017). Critical
humanists disapprove of diagnostic psychological labels and
categories that create a “medicalization of injustice” (Saleem et al.,
2021).

In the discussion of the critical perspective, we noted that some

theorists in the Global South are creating new theories out of the
synthesis of Indigenous knowledge and theories from the Global
North. Here is an example of that synthesis. Robert Chigangaidze
(2021a, 2021b) proposes a synthesis of African Ubuntu philosophy
and the humanistic-existential theoretical perspective and
recommends the ubuntufication of social work. Ubuntuism is

an African philosophical framework that is characterized by

interconnectedness of all things and beings; the spiritual nature
of people; their collective/individual identity and the
collective/inclusive nature of family structure; oneness of mind,
body, and spirit; and the value of interpersonal relationships.
(Chigangaidze et al., 2022, p. 320)

Ubuntu originated with the Bantu people of South Africa and is known
by different names across the continent of Africa. It is rooted in the
sayings, “I am a person because you are, I am because I share and
participate” and “I am because of others” (Chigangaidze, 2021a, p.
148; Chigangaidze et al., 2022, p. 320). Chigangaidze (2021a)
identifies the following concepts as crucial to the synthesis of
ubuntuism and the humanistic-existential perspective: self-
awareness, self-determination, human dignity, connectedness and
wholeness of life, pursuit of social justice and human rights,
motivation, social inclusion and social cohesion, spirituality, and death
as an inevitable reality.

Critical Analysis of the Humanistic-Existential Perspective

In terms of coherence and conceptual clarity, theories in the

humanistic perspective are often criticized for being vague and highly
abstract, with concepts such as uniqueness, personal freedom, self-
actualization, and phenomenological experiences. The same
evaluation can be made of many concepts from the emerging critical
humanism with the exception of critical consciousness, which is
clearly and consistently stated. However, Rogers’s person-centered
theory and recent positive psychology approaches are clear and
coherent. Theorists in the humanistic-existential perspective, in
general, have not been afraid to sacrifice coherence to gain what they
see as a more complete understanding of human behavior. Over
time, theorists have worked to refine and clarify the major concepts.

In terms of testability and empirical support, concepts from the

humanistic-existential perspective can be rated average for
generating research. Self-actualization continues to be a popular
concept to research (see Kaufman, 2020; Krems et al., 2017; Ortiz,
2020). Rogers began a rigorous program of empirical investigation of
the therapeutic process, and such research has provided strong
empirical support for his conceptualization of the necessary
conditions for the therapeutic relationship: unconditional positive
regard, empathic listening, and authenticity (see Lynch et al., 2019;
Ryan & Ryan, 2019; Smith et al., 2021). A scale has been developed
for measuring critical consciousness (Diemer et al., 2020). The
positive psychology movement is focusing on producing empirical
support for the role of human strengths and virtues in human well-
being (see Chaves et al., 2017; Singh, 2016). Some researchers
have suggested that neuroscience research is calling the notion of
free will (human agency) into question, arguing that it provides clear
evidence that human behavior is determined by the gene–
environment interactions that shape the brain (Kurzweil, 2012). Other
neuroscientists provide evidence that humans have the power to “live
our lives and train our brains” in ways that shift emotions, thoughts,
and behaviors (Davidson & Begley, 2012, p. 225). That is a high
endorsement for some of the tenets of the humanistic-existential
perspective.

The humanistic-existential perspective is low to moderate in

comprehensiveness. The internal life of the individual is the focus of
the classical humanistic-existential perspective, and it is strong in
consideration of both psychological and spiritual dimensions of the
person. It makes important contributions by its approach to motivation
and by introducing the meaning of death to the understanding of
human behavior. With its emphasis on a search for meaning, the
humanistic perspective is the only perspective presented in this
chapter to explicitly recognize the role of spirituality in human
behavior. In addition, Maslow recognizes the importance of
satisfaction of basic biological needs. Early humanistic-existential
theorists noted the importance of relationships with other people and
relationships with nature, and these ideas have become more
prominent in critical humanism. Critical humanism is concerned with
large-scale systems of dehumanization and oppression. The positive
psychology movement has begun to examine positive environments
that can promote human strengths and virtues, including school,
work, and community environments (Lopez et al., 2019).

Although the classical humanistic-existential perspective was

concerned about dehumanization, it receives low marks for direct
attention to anti-racism, diversity, equity, and inclusion. However, the
client-centered approach to intervention promotes the dignity and
worth of all and gives value to the lived experiences of all, including
members of oppressed and marginalized groups. The focus on
alienation provides tools for considering the impact of racism and
other forms of oppression on individuals, communities, and societies.
In recent years, the humanistic-existential perspective has been used
to understand diversity. Here are two examples. Positive psychology
has been promoted as a helpful way to understand Islamic
psychology and Muslim well-being (Pasha-Zaidi, 2021). Ortiz (2020)
analyzes how self-actualization should be understood in collectivistic
cultures, achieved through relationships and the honoring of
collective values.

The humanistic-existential perspective gets high marks for usefulness

for social work practice. It was developed by psychotherapy
practitioners and is being revised by critical humanists devoted to the
advancement of human rights and promotion of justice. The
Educational Policy and Accreditation Standards of the Council on
Social Work Education (2022) includes language that is consistent
with the humanistic-existential perspective: “Social workers value the
importance of human relationships ... use empathy, reflection, and
interpersonal skills ... demonstrate respect for client self-
determination” (p. 11) and “engage in practices that advance human
rights to promote social, racial, economic, and environmental justice”
(p. 9). The perspective provides guidelines for engaging with client
groups at every level of practice—with authenticity, unconditional
positive regard, and empathic listening. The perspective is strong in
recommendations for engaging with individuals, families, groups,
organizations, and communities but also useful for assessment and
intervention. With its emphasis on the individual drive for growth and
competence, it recommends a “strengths” rather than deficit
approach to practice (see Corcoran, 2022; Saleebey, 2012). The
emphasis on motivation has served as the impetus for the
development of the motivational interviewing approach to practice
(Corcoran, 2016; Iarussi, 2020). Appreciative inquiry is an
organizational model that focuses on identifying the positives and
dreams of what might be in organizations (Lewis et al., 2016).
Positive psychology is popular in clinical work and proposes
guidelines for developing positive environments in schools,
workplaces, and communities.

Critical Thinking Questions 2.4

Both theories of cognitive learning and theories in the humanistic-

existential perspective emphasize the important role of human
agency, the capacity to intentionally make things happen, in human
behavior. Other theories in the learning perspective and most of the
other perspectives discussed here put less emphasis on human
agency. Now that you have examined seven theoretical perspectives,
how much agency do you think humans have over their behavior, in
general? Explain. How much agency do you think Mariana Rodriguez
and her family have? Explain.

The Merits of Multiple Perspectives

You can see that each of these perspectives puts a different lens on
the unfolding story of Mariana Rodriguez and her family. Although
they all are seeking to understand human behavior, different aspects
of behavior are emphasized. No one theory will ever tell the whole
story of human behavior, but each of these perspectives tells an
important partial story—a partial story that will be particularly helpful
in some situations. You can also see that each of the seven
perspectives has been used to guide social work practice over time.
Some of the perspectives are particularly useful for suggesting how to
engage with client systems, some are especially useful for
assessment, some are particularly strong for suggesting social work
interventions, and some can be used to guide practice evaluation. It
was suggested in Chapter 1 that each situation can be examined
from several perspectives and that using a variety of perspectives
brings more dimensions of the situation into view. Cognitive
psychologists have provided convincing evidence that all of us,
whether new or experienced social workers, have biases that
predispose us to do too little thinking, rather than too much, about the
practice situations we confront. We are particularly prone to ignore
information that is contrary to our hypotheses about situations.
Consequently, we tend to end our search for understanding
prematurely. One step we can take to prevent this premature closure
is to think about practice situations from multiple theoretical
perspectives.

We have provided an overview of seven theoretical perspectives in

this chapter and discussed some of the theories related to them. In
Chapters 4 through 8 and 10 through 14, you will encounter other
theories related to these perspectives, theories used to understand
specific dimensions of person and environment. To help you see the
connections between the perspectives discussed here and theories
discussed in subsequent chapters, Table 2.2 cues you to where you
will find these related theories in subsequent chapters.

Table 2.2
To be competent professionals, we must view the quest for adequate
breadth and depth in our knowledge base as an ongoing, lifelong
challenge and responsibility. As we worked to revise this chapter, we
were challenged to rethink some of our own understanding of human
behavior and we were excited and sometimes awed to see the extent
to which recent events have spurred theorists, researchers, and
clinicians to reevaluate the ways they have been approaching the
study of human behavior. You can become an important part of this
ongoing reflection and revision. With the current state of knowledge
about human behavior, recognizing the ever-evolving state of such
knowledge, we recommend these seven theoretical perspectives for
social work engagement, assessment, intervention, and practice
evaluation. Different perspectives will be more or less useful in
different types of practice situations. We believe that many practice
situations would benefit from using these multiple theoretical
perspectives in an integrated fashion in order to see the many
dimensions—the contradictions as well as consistencies—in stories
like the one of Mariana Rodriguez and her family. We encourage you
to be flexible and reflective in both your thinking and your doing
throughout your career. We remind you, again, to use general
knowledge such as that provided by theoretical perspectives only to
generate hypotheses to be tested in specific situations, not as facts
inherent in every situation.

Critical Thinking Questions 2.5

At the beginning of the chapter, we wondered what got your attention

when you read the story of Mariana Rodriguez and her family. As you
read about the seven theoretical perspectives, did you see any ideas
that addressed the story elements that caught your exhibiattention? If
so, what were they? Were there issues or ideas that caught your
attention that did not seem to be addressed by any of the
perspectives? If so, what were they? Which perspectives seemed
more closely aligned with what caught your attention upon first
reading the story? Which perspectives provided you with useful new
ways to think about the story?
Implications for Social Work Practice

The seven perspectives on human behavior discussed in this chapter

suggest a variety of principles for social work assessment and
intervention.

In assessment, consider any recent system changes that may be

affecting the client system. Assist families and groups in
renegotiating unsatisfactory system boundaries. Develop
networks of support for persons experiencing challenging life
transitions.
In assessment, consider power arrangements and forces of
oppression and the alienation that emanate from them. Assist in
the development of advocacy efforts to challenge patterns of
dominance, when possible. Be aware of the power dynamics in
your relationships with clients; when working with nonvoluntary
clients, speak directly about the nature of the relationship
including the limits and uses of your power.
In assessment, consider the patterns of exchange in the social
support networks of individual clients, families, and
organizations, using network maps where useful. Assist
individuals, families, and organizations in renegotiating
unsatisfactory patterns of exchange, when possible. Recognize
the role of both reason and emotion in the policymaking process.
Begin your work by understanding how clients view their
situations. Engage clients in thinking about the environments in
which these constructions of self and situations have developed.
When working in situations characterized by differences in belief
systems, assist members in engaging in sincere discussions and
in negotiating lines of action.
Assist clients in expressing emotional conflicts and in
understanding how these are related to past events, when
appropriate. Help them develop self-awareness and self-control,
where needed. Assist clients in locating and using needed
environmental resources.
In assessment, consider the familial, cultural, and historical
contexts in the timing and experience of developmental
 transitions. Recognize human development as unique and
lifelong.
In assessment, consider the variety of processes by which
behavior is learned. Be sensitive to the possibility of learned
helplessness when clients lack motivation for change. Be aware
of your own fast and slow thinking and implicit and explicit
cognitions. Consider issues of social justice and fairness before
engaging in behavior modification.
Engage clients by listening to how they see their situations, what
kinds of changes they would like to see, and what methods they
would like to use to accomplish those changes. Be aware of the
potential for significant differences between your assessment of
the situation and the client’s own assessment. Focus on
strengths rather than pathology; recognize the possibility of
learned hopefulness as well as learned helplessness.

Chapter Review

Key Terms

Agency
Anthropocene
Binary oppositions
Critical perspective
Critical race theory (CRT)
Cumulative advantage
Cumulative disadvantage
Developmental perspective
Efficacy expectation
Epigenetic model of human development
Feminist theories
Hierarchy of needs
Humanistic-existential perspective
Learned helplessness
Learned optimism
Learning perspective
Microaggressions
 Protective factors
Psychodynamic perspective
Risk factors
Self-efficacy
Social capital
Social constructionist perspective
Symbolic interaction theory
Systems perspective

Active Learning

1. Reread the COVID-19 in the family case study (Case Study 2.1)
at the beginning of the chapter and review the important
principles of the seven theoretical perspectives as presented in
Table 2.1 . Choose three specific important principles that you
think are most helpful in thinking about Mariana Rodriguez and
her family. For example, you might choose this principle from the
systems perspective: Each person is involved in multiple
interacting systems. You might also choose this principle from
the humanistic-existential perspective: Humans have the
capacity to make choices, search for meaning, and constantly
strive for personal growth. Likewise, you might choose another
specific principle from any of the perspectives. The point is to
choose the three principles that you find most useful. Now, in a
small group, compare notes with three or four classmates about
which principles were chosen. Discuss why these particular
choices, and not others, were made by each of your classmates.
2. Choose one of the theoretical perspectives described in this
chapter. Spend 5–8 minutes thinking about how you would
describe that perspective to a class of sixth graders. Prepare an
outline of the presentation you would make to the sixth graders.
Post your outline for your classmates to review and provide
feedback.
3. Choose a current event or recent news story. Read the story
carefully and then think about which of the seven theoretical
perspectives discussed in this chapter is most reflected in the
story.
Descriptions of Images and Figures

Back to Figure

At the center of the road map, two people are sitting across the table.
They are connected to a factory, educational institution, office, park,
entertainment center, hospital, home, and other people by a network
of roads that have bidirectional flow.

Back to Figure

At the center is capitalism surrounded by power, exploitation,

exclusion, and domination. The next outer circle consists of
neuroconformity, white supremacy, colonialism, heteronormativity,
cisnormativity, and ableism. Surrounding this people are separated by
divide and control. Various strengths of people are separated by
divide and control.

Back to Figure

At the center is the social construction of realities. On all sides

surrounding this are truth, worldview, sense of self, and meaning. On
each side the following icons are there elderly person, a person in a
wheelchair, a person with a child, and a woman. They are
interconnected with each other. This is surrounded by cultural
systems, political systems, and economic systems on all the sides.

Back to Figure

An illustration of a person running. Two tangents behind him at an

acute angle one representing mastery, capitalism, and adaptation and
the other representing defense, threat, and physiological states. The
content inside these tangents is drive, emotions, needs, mental
states, and emotions. This constitutes the psychodynamic
perspective.

Back to Figure
The developmental perspective is as follows:

The figures on the flowchart are as follows, crawling child, child with
balloon, group of children, two adults dancing, two women, a
pregnant woman, a person with a child, two persons standing and
another in a wheelchair, and a person with a walking stick. This is
accompanied by tasks, roles, and statuses in a cyclic manner. At the
center is a triangular flowchart interconnected to each other. The
three ends are the biological process, psychological process, and
social process.
Part II The Multiple Dimensions of Person
The multiple dimensions of person, environment, and time have
unity; they are inseparable and embedded. That is the way we think
about them and the way we encourage you to think about them.
However, you will be better able to think about the unity of the three
aspects of human behavior when you have developed a clearer
understanding of the different dimensions encompassed by each
one. A review of theory and research about the different dimensions
will help you to sharpen your thinking about what is involved in the
changing configurations of persons and environments.

The four chapters in Part II provide you with an up-to-date

understanding of theory and research about the dimensions of the
person. The section begins with Chapter 3 on the biological
dimension. Chapter 4 provides an overview of the basic elements of
a person’s psychology, cognition, emotion, personality, and self.
Chapter 5 considers the processes involved in human relationships,
stress, and coping. Part II ends with Chapter 6, which covers the
spiritual person.

With a state-of-the-art knowledge base about multiple dimensions of

persons, you will be prepared to consider the interactions between
persons and environments, which is the subject of Part III. And then
you will be able to think more comprehensively and more clearly
about the ways configurations of persons and environments change
across the life course. The discussion of the life course in the
companion volume to this book, The Changing Life Course, attempts
to put the dimensions of persons and environments back together
and help you think about their embeddedness across time.
3 The Biological Person

Stephen French Gilson and Elizabeth DePoy

Learning Objectives

3.1 Compare one’s own emotional and cognitive reactions to six

case studies involving biological systems.
3.2 Articulate how the body and surroundings comprise a
continuous environment.
3.3 Describe the major structures and functions of six biological
systems (nervous, endocrine, immune, cardiovascular,
musculoskeletal, and reproductive) and give examples of how
different biological systems interact to produce health and
disease.
3.4 Explain socioeconomic, racial, and other health disparities
using the bioecodevelopmental framework.
3.5 Apply knowledge of human biology to recommend guidelines
for social work engagement, assessment, intervention, and
evaluation.

Six Case Studies of the Biological Person

Case Study 3.1: Cheryl’s Legs and Head

Cheryl grew up in rural Idaho in a large extended family and enlisted

as a private in the army just after she finished her third year in high
school. After basic training, she was first deployed to Iraq and
subsequently to Afghanistan for active combat duty. Traveling en
route to Ghorak base in southern Afghanistan, Cheryl’s Humvee
contacted an explosive device, throwing Cheryl from the vehicle and
causing massive injuries to both legs. She sustained a blow to the
head as well and lost consciousness for 30 minutes. As a result of
serious injuries, Cheryl was medevacked to the intensive care unit of
the closest military hospital. After she underwent surgery, Cheryl was
informed by her physician and the social worker that in order to save
her life, both of her legs had to be amputated below the knee. To the
delight of her medical team, Cheryl’s reaction to this news was not
extreme.

Over the 10-month course of her rehabilitation, Cheryl was fitted with
different types of prostheses, none of which restored her ability to run
and engage in sports. She also experienced “phantom pain” in her
right leg, a condition in which pain is experienced in a body part that
is no longer present. Following her honorable discharge from the
Army, Cheryl traveled to MIT, where she was accepted into an
experimental prosthetics program. She was fitted with two below-the-
knee robotic prosthetics that are controlled by sensors. While she did
well in her mobility training, Cheryl had a hard time with simple
mathematical calculations and her friends and family remarked that
Cheryl’s affect seemed vacant compared to how she was prior to her
accident. Cheryl was referred to a social worker for counseling due to
suspected depression. In his wisdom, however, the social worker,
who had extensive experience with clients who had traumatic head
injuries, referred Cheryl for neurological and neuropsychological
testing. Cheryl’s MRI scan detected injury to the frontal cortex, the
region of the brain that controls affect.

Case Study 3.2: A Diabetes Diagnosis for Jenna

Jenna, a 12-year-old Franco American girl who lives in rural Maine,

was doing well in school, riding in pony club in the summer and alpine
ski racing in the winter. The youngest of three children, Jenna also
worked on her parents’ blueberry farm, raking berries to earn
spending money. Like many girls her age, Jenna had a sweet tooth,
but her parents watched her nutrition, making sure that she was
adequately nourished. Drinking sufficient fluids each day was easy for
Jenna, because it seemed that she was always thirsty for water. But
when Jenna started losing weight and increased afternoon napping,
Jenna’s parents were concerned that she could be exhibiting an
eating disorder. They made an appointment with their family health
provider.
On the morning of her appointment, Jenna did not come down from
her bedroom. Because it was very unusual for her not to join her
family at the breakfast table, her parents became alarmed and
immediately went upstairs to find Jenna sitting on her bed, still in her
nightgown, which was drenched with perspiration. Jenna was
confused and unable to answer simple questions with correct
responses. Jenna’s parents immediately took her to the local
community hospital.

In the emergency department (ED), after some blood work, a doctor

diagnosed Jenna with type 1 diabetes. The ED social worker, well
versed in contemporary medical strategies, referred Jenna to the
waiting list for PEC-Direct stem cell clinical trials, an experimental
strategy to “act as a replacement pancreas.”

Case Study 3.3: Shay and Terry

Shay and Terry married 3 years ago in New York. Shay works from
home as a metal artist, and Terry is a video game designer who splits
work time between the office and home. As a non-heterosexual
couple, they did not consider having biological children. However,
over the past two years, both have articulated feeling unfulfilled
without a family of their own. Since they both have flexible work
schedules, they have been investigating options for bringing an infant
into their lives. At first, they considered adoption, but surrogacy and in
vitro fertilization opened the world for their procreation. They are now
in the process of exploring these options and seeking genetic
counseling to support their decisions and actions.

Case Study 3.4: HIV: Thomas’s Hero

Thomas is a 6-year-old boy who lives with his parents. When he

turned 3, he was diagnosed with leukemia. New research and
experimental treatments have been conducted on one’s own immune
system as a means to fight and cure certain cancers, leukemia being
one of them. The human immunodeficiency virus (HIV) has been
manipulated as a hunter, one that can ferret out, activate one’s own
immunity, and eliminate cancer cells, particularly in the blood. As
Thomas continued to fail, showing no positive responses to
conventional treatments, his parents decided to enroll him in an
experimental program in which HIV was a primary treatment agent.
Thomas underwent the preparation of t-cell protection and then was
treated with modified HIV (chimeric antigen receptor t-cell therapy). At
age 6, there is no evidence of cancer in his body.

Case Study 3.5: Louise and Huntington’s and Stewart’s Obesity and Cardiovascular Disease

Louise was an 84-year-old woman who lived on the west coast of

Florida in her own apartment. At the age of 49, Louise was diagnosed
with Huntington’s disease, a genetically transmitted
neurodegenerative condition affecting all aspects of function,
including musculoskeletal integrity, cognition, self-care, speech, and
mood. Until the age of 70, Louise was able to walk with the
assistance of a wheeled suitcase and a hiking stick. She engaged in
social interactions and light chores in the house. As her disease
progressed, she became increasingly limited in mobility, fine motor
skills, speech, and swallowing. Her husband, Stewart, who was
grossly obese and thus unable to provide full care for Louise, found
an agency that brought Haitian families into the United States to
provide care for elders. Anne, the 39-year-old caregiver, came to
work at Louise’s home each day, sometimes bringing her 10-year-old
daughter. When Louise’s husband died suddenly of a massive heart
attack, Anne and her daughter moved into the guest bedrooms of
Louise’s home. Anne’s daughter has graduated from college and
plans to obtain a master’s degree in social work. Anne remained with
Louise at home until her death at 84 despite Louise’s son’s attempt to
put his mother in a nursing home. Louise’s daughter, now in her early
60s, has Huntington’s but benefits from the new drugs to reduce
symptoms and from her exercise regimen that has been empirically
shown to reduce the rate of neural degeneration. Upon autopsy, it
was noted that Louise had COVID-19, but it was not named as the
cause of death.

Case Study 3.6: Juan and Belinda’s Sexual Life in Retirement

Juan and Belinda, now both 72 years old, grew up in the same
neighborhood of a southwestern city in the United States and knew
one another because they attended the same church. Over the years,
they each went their way in life. Each had a family and children, and
both had been widowed for several years. Until they met a few years
ago at the local community college where they are taking classes,
they had not seen one another since adolescence. Juan lives in an
apartment and Belinda resides in her home of 60 years. Over the
past few months, Belinda has become concerned about her heart
health as she has experienced palpitations in the late evening. At her
health provider’s office, she found that her blood pressure was
elevated but not considered hypertensive yet. Juan, a distance
runner, trains by running and jogging daily. He has noticed that his
night vision has become compromised and is considering cataract
surgery.

Both Juan’s and Belinda’s parents immigrated to the United States

from Mexico, seeking to improve opportunities for their families.
Because of their common background and religion, Juan and Belinda
have found companionship, now turning to love. After spending
several months becoming reacquainted, Juan asked Belinda to spend
the night at his apartment. Belinda thought her sex life was over but is
excited by the potential for intimacy once again. However, she just
does not know how to be with Juan, is concerned that he will not find
her attractive, questions how to dress for the evening, and is nervous
about how to engage in satisfying sex at her age.

An Integrative Approach for Understanding the Intersection of Interior

(Proximal) Biological Health and Illness and Exterior (Distal) Environmental
Factors

Thinking about Cheryl, Jenna, Shay and Terry, Thomas, Louise and
Stewart, and Juan and Belinda highlights the important roles of
biology in the social worker’s intellectual toolbox. And as the COVID-
19 pandemic refuses to disappear, biology can no longer be
considered from a single disciplinary perspective. That is to say,
biology is inextricably intertwined with experience, behavior, objects,
and distal (exterior) environmental influences. Of particular note, two
important points are raised about exterior environmental influences.

First, the clout of politics needs to be extracted from science in social

work thinking and action. COVID and racialized medicine illustrate the
critical need to evaluate and distinguish well-supported evidence from
political story. The COVID-19 vaccination debate is only one example
of myth as killing field. Too many people died unnecessarily as they
followed the health leadership of politics over science. Although
confusing in epidemiological statistics, who died with COVID (as
Louise, Case Study 3.5, did) and who died from COVID, especially
before any vaccination or treatment availability, cannot be disputed.
Thus, skepticism about the magnitude of death should not have
eroded recognition of the medical calamity of the disease and the
critical need for social work to support public health efforts to contain
it.

Now consider the recent research characterizing the human genome.

This repository of Nobel-worthy work has revealed no genetic racial
differences, yet we often see biological essentialism in practice (Bain
et al., 2014; Barrett, 2014). Biological essentialism refers to the
thinking that groups exist on the basis of a single common
characteristic such as skin color. This characteristic is translated into
a biological difference that then promotes assumptions about other
common features of those who belong to the constructed group, and
thus gives rise to race-based medicine. The cautionary tale is not to
eschew the difference baby with the bathwater, but rather to
understand the group and its needs as a social, economic, and
geographic entity rather than a biological one.

Second, human behavior must be understood in the context of

transhumanism and posthumanism. These two terms refer to
profound change in what is considered to be human, and thus
biologically legitimate (Braidotti, 2019; DePoy & Gilson, 2022a), but
the two terms, while overlapping, are distinct in their meaning. The
transhuman transcends human limitations by technological means.
We think of the transhuman as a future or even contemporary human
in cyborg attire, pushing the boundaries of how many mechanical
gizmos can be part of the corpus (body) before one is no longer
considered human (see Chapter 2 in this book for discussion of the
cyborg concept). Posthumanism is an interdisciplinary movement to
jailbreak people from enlightenment proposals about the human form,
values, and ways of being, morph into an understanding of humans
as relational beings, and rethink humans’ place in society. While a
complex discussion of both terms is beyond the scope of this chapter,
social work must consider the constructs and their practice in
evaluating what a body is and how it should function. We take on
these issues specific to biology throughout the chapter.

Consistent with contemporary theory, social workers can best

understand and apply biological knowledge to practice within an
expansive proximal to distal environment continuum, with
environment defined as the entire set of conditions under which one
operates (DePoy & Gilson, 2018). The interior (proximal) is
concerned with the description and explanation of embodied
conditions, such as internal organ systems, genetics, interior
psychological structures and processes, and so forth, increasingly
with some transhuman inorganic flies such as pacemakers and other
implanted devices embedded within the proverbial ointment. Consider
several examples. The first is a newly purchased joint to replace one
that no longer is useful. While not organic in composition, a new
knee, hip, ankle, or other joint can be bought and located by a
surgeon assisted by a robot inside organic property fenced inside the
skin. The new devices restore mobility, and if properly outfitted, even
sensation to the receiver. But the new body part is not organic, so do
we classify it as a body part or consider the new joint as an
interloper? And what conditions might influence the extent to which
the new body part even stays in our thoughts and awareness?

Exterior (distal) environments are characterized as nonorganic

conditions not contained within the skin’s perimeter (DePoy & Gilson,
2018). But again, the dividing line between interior and exterior is as
unclear as what constitutes a body. Consider eyeglasses, for
example. This “exterior” device enhances sight, and once perched on
the nose, it is not only functional but is part and parcel of our
appearance and identity. Sight, appearance, and identity may seem
interior, but they are networks of meanings and experiences that
render embodiment and its boundaries difficult to draw.

Now think of the spoken message. Where does it begin and end?
Isn’t the spoken word learned from the distal environment? And once
learned, speech itself is organic and malleable, acted upon by so
many elements. Is speech a brain production, a production of the
mouth’s structure and movement, a vibration that reaches beyond the
speaker? Once articulated, how far does the message move distal to
the speaker and what types of responses are elicited? Adding
screen-mediated speech of the 21st century, such as Siri, to the mix
further obfuscates the exterior-interior binary. What about the tattoo?
Art, body, both?

Consider skin color to look at the reverse direction. While its origin is
visible in embodied nature, the human genome project has clearly
illustrated the absence of genetic differences related to color, but race
itself is socially and thus distally constructed by the visible organic
material of the skin.

So now that we have introduced the complexity of the biological

environment, we recline somewhat on the simplicity sofa for
instructive purposes. But stay alert as even this comfortable position
is challenging as we illustrate throughout. For the purpose of
familiarity with classical biology in which an array of systems
comprises the biological body, we first parse the proximal into its
classical system taxonomy and discuss the structures and processes
of each. We then reengage in social work thinking as we reunite
interior and exterior with the assistance of our case exemplars. While
you may have considered biology as a separate organic world, it is
incumbent upon social work to stay current and creatively apply the
interconnected beauty of this world in thinking about our clients. So
even when practicing in arenas that do not appear to directly
intervene with individuals and families, such as the policy universe,
social work is committed to improving life for people. All people have
bodies, and thus knowing about the body, its complexity, and the
fabric in which embodiment is activated are major knowledge
repositories necessary for sound social work practice.
Returning to the cases of Cheryl, Jenna, Shay and Terry, Thomas,
Louise and Stewart, and Juan and Belinda, their interior (proximal)
environments are the initial reason they are seeking social work
assistance. Social workers must be sufficiently informed about interior
(proximal) environment conditions to be able to address relevant
details of biological functioning with clients when indicated (Wolkowitz
et al., 2011). But we urge you not to get mired in the knowledge of
biology as a set of structures and functions. Understanding the
interior (proximal) environment as part of humanness (DePoy &
Gilson, 2022a) is critical for informed social work practice as
exemplified by each of the chapter-opening case studies.

Systems frameworks describe and explain phenomena as sets of

interrelated parts. Classical systems theory is linear, simplifying links
among system parts as nonstop routes. Contemporary systems
theories that build on the linear foundation range from networks to
mathematical modeling. Such computational choreography was
seminal to the research that resulted in painting the human genome
portrait (Tavassoly et al., 2018). To add to biological complexity, the
scope and nature of the parts interrogated in biological systems
theories are expansive as well, ranging from embodied or interior
systems, to human systems composed of both humans and their
surroundings, and even extending to systems that do not contain
embodied human elements (DePoy & Gilson, 2018; Weitz, 2019).

The relationship of mind and body has been a large philosophical

debate since the ancient Greeks. Its serious scientific garb is way
more recent but incredibly productive. As early as 2001, the National
Institutes of Health acknowledged the inseparability of mind and body
in their conference entitled Vital Connections: The Science of Mind–
Body Interactions (MacArthur Network on Mind–Body Interactions,
2001). This event spearheaded an important agenda advancing
theory and knowledge development linking interior (proximal) and
exterior (distal) systems and environments. Renowned scholars then
and now report on varied topics focusing on the interaction of exterior
(distal) and interior (proximal) environments that continue to receive
intense research scrutiny—for example, the neurobiology of human
emotions, early care and brain development, the biology of social
interactions, socioeconomic status (SES) and health,
neuroendocrinology of stress, the role of sleep in health and
cognition, the critical interaction of movement and brain health,
technological changes in attention, outdoor exercise and health,
virtual engagement and brain function, and climate change and
human health.
A medical researcher examines data to test a hypothesis.

© AbleStock.com/Thinkstock
Although attempts to understand mind–body connections have led to
many important theories about health and illness, they may also be
misinterpreted. Social workers therefore are advised to heed the
warning of a number of medical researchers and social critics against
explaining behavior and emotion through a purely medicalized lens
(see Correia, 2017; Lane, 2022). Such a reductionist perspective may
undermine our ability to consider the full range of distal environmental
influences on embodied phenomena. Moreover, as defined,
medicalization is a process that serves to pathologize typical daily
experience and serve it up for medical intervention. Oransky (2012),
in a now classic TED Talk, referred to this phenomenon as “pre-
death,” in which typical human transitions are seen as conditions to
be treated in order to prevent further exacerbation.

On the flip side of this caution, over-attribution of physical

experiences to psychological and social conditions fails to consider
the interior (proximal) environmental causes of illness. Look at Cheryl
as an example. Her flattened affect is a common symptom of frontal
lobe damage, yet it went unrecognized until the social worker referred
her for assessment. As the COVID-19 pandemic has reminded us,
we cannot separate health and illness from exterior (distal) social,
political, cultural, technological, economic, intellectual, and aesthetic
environmental conditions (DePoy & Gilson, 2022a, 2022b; Saleebey,
2012; Shalev et al., 2021). Thus, comprehensive analysis of
embodied integrity is warranted and requires knowledge of all
biological systems, exterior (distal) environment conditions, and their
reciprocation. While the efficiency of a single explanatory framework
is seductive, such thinking may limit our ability to expansively identify
the broad nature of problems and needs and constrain a range of
appropriate interventions to resolve problems (DePoy & Gitlin, 2020).

The constructivist perspective, also named constructionist by some

theorists, suggests that human phenomena are pluralistic in meaning
and derive from social interactions. As such, knowledge is not
monistic truth or discoverable through experimental-type methods,
many of which form the basis for evidence-based practice. For
example, rather than being a singular, scientifically supported entity,
through the lens of social construction, a disabling medical condition
such as paralysis or low vision is defined in large part by its meaning
from interior (proximal) views as well as from political, social, cultural,
virtual, technological, aesthetic, and economic exterior (distal)
environments (Anastasiou et al., 2016; Krahn et al., 2021). Thus,
using a social constructivist perspective, the experience of having
atypical low vision can be ascertained in terms of shared cultural
understandings of the “expected roles” for persons with atypical
vision, or in terms of actions or inactions of political institutions to
promote or impede this subpopulation’s access to physical, social,
technological, and virtual environments. We may automatically
assume that someone with atypical low vision is in need of
professional intervention, but that person may in effect have their life
well organized and function well in all chosen living and working
environments. Consider Kish (Thaler et al., 2022), who is blind but
has devised a human sonar system comprised of tongue clicks to
“see.” Thus, rather than being explained by the biological condition
itself, limitation associated with an atypical biological condition may
be a function of the exterior (distal) environment or not; the
characteristics of the task; personal attitude; available resources such
as technology; assistance from family, friends, or employees;
accessible transportation; innovative thinking; and welcoming, fully
accessible communities (DePoy & Gilson, 2014).

Consider another option through the perspective of the

transhumanist, the bionic eye. In 2017, Tufts University pioneered
Argus II, a bionic implant to allow people with low or no vision from
diagnosed retinitis pigmentosa to once again see the light
(TuftsMedicine, 2022).

Now consider a humanist exemplar. Although social workers do not

make medical diagnoses for embodied conditions in the scope of
their practice, the social work administrator who is developing or
operating a shelter, a food kitchen, or an advocacy center may
integrate medical and mental health services with employment,
housing, financial, and companionship assistance (Kirst-Ashman,
2022). In response to the fractures of advanced capitalism, Springer
(2020) recommends a model of caring geographies that promotes
healthy and compassionate communities over those that seek profit
as a unitary goal.

Consistent with this work, DePoy and Gilson’s (2022a) model of

humanness literacy proposes that flourishing, acceptance, and
comfort can occur only when the full range of human diversity is
appreciated and celebrated. As the study of human biology becomes
increasingly complex and expansive in its scope, biological diversity
includes but extends way beyond race, ethnicity, class, and gender.
According to the posthumanists, embodiment can and should take
many biological or nonorganic forms, unseating the binary gendered
enlightenment body pictured in Vitruvian man (Braidotti, 2019) as the
model of humanness. Consider, for example, transgender individuals
who now can change their organic corpus to fit a gender identity
discordant different from that assigned at birth. Or think of the cyborg,
a client with Parkinson’s disease who has undergone deep brain
stimulation, now with an implanted device to control tremors (Michael
J. Fox Foundation, 2022). The constructed meaning of human
diversity reconfigured by recrafting biologies is different than it was
even a few years ago.

Critical Thinking Questions 3.1

How does technology continue to change the conceptualization of the

body? What are the implications for how social workers should think
about humanness? What are the implications for how social workers
should think about the role of the body in human behavior?

Systems Taxonomy: Six Interior (Proximal) Environment Systems

Taxonomy is defined as “the science or practice of classification”

(Merriam-Webster, n.d.). The criteria for a classification system differ
not only according to topic area but to who does the classifying and
the contextual factors that bear on the knowledge. Over the past
decades, taxonomies of human biological systems have therefore
predictably shifted away from a linear depiction based on classical
system structures, composition, and functions to a network approach
in which the interaction of systems, previously classified as distinct, is
acknowledged. While a network framework begins to foreground
complexity, we do not begin our discussion there, as the building
blocks first need to be cemented before a more textured foundation of
understanding can occur. So, we now turn to what we refer to as a
“paper doll” approach in which we both present and then simply dress
the classic foundations of six biological systems: the nervous system,
the endocrine system, the immune system, the cardiovascular
system, the musculoskeletal system, and the reproductive system
(with some information here on the human genome and genetics),
systems that social workers will most directly encounter. The
biological systems not detailed in this chapter (digestive, respiratory,
and urinary system) will make appearances, sometimes initially
undetected but often responsible for problems. A simple example is
the manner in which urinary tract infections can masquerade as
delirium, confusion, and even hallucinations in elders (Krinitski et al.,
2021). We urge you to use the discussion of the six systems as a
template for your own research and discovery about the corpus. As
you read the descriptions of these six interior (proximal) environment
systems, think about each as more than its own container.

Nervous System

In Case Study 3.1, Cheryl sustained multiple injuries during military

service. Although limb loss was the most obvious and thus the initial
locus of intervention, injury to her interior corpus, namely the central
nervous system, was equally as problematic and pervasive.
Traumatic brain injury can range from mild to severe. But even with
mild damage, as exemplified by Cheryl, there are typically changes in
functioning, perhaps not immediately obvious. We turn to the
structures and functions of the nervous system classification and
revisit Cheryl throughout the discussion. Also recall Louise, Case
Study 3.5. At 84, she died after living with the sequela of Huntington’s
disease. Because of central nervous system damage, particularly in
the brain, Louise was not able to walk, speak clearly, or swallow
easily during the final years of her life.
The nervous system provides the structure and processes for multi-
way communication of sensory, perceptual, and autonomically
generated information throughout the body. On the basis of function
and cell composition, three major divisions are identified as
comprising the nervous system:

1. Central nervous system (CNS): the brain and the spinal cord
2. Peripheral nervous system (PNS): spinal and cranial nerves
3. Autonomic nervous system (ANS): nerves controlling
cardiovascular, gastrointestinal, genitourinary, and respiratory
systems

Each has a primary set of functions, but remember that the three act
together, and of course with other interior and exterior systems, in
providing a control architecture and electrical grid for all human
activity. The brain is considered to be the body boss. It sends
electrical signals received from throughout one’s environments to the
spinal cord, which in turn relays the message to specific parts of the
body by way of the PNS. Messages from the PNS to the brain travel
back via a similar pathway (Martin, 2021). Note that Cheryl’s brain
injury affects only the part of her nervous system that mediates affect,
while Louise’s damage is much more pervasive. Let’s look at Cheryl
to understand the process. Cheryl’s rehabilitation provider has told
Cheryl that she is doing exceptionally well with her robotic legs, but
Cheryl shows no emotional response and acts almost as if she has
not heard the compliment. Given that damage to the right
hemisphere, specifically the cingulate cortex, which is the seat of
affect, damage to the neural structures (neurons) in that area do not
allow for arousal, awareness, and emotional response. The electrical
grid is scarred. Now look at Louise. Extensive damage to the cells in
her brain resulted in multiple impairments.

The human brain, which constitutes only about 2% of one’s total body
weight, may contain as many as 10 million neurons. Three major
internal regions of the brain are named for their location inside the
skull, the forebrain, midbrain, and hindbrain. Viewed from the side
(see Figure 3.1), the largest structure visible is the cerebral cortex,
part of the forebrain and the site of Cheryl’s and some of Louise’s
damage. The cerebral cortex is the home of higher mental functions,
including thinking, planning, problem solving, affect, and more. This
area of the brain is divided into two parts named for their location (left
and right hemispheres) and connected by nerve fibers. Until the late
20th century, it was asserted that the cerebral cortex is more highly
developed in humans than in any other animal. However,
contemporary research may be toppling the idea that Homo sapiens
are the pinnacle of the cognitive hierarchy. Also undergoing
significant revision is the characterization of brain function as
hemispherically situated, ostensibly with one side for language and
the other for processing of spatial information such as images and
pictures. This binary, while part of popular culture and often used for
clinical practice guidance, is not as clearly delineated as once
thought. Contemporary brain research affirms hemispheric
differences to some extent but reveals complexity and the amazing
capacity of neural material to learn and relearn. Thus, although each
hemisphere generally controls the motor and sensory function on the
opposite side of the body, neuroscience research indicates a great
deal of neuroplasticity , the ability of the brain to form and reorganize
synaptic connections in response to learning or experience following
an injury. Given the amazing neuroplasticity of the brain, creative
interventions can be used to teach undamaged cells in alternate
locations to learn to feel and move limbs that have been deactivated
by brain damage (Martin, 2021). Note again the relationship between
the musculoskeletal system and the nervous system electrical grid.
Description

Figure 3.1 Selected Areas of the Brain

The cerebral cortex has four lobes, depicted in Figure 3.1 . As Table
3.1 explains, functions such as vision, hearing, and speech are
distributed in specific regions, with some lobes being associated with
more than one function. The frontal lobe is the largest, comprising
nearly one-third of the surface of the cerebral cortex. Lesions of any
one of the lobes can have a dramatic impact on the functions of that
lobe (Martin, 2021). Other forebrain structures process information
from the sensory and perceptual organs and send it to the cortex, or
receive marching orders from cortical centers, and then relay them
down the grid through central nervous system structures to central
and peripheral elements throughout the body. Also in the forebrain
are centers for memory and emotion, as well as control of essential
functions such as hunger, thirst, and sex drive. It is no wonder that so
much empirical and clinical attention has been directed to the brain!

Table 3.1

The midbrain is a small area, but it contains important centers for

sleep and pain as well as relay bridges for sensory information and
control of movement.

In Figure 3.1, part of the hindbrain, including the cerebellum, can also
be seen. The cerebellum controls complex motor programming,
including maintenance of muscle tone and posture. This part of the
brain was significantly affected in Louise. Other hindbrain structures
are essential to the regulation of basic physiological functions,
including breathing, heart rate, and blood pressure. In Louise’s life
and death, the poor regulation resulting from hindbrain damage, not
COVID-19, was responsible for her mortality.
The brain stem connects the cerebral cortex to the spinal cord. The
basic working unit of the nervous systems is the neuron , or nerve
cell. While the human body has great diversity of neuronal types, all
are consistent with the composition of a cell body with a nucleus and
a conduction fiber, an axon . Extending from the cell body are
dendrites, which function as passages for impulses to the neurons
from the axons of other nerve cells. Figure 3.2 shows how neurons
are linked by axons and dendrites.
Description

Figure 3.2 Neurons, Axons, and Dendrites

Between each axon and dendrite a gap, synapse , exists across

which chemical and electrical neurotransmitters (also referred to as
messenger molecules) communicate. As the inset box in Figure 3.2
shows, nerve impulses travel from the cell body to the ends of the
axons, where they trigger the release of neurotransmitters. The
adjacent dendrite of another neuron has receptors distinctly shaped
to fit particular types of neurotransmitters, such that when the
neurotransmitter dives into a slot the message is passed along.

Although neurotransmitters are the focus of much current research,

scientists have not yet articulated all that these busy swimmers do.
Essentially, they may either excite (activate) or inhibit (calm) nervous
system responses. Recent discovery of the vacuuming and cleaning
function of chemical messengers in the brain has illustrated new
knowledge particularly pertinent to the creation of contemporary
pharmaceuticals for ADHD, depression, and other attentional
disorders (University of Copenhagen, 2020). Researchers still have
much discovery work to learn about the full array of neurotransmitters
and their actions. Here are a few that are well known.

Acetylcholine (ACh). This neurotransmitter, concentrated in the

brainstem but also present in other places, is excitatory.
Acetylcholine is involved in control of the skeleton and smooth
muscles, including the heartbeat, and some glandular functions.
It is critical to the transmission of messages between the brain
and the spinal cord and affects arousal, attention, memory, and
motivation.
Dopamine (DA). This inhibitory neurotransmitter makes its
appearance in many parts of the body, playing a role in
regulation of motor behavior, the endocrine system, and the
pleasure centers of the brain, and influencing emotional behavior
and cognition. Dopamine abnormalities in the limbic system are
thought to be involved in schizophrenia. But dopamine is not
dopamine, is not dopamine. There are five subtypes of dopamine
receptors and thus several versions or subtypes of dopamine
itself. Remember that the receptors are custom made to accept
only certain divers and reject others, allowing complex functions
to occur in designated cells and brain regions. Researchers
continue to investigate and characterize the range of structures
and functions of dopamine.
Norepinephrine (NE). NE, located in the sympathetic nerves of
the peripheral and central nervous systems, is excitatory. It is
secreted by the adrenal glands in response to stress and
influences emotional behavior and alertness as well as having a
say in the regulation of anxiety and tensions.
Serotonin. Present in blood cells, the lining of the digestive tract,
and a tract from the midbrain to all brain regions, serotonin is an
inhibitory transmitter. It is involved in sensory processes,
muscular activity, thinking, regulation of states of consciousness,
mood, depression, anxiety, appetite, sleep, and sexual behavior.
Several subtypes have been identified in recent years. You may
have heard of the class of anti-depressant drugs called SSRIs
(selective serotonin reuptake inhibitors). While their processes
and influence have not been fully understood, these drugs
ostensibly function to increase the cellular level of serotonin.
However, a recent meta-analysis of research examining the
relationship between serotonin and depression did not reveal any
association at all, and thus the mechanisms of SSRIs in treating
depression are not only unknown but are now fostering
skepticism. It is interesting to note that SSRIs are also used to
treat eating disorders and anxiety, and even improve the
consequences of a stroke. This array of uses provides not only a
view of the expansiveness of serotonin, but it can provoke
questions about the potential interrelatedness of the conditions
treated by these chemicals as well as their efficacy in doing so
(Wenner Moyer, 2022).
Amino acids. Some types of these molecules, found in proteins,
are distributed throughout the brain and other body tissues. One
amino acid, gamma aminobutyric acid (GABA), is thought to play
a critical role in inhibiting the firing of impulses of some cells.
Thus, GABA is believed to be instrumental in many functions of
 the CNS, such as motor activity, cardiovascular reactions,
pituitary function, and anxiety. Current research identifies the
“downer” function of GABA, and a supplement form is being sold
to reduce heightened states of anxiety and fear. While there is
some evidence of its efficacy, additional research is suggested to
characterize its processes and outcomes (Hepsomali et al.,
2020).
Peptides. Amino acids that are joined together have only recently
been studied and admitted to neurotransmitter membership.
Opioids, many of which are peptides, play an important role in
activities ranging from moderating pain to causing sleepiness.
Endorphins, opioid-like substances produced by the body itself
(endogenous production), help to minimize pain and enhance
adaptive behavior. Over the past several years, the opioid
addiction epidemic has burgeoned, highlighting advantages,
dangers, and the power of these pharmaceuticals (Fricker et al.,
2020). On the flip side, peptides are also identified as critical in
new targets and mechanisms for mRNA medication (familiar for
their recent use in vaccines for infectious diseases such as
COVID-19, treatment for rare genetic diseases, and cancer
immunotherapies) delivery (Yokoo et al., 2022).

Biologically, behavior is affected not only by the levels of a

neurotransmitter but also by the balance between two or more of
them. Psychotropic medications, such as the SSRIs introduced
above, are thought to influence behaviors and symptoms associated
with diagnoses of mental illness, ostensibly by affecting the levels
and balance of specific neurotransmitters. Given the current
skepticism, but with documented positive clinical outcomes, social
workers would be well advised to keep current on relevant medical
research about the effects of neurotransmitters on human behavior
when working with people referred for medication evaluation and
when following up with individuals who have been placed on
medication treatment regimens. Moreover, the raging opioid epidemic
behooves professionals to keep abreast of all relevant developments
in pharmacology use and its range of negative to positive
consequences.
For Cheryl, as for many people living with mild traumatic brain injury,
her affect may be influenced by both interior (proximal) and exterior
(distal) environment circumstances—including damage to the frontal
lobes and the expectations that her family and friends have of her
based on how they knew her in her social settings prior to her injury.
The complexity of lower limb amputation renders her mood difficult to
decipher, as anyone experiencing such a profound loss might be
expected to be depressed. The more that social workers understand
brain functions, brain plasticity, and the interaction of affect with other
influences on mood, the more efficaciously social work can
communicate with medical personnel in a well-informed manner. As
she proceeds thorough physical rehabilitation, Cheryl could also
benefit from affective retraining to improve her own awareness of how
she is perceived by others (external social environment), and then to
provide guidance in affect regulation. A social worker working with
Cheryl may fill several roles: case manager, educator, counselor,
resource coordinator, and referral source.

Social work with Louise was complex. There was little that could be
done to improve her condition and prognosis. However, keeping
Louise and her caregivers apprised of new treatment developments
and assisting her to live in her chosen setting were important areas
for social work attention while she was alive.

Endocrine System

Remember Jenna, the youth diagnosed with type 1 diabetes in Case

Study 3.2? Although there is a significant body of research on her
condition, no cure has yet been developed. Thus, Jenna now has a
condition that must be medically managed. The importance of diet,
exercise, and careful attention to her blood sugar regulation is not a
typical experience for youth of her age. Further, the endocrine
disorder is directly entwined with interior environmental elements
such as the musculoskeletal, neurological, and digestive systems, as
well as implanted technology and the immune system.

The endocrine system plays a crucial role in growth, metabolism,

development, learning, and memory. It is comprised of glands that
secrete hormones into the blood stream; those hormones bind to
receptors in target organs, much as neurotransmitters do in the brain,
and affect the metabolism or function of organs (Hinson, 2022).
Distinguishing differences among hormones and neurotransmitters
are often the distance of travel from the point of release to the target,
as well as the route of travel. Hormones traverse long distances
through the bloodstream; neurotransmitters take shorter jaunts from
cell to cell, across the synaptic cleft.

Endocrine glands include the pineal, pituitary, thyroid, parathyroid,

pancreas, and adrenal. Endocrine cells are also found in some
organs that have primarily a non-endocrine function: the
hypothalamus, liver, thymus, heart, kidney, stomach, duodenum,
testes, and ovaries. Table 3.2 lists some of the better-known glands
and organs, the hormones they produce, and their effects on other
organic structures.

Table 3.2
The most basic form of hormonal communication occurs as an
endocrine cell transmitted as a floater so to speak through the blood
system to a target cell. A more complex form involves direct release
from one endocrine gland to a target endocrine gland.

Feedback control mechanisms are the overseers and regulators of

hormonal activity. Output refers to the release of hormones from an
endocrine gland, whereas input describes the absorption of
hormones by a target tissue or organ. Because of the precise
feedback apparatus, the healthy endocrine system is self-regulating.
And as noted above, similar to the design of neurotransmitters,
hormones have specific receptors, so that the hormone released from
one gland follows interior GPS direction to an exact location (Hinson,
2022).

A good example of a feedback loop is presented in Figure 3.3 . The

hypothalamus secretes the gonadotropin-releasing hormone (GnRH),
which binds to receptors in the anterior pituitary and stimulates the
secretion of the luteinizing hormone (LH). LH binds to receptors in the
ovaries to stimulate the production of estrogen. Since estrogen has a
negative effect on the secretion of LH and GnRH, the loop is
completed by both the pituitary and hypothalamus. These elegant
loops allow the body to finely control the secretion of hormones.
Description

Figure 3.3 An Example of a Feedback Loop

Forensic analysis, the analysis of why something fails, is a powerful

way to understand the feedback control mechanism (DePoy & Gilson,
2022b). Consider what has happened to Jenna. In Type 1 diabetes,
insulin production is deficient or absent. Without insulin, the body
cannot process carbohydrates. When a person without diabetes
ingests carbohydrates, blood glucose becomes elevated, triggering
the release of insulin, which in turn helps to decrease blood sugar by
promoting the uptake of glucose by tissues. Additionally, low blood
sugar stimulates the release of glucagon, which in turn tells the liver
to release glucose, raising blood sugar. This balancing act does not
occur when insulin is not properly produced, creating a cacophony of
sequalae including but not limited to muscle cell and brain deprivation
of glucose, potentially leading to heart disease, stroke, and lower limb
amputation. When deprived, muscle cells devour fat and protein
reserves in muscle tissue as an energy source, which may negatively
affect the musculoskeletal system. Since the brain uses glucose as its
exclusive fuel source and the brain is the body boss, low blood sugar
can seriously affect cognition and overall function. In people with
advanced and uncontrolled diabetes, the consequences are severe
and pervasive. As example, wasting of muscles, weakness, weight
loss, and metabolic acidosis, a chemical imbalance in the blood, can
occur. Poor circulation on the periphery of the body may lead to
gangrene in lower limbs and amputation to remove dead tissue and
its complications such as infection. The increase in blood acidity may
suppress higher nervous system functions, leading to coma, and
malfunction of the respiratory centers in the brain can lead to death
(Gallo de Moraes & Surani, 2019).

Epidemiologists report a dramatic increase in the incidence of

diabetes worldwide in recent years. In the United States alone, it is
estimated that 37.3 million people have diagnosed and undiagnosed
diabetes. The disease is expensive, both for the patient who has it
and for the systems that pay for it. In the most recent cost analysis,
the treatment costs alone, not including loss of life, function, and lost
productivity, were estimated at $327 billion annually (Centers for
Disease Control and Prevention [CDC], 2022a). Non-Hispanic whites
have a disproportionately higher incidence of type 1 diabetes than
other racial and ethnic groups, a phenomenon that bears complex
investigation to ascertain the multiple interior and exterior factors that
coalesce as casual. Type 2 diabetes is associated with older age,
obesity, family history of diabetes, history of gestational diabetes,
impaired glucose metabolism, physical inactivity, and appearance in
particular races or ethnicities. Compared with non-Hispanic white
adults, the prevalence of diabetes is 18% higher among Asian
Americans, 66% higher among Hispanics/Latinos, and 77% higher
among non-Hispanic Blacks (CDC, 2022a). Association is important
to consider, but further research on how relational variables are linked
to cause is needed to inform treatment.

A crucial role for the social worker working with Jenna and her family
is to keep her family well informed while helping Jenna and her family
manage her diabetes in a manner that fits her lifestyle. Thus, the
social worker stays current on new research and technology and has
Jenna on a wait list for PEC-Direct stem cell clinical trials, an
experimental strategy to “act as a replacement pancreas” (Endocrine
Society, 2022, para. 1).

Critical Thinking Questions 3.2

What are the ethical questions that the social worker might have to
answer regarding the potential negative or null consequences of a
clinical trial? How can social workers be helpful to people living with
type 1 and type 2 diabetes?

Immune System

The immune system is made up of organs and cells commonly

thought of as working in tandem as the body’s defensive team to
eliminate antigens (toxins or other foreign substances that induce an
immune response in the proximal environment) (Sarafino & Smith,
2022). When operating in an optimal manner, the immune system
distinguishes the body’s own cells and organs from distal interlopers
or proximal contaminants (Sarafino & Smith, 2022). The immune
system mobilizes body resources and attacks when it detects the
presence of interlopers. Remember that we cautioned you about the
arbitrary distinction between exterior (distal) and interior (proximal)
environments? Here is a good example. The foreign substance
(which may be organic in composition and thus fit the definition of
interior [proximal] environment) that can trigger an immune response
may be a tissue or organ transplant or even a device such as an
insulin pump.
Sometimes, however, the immune system mistakenly directs its fury
at parts of the interior environment it was designed to protect,
resulting in an autoimmune response , during which the body’s
immune system mistakes its own healthy tissues as dangerous
interlopers and attacks them. Disease examples include rheumatoid
arthritis, rheumatic fever, and lupus erythematosus. Diabetes, some
cancers, autism, and Huntington’s disease are also on the suspect
list of autoimmune conditions (Sarafino & Smith, 2022). With
rheumatoid arthritis, the immune system turns on its own tissues and
bones at the joints. In rheumatic fever, the immune system attacks
the heart muscle that pumps its life’s blood, and the individual with
lupus erythematosus has an immune system that wages war against
various parts of its interior environment, including the skin and
kidneys (Sarafino & Smith, 2022).

The immune system organs are integrated throughout the body. The
organ list below demonstrates their wide reach:

Bone marrow. Protected inside the body’s scaffold, bone marrow

is the largest organ in the body. There are two types of bone
marrow, red and yellow. Yellow bone marrow is the body’s
disaster preparedness nourishment. It stores fat, which the body
consumes in cases of extreme starvation. At birth, all bone
marrow is red, but as the body ages, more and more red bone
marrow moves over for its yellow cousins. In adults, red bone
marrow is found in the sternum, ribs, vertebrae, skull, and long
bones. The bone marrow produces both red (erythrocytes) and
white (leukocytes and lymphocytes) blood cells.
Lymph nodes. These small oval or round spongy masses are
distributed throughout the body and interact in a network
structure of nodes and vessels (Sarafino & Smith, 2022). This
complex design provides the thruway for lymph to circulate.
Lymph has the sanitation jobs of bathing cells, removing
bacteria, and eliminating certain proteins from the proximal
corpus. As the lymph passes through a lymph node, it is purified
of infectious organisms, with detritus (waste) being emptied into
the bloodstream to be shuttled away.
 Spleen. An organ in the upper-left quadrant of the abdomen, the
spleen functions much like a very large lymph node, but one that
acts on blood. The spleen filters out antigens and removes
ineffective or worn-out red blood cells from the body (Sarafino &
Smith, 2022). While the spleen is dispensable, its removal
renders the person without it susceptible to certain infections.
Thymus. Located along the trachea in the chest behind the
sternum, the thymus secretes thymosins , hormones believed to
trigger the development of T cells introduced in Case Study 3.4.
T cells , white blood cells that mature in the thymus, have the
warrior task of slowing down, fighting, and attacking antigens.
The immune system’s response to antigens occurs in both
specific and nonspecific ways, although not surprisingly by now,
the boundary between the two is not always distinct. A detailed
discussion of specific and nonspecific immunity is way beyond
the scope of this chapter, but general tenets of immunity are
provided.

Nonspecific immunity , also called innate immunity, is generalized

immunity that all humans are born with to protect against pathogens.
“Scavenger” cells, or phagocytes, lurk in the blood and lymph until
activated by biochemical signals to congregate at the site of a wound
and ingest antigens (Sarafino & Smith, 2022). This process, known
as phagocytosis, is quite effective but has two limitations: (1) Certain
bacteria and most viruses can survive after they have been engulfed,
and (2) because our bodies are under constant attack and our
phagocytes are constantly busy, a major assault on the immune
system can easily overwhelm the nonspecific response. Thus,
specific immunity is the back-up plan, so to speak (Sarafino & Smith,
2022).

Specific immunity , or acquired immunity, relies on lymphocytes to do

its work. They not only respond to an infection but also develop a
memory of that infection such that the body can mobilize a rapid
defense against it in subsequent exposure. Certain lymphocytes
produce antibodies , protein molecules designed to attach to the
surface of specific invaders and destroy them. The antibodies may
recruit other protein substances that puncture the offending micro-
organism’s membrane, causing the invaders to explode. Antibodies
are assisted in battle by T cells, which destroy foreign cells directly
and further choreograph the immune response. Following the primary
response, the antibodies remain in the circulatory system at
significant levels until they are no longer needed. With re-exposure to
the same antigen, a secondary immune response occurs,
characterized by a more rapid rise in antibody levels—over a period
of hours rather than days. This rapid response is possible because,
during initial exposure to the antigen, memory cells were created.
Memory T cells store the information needed to produce specific
antibodies. They also have very long lives, making their long-term
memory an accurate defensive weapon (Sarafino & Smith, 2022).
This process has been simulated in the lab by the mRNA avatar,
infamous for its role in the COVID-19 vaccine (Bettini & Locci, 2021).

Vaccines are not the only immune therapies being developed. New
therapies for some cancers, such as Thomas’s in Case Study 3.4,
extract T cells from the proximal corpus and reprogram them,
teaching them to attack targeted cancer cells, and then reintroduce
these modified sentries into the proximal environment where they
execute offending malignancies (Deyá-Martìnez et al., 2021). Bone
marrow transplant is in experimental phase for treatment of HIV
(Mandavilli, 2022).

The immune system becomes increasingly vital throughout childhood

and declines in effectiveness in older adulthood. For this reason,
older adults are often the first recipients of new vaccine technology as
was the case in the rollout the Pfizer and Moderna vaccines to
combat the spread of COVID-19. Infants are born with relatively little
immune defense. Because of their perceived vulnerability and the
limited testing of the COVID-19 vaccine, infant eligibility was delayed.
Now children over the age of 6 months are encouraged to receive the
vaccine, given that their immune system gradually becomes more
efficient and complex. Thus, as a child develops, the incidence of
serious illness declines. During adolescence and most of adulthood,
the immune system, for most people, functions at its peak. As we
age, although the numbers of lymphocytes and antibodies circulating
in the lymph and blood do not decrease, their potency diminishes.
The functioning of the immune system is intricately tied to the exterior
environment in that immunity may be compromised by a diet low in
vitamins A, E, and C, and high in fats and cholesterol. Excess weight
may also rob the immune system of its power and potency (Sarafino
& Smith, 2022). Serious threats to immunity can occur, such as HIV,
other viruses, and even one’s own genetic structure in which immune
deficiency is transmitted from parent to child. HIV follows an insidious
pathway as infected cells in essence become factories that make
copies of themselves, which then proceed to infect, hijack, and
destroy other cells. T cells, which instruct other cells when to start
fighting off infections, are desirable targets of the HIV virus. By
deactivating T cells, HIV weakens the immune system and leaves the
proximal body vulnerable to opportunistic infection. Most of us host
organisms such as fungi, viruses, and parasites that cohabitate
peacefully with us. However, for people with HIV, because of the low
T cell count, these same organisms are not necessarily good guests
and thus may cause serious infection. When such a disease occurs
or when the individual’s number of T cells drops below a certain level,
the person with HIV is considered to have AIDS (AHEAD, 2021).

With contemporary therapy, people infected with HIV may live a

typical life span, but for their health and that of those in their intimate
environment, people with HIV must remain on alert. For example,
females may be at increased risk for repeated serious vaginal yeast
infections, increasing the potential of cervical cancer and pelvic
inflammatory disease. These conditions, along with the HIV virus,
influence childbearing efficacy. Although held in abeyance by therapy,
all genders with HIV are vulnerable to opportunistic diseases and
infections such as Kaposi’s sarcoma, cytomegalovirus (CMV), AIDS
retinopathy, pneumocystis carinii pneumonia (PCP), mycobacterium
tuberculosis, and Candida albicans (thrush); atypical functioning such
as AIDS dementia, loss of memory, loss of judgment, and depression;
and other symptoms such as gastrointestinal dysfunction/distress,
joint pain, anemia, and low platelet counts. (Details on these
conditions can be found in medical sources.)

The social worker may help to educate people with HIV about these
increased risks. In order to protect their health and the health of
others, those infected with HIV should be advised to take special
precautions. Childbearing will require meticulous surveillance to
prevent HIV from doing harm to partners and unborn child. The social
worker therefore has many functions in working with HIV and those
who navigate life with this diagnosis.

Because of the tremendous costs for interventions, highly active

antiretroviral therapy (HAART) and pregnancy surveillance, the social
worker may link clients to sources of financial support. Given
advances in medical diagnostics and therapeutics, recent estimates
indicate that the cost of health care associated with HIV may be
$1,800 to $4,500 per month (Swiner, 2022). In addition to providing
information about the immune system, HIV, AIDS, and other health
issues, the social worker can advise about the protections
guaranteed under the Americans with Disabilities Act of 1990 and the
Amendments Act of 2008. A more distal social work function than
direct intervention is prevention and public health promotion, perhaps
by providing HIV/AIDS education online and on-site to business
groups, schools, civic and volunteer associations, and so forth.
Considering Thomas and the HIV hero, a major role for social work is
to maintain the most current knowledge of HIV, being aware of fear
and stigma that may interfere with an understanding of how HIV can
be harnessed to benefit health.

Cardiovascular System

Louise’s husband, Stewart (Case Study 3.5), was one of many

people with cardiovascular disease (CVD), pathology of the heart and
blood vessels. The most common types of CVD are coronary
disease, hypertension, atrial fibrillation, and stroke. CVD is the most
common cause of death globally, killing 18.6 million people in 2019,
responsible for 1 in 4 deaths. Stroke is fatal for approximately 6.6
million people yearly throughout the globe (American Heart
Association, 2021). New “clot-buster” medications and interventions,
if delivered immediately, are responsible for decreasing the damage
that stroke causes to the brain (Sobey, 2018). Just in the United
States, 126.9 million people report having been diagnosed with some
form of coronary heart disease. Geography, race, ethnicity, weight,
age, physical activity, and other health conditions such as diabetes
are associated with incidence of CV (Virani et al., 2021).

Stewart was morbidly obese, sedentary, and diagnosed with type 2

diabetes and hypertension. He therefore had four of the major risk
factors for serious heart disease. In 2021, it was estimated that just
below half of all adults in the United States (47.6%) had high blood
pressure, with a large majority aware of their condition but only a little
over one-half taking measures to control it (Virani et al., 2021). In
90% to 95% of the cases of individuals with high blood pressure, the
cause is unknown, but associated risks can be identified and should
be heeded. Between 2015 and 2018, the direct and indirect costs of
treating CVD were $363.4 billion in the United States—$216.0 billion
in direct costs and $147.4 billion in lost productivity (American Heart
Association, 2021).

To better understand cardiovascular disease, it is first important to

gain insight into the functioning of the cardiovascular system . This
delicate system has two main structures: the heart and the blood
circulatory system. The heart’s walls act as a pump comprised of
specialized muscle. As the muscle shortens and squeezes the hollow
cavities of the heart, blood is forced in the directions permitted by the
opening or closing of valves. Blood vessels are conduits throughout
the body, carrying blood from the heart to the rest of the body’s
tissues and then returning the blood to the heart. Figure 3.4 shows
the direction of the blood’s flow through the heart.
Description

Figure 3.4 The Direction of Blood Flow Through the Heart

There are three types of blood vessels:

1. Arteries. These have thick walls containing elastic and muscular

tissues. The elastic tissues allow arteries to expand and
accommodate the increase in blood volume that occurs after
each heartbeat. Arterioles are small arteries that branch into
even smaller vessels called capillaries.
2. Capillaries. The nutritional and cleaning workhorses of the
circulation system, capillaries exchange nutrients and waste
 material with the body’s cells. Oxygen and nutrients transfer out
of a capillary into the tissue fluid in surrounding cells, and carbon
dioxide and other wastes from the cells are then absorbed.
3. Veins. Veins are transit ways to move blood from the capillaries
back to the heart. Some of the major veins in the arms and legs
have valves allowing the blood to flow only toward the heart
when they are open and block any backward flow when they are
closed.

Each side of the heart is divided into an upper and a lower chamber.
The two upper, thin-walled chambers are called atria . It is not
surprising that atria are smaller than the two lower, thick-walled
chambers, called ventricles , since ventricles are the power pumps
that initiate blood circulation to the lungs and throughout the body.
Valves within the heart direct the flow of blood from chamber to
chamber and, when closed, prevent backwash.

As Figure 3.4 shows, the right side of the heart pumps blood to the
lungs, and the left side pumps blood to the tissues of the body. Blood
returning from body tissues, which is low in oxygen and high in
carbon dioxide (deoxygenated blood), enters the right atrium. The
right atrium then sends blood through a valve to the right ventricle. In
turn, the right ventricle propels blood through another valve and the
pulmonary arteries into the lungs. The lungs are the site of exchange,
in which the blood rids itself of carbon dioxide waste collected from
tissues and accepts oxygen to be delivered throughout the body.
Pulmonary veins then carry blood that is high in oxygen (oxygenated)
from the lungs to the left atrium. From the left atrium, blood moves
through a valve to the left ventricle then to be jettisoned through a
valve into the aorta for distribution around the body.

Contraction and relaxation of the heart musculature moves the blood

from the ventricles to the lungs and to the body. The right and left
sides of the heart contract together—first the two atria, then the two
ventricles. Contraction is heard as the heartbeat, which at rest for
healthy person occurs about 70 times per minute or less. The
contraction and relaxation cycle is called the cardiac cycle.
Although the heart will beat independently of any nervous system
stimulation, regulation of the heart is primarily the responsibility of the
ANS. Once again, consider the network metaphor for proximal
environment systems. Parasympathetic activities of the nervous
system, which tend to be thought of as normal or routine activities,
slow the heart rate. Sympathetic activities, associated with stress,
increase the heart rate. As blood is pumped from the aorta into the
arteries, their elastic walls swell, followed by an immediate recoiling.
The alternating expansion and recoiling of the arterial wall is the
pulse, which fluctuates with age, activity, and health status. A normal
resting pulse for children ages 6 to 15 is 70 to 100 beats per minute,
and for adults age 18 and older, 60 to 100 beats per minute
(Laskowski, 2022).

Blood pressure is the measure of the pressure of the blood exerted

against the wall of a blood vessel. A sphygmomanometer (blood
pressure cuff) is the familiar apparatus used in most medical offices
that feels as if it is hugging our arms in order to measure blood
pressure. The cuff is placed around the upper arm over an artery
such that a pressure gauge can be used to measure the systolic
blood pressure, the highest arterial pressure, which results from
ejection of blood from the aorta. Diastolic blood pressure, the lowest
arterial pressure, occurs while the ventricles of the heart are relaxing.
It is easier than ever to keep watch over one’s blood pressure
numbers. A new apparatus for home surveillance includes a cuff and
Bluetooth connection to a smartphone. Such devices can automate
recording of daily measures and be virtually shared with medical and
health personnel. Increasingly, wearables measure or record blood
pressure. Currently, several smart watches measure and record blood
pressure and it appears as if such devices are increasing in number,
decreasing in cost, and becoming ubiquitous (Groppelli et al., 2022).

Blood pressure essentially ascribes a standard number to assess the

pumping force and beat rate of the heart as the blood moves through
the arteries. Currently, the CDC identifies healthy blood pressure for
any age below 120/80 mmHG (Harvard Health Publishing, 2021). The
diameter and elasticity of arteries affects blood pressure, as smaller
spaces and less elastic arteries resulting from clogs require more
force to transport blood. The heart is the responsible party for moving
blood to the body via arteries and arterioles, while skeletal muscle
contraction is the mechanism that actuates the blood as it moves
through the venous system and returns to the heart. As skeletal
muscles contract, they push against the thin or weak (by design)
walls of the veins, causing the blood to move past valves. Once past
a heathy valve, the blood cannot return, forcing it to move toward the
heart.

High blood pressure has been called the silent killer because many
people like Stewart have it without noticeable symptoms. It is the
leading cause of strokes and is a major risk factor for heart attacks
and kidney failure.

Stewart was aware that his obesity was a major risk for heart
disease. And while he had regular warnings from his cardiologist,
Stewart was unable to lose weight. He therefore was fatigued and
had difficulty walking. It is possible that regular intervention from
social work might have influenced Stewart to start on a mild exercise
regimen. However, such intervention should have occurred early in
Stewart’s life for him to attenuate the cardiovascular damage from
obesity and his sedentary lifestyle. Perceptions of exterior (distal)
conditions such as daily concern about Louise’s neurodegenerative
disease may have further been responsible for Stewart predeceasing
his wife.

Now consider Juan and Belinda (Case Study 3.6). Juan has been an
active athlete throughout his life and thus is less at risk for
cardiovascular disease than Belinda is. However, Belinda is now
aware of her need to monitor her blood pressure and to engage in
heart-healthy activity. Being better informed about the cardiovascular
system and its care can help Belinda maximize the benefits of
medical examination and treatment. A social worker may participate
in medical care by helping Belinda learn the essential elements of
effective health practice, including causes, risks, and prevention of
hypertension. Health coaching is an increasing service provided
through community and insurance venues. A social worker in this role
can support Belinda and advise her to monitor her blood pressure
with fancy new gizmos. As Belinda enters an intimate relationship
with renewed energy, she has decided to purchase a fitness tracker
to monitor her overall health and activity. As advised by her health
coach, she will join a virtual community to motivate herself to remain
physically fit, thereby lowering her risk for high blood pressure and
cardiac disease. Because high blood pressure has been shown to run
in families, the social worker can also work with Belinda’s adult
children to discuss lifestyle and hereditary factors that might place
them at risk for high blood pressure. The social worker may also work
with community organizations, community centers, online groups, and
other organizations to advance policy and public health practices to
support education and prevention programs as well as physician and
health care provider referral programs.

Before leaving the cardiovascular system, visit its electrical grid. If

abnormal electrical signals override a consistent heart rhythm, atrial
fibrillation, or Afib, can occur. Afib is an abnormal heartbeat rhythm
and speed, often accelerated. This condition has serious
consequences such as stroke or heart failure. To detect Afib, a heart
monitor must be worn for at least 24 hours. Use of this device is often
sidestepped or neglected in primary care as symptoms of Afib can be
misinterpreted or not even recognized (Mayo Clinic, 2022a).

Critical Thinking Questions 3.3

With the compelling evidence about the role of exercise in cardiac

(and other system) illness prevention, how could on-site and online
social work programs be developed to engage sedentary individuals
in movement? In what types of settings should such programs be
offered?

Musculoskeletal System

Both Louise (Case Study 3.5) and Cheryl (Case Study 3.1) provide
exemplars of musculoskeletal system issues, involving bones,
muscles, tendons, ligaments, and soft tissues. After a number of
years with a variety of physical signs that included what looked like
ongoing fidgeting and involuntary twitches, Louise was diagnosed
with Huntington’s disease. While this condition is a
neurodegenerative pathology, observable musculoskeletal signs are
the most obvious symptoms and often are the provocateurs of
medical assessment. Stiffness and rigidity of muscles can further
impair mobility and movement as the disease progresses, and Louise
experienced all of these problems over the course of her life to the
point of being fully dependent on assistance for all activities of daily
living.

Cheryl provides an exemplar of musculoskeletal disorder as well.

Cheryl’s condition is localized while Louise illustrates the networked
nature of movement and posture. When a limb is beyond repair from
injury, infection, or other disease process such as diabetes, the body
part is amputated. In the blast from the explosive device, the damage
to both of Cheryl’s legs was so severe that surgical repair was out of
the question. Lower extremity limb loss is classified as below knee
(BK) or above knee (AK) amputation (Dua, 2020). Cheryl’s injuries
resulted in bilateral BK amputations. She also experienced phantom
right limb pain, a condition in which the brain perceives pain in a
missing limb. Again, note the manner in which the central nervous
system and the musculoskeletal system are inseparable even in the
absence of a body part.

Cheryl benefitted from the recent development of advanced robotic

prostheses for both legs. As she rehabbed, she was able to regain a
comfortable and smooth gait that would not have been possible
before the availability of this technology. These transhuman devices
rely on small sensors that are implanted in the musculature of the
remaining leg stump, which then transmit wireless signals to a
miniaturized computer embedded in the artificial limb. The user learns
seamless control to move naturally (Dua, 2020). Cheryl was able to
regain not only mobility but her ability to engage in fitness activity.
Thus, the technology, while not fully imitating the activity of the
musculoskeletal system, is close enough to restore the capacity to
move, navigate, and engage in healthy exercise in a fluid manner.
Currently, devices are being developed and marketed that link to the
user’s sensory system, mimicking or even surpassing the human
body part function (Ferng, 2019).

Over 2 million people in the United States have lost one or more
limbs. The primary causes are vascular insufficiency resulting from
diabetes and peripheral arterial disease; traumatic injury, particularly
among veterans; and cancer in one of the systems contained in a
limb (Amputee Coalition, 2021). Limb loss is complex, frequently
involving significant pain and impairment. Amputation can leave a
person feeling depressed, in mourning due to the loss of a proximal
body part, and the object of stigma and pity. However, this picture is
changing. Over the past several decades, prosthetic replacements
have advanced a great deal. Celebrities such aa Aimee Mullins, an
athlete, model, and actress who lost both lower limbs as a child, and
Hugh Herr, a double amputee who lost his lower limbs in a mountain
climbing accident, have raised awareness of the potential for
technology to be used innovatively to restore function after limb loss.
Mullins ran competitively using “cheetah legs,” specialized prosthetics
designed for speed. Both Herr and Mullins are well known for their
adherence to transhumanist viewpoints, each suggesting that limb
loss is an opportunity not only for creativity but for advancing the
notion of cyborg as the next evolutionary step in humanness
(Goodley et al., 2014). Moreover, both have been vociferous
proponents and promoters of alternative body structures and
eschewal of amputation as impairment (“Aimee Mullins,” 2022).
According to Herr (2018), disability is defined as technology not yet
invented, illustrating the integration of transhuman thinking and
engineering to change bodies.

Back to the humanist body, the contraction and relaxation of muscles

attached to the skeleton is the basis for all voluntary movements.
Over 600 skeletal muscles in the body account for approximately
40% of body weight. When a muscle contracts, it shortens; it can only
pull, not push. Therefore, extension (expanding the angle of a joint)
and flexion (decreasing joint angles) operate on muscles working as
“antagonistic” pairs. As an example, when the hamstring group in the
back of the leg contracts, the quadriceps in the front relax. This action
allows the leg to bend at the knee. When the quadriceps contract, the
hamstring relaxes, allowing the leg to extend.

Highlighting the network of proximal systems, the contraction of a

muscle occurs as a result of the body’s electrical grid through which
an impulse passes to the muscle through a controlling nerve that
releases acetylcholine. When a single stimulus is given to a muscle, it
responds with a twitch, a contraction lasting only a fraction of a
second. But when there are repeated stimulations close together, the
muscle cannot fully relax between impulses. As a cumulative result,
each contraction benefits from the previous contraction, giving a
combined contraction that is greater than an individual twitch. When
stimulation is sufficiently rapid, the twitches cease to be jerky and
fuse into a smooth contraction/movement called tetanus. To an
extent, tetanus is functional, producing movement. However,
excessive tetanus that continues eventually produces muscle fatigue
due to depletion of energy reserves. The social worker might be well
advised to incorporate this knowledge into any exercise program.

Tone is defined as skeletal muscles in a constant state of contraction,

critical for the maintenance of body posture. If all the muscle fibers in
the neck, trunk, and legs were to relax, our bodies would collapse
during waking as they do in sleep. Nerve fibers embedded in the
muscles emit impulses that communicate the state of particular
muscles to the CNS. This communication allows the CNS to
coordinate the contraction of muscles, the brain as boss once again.
In its entirety, the musculoskeletal system both provides a scaffold for
the proximal body and activates its movement. The skeleton,
particularly the large heavy bones of the legs, supports the body
against the pull of gravity. However, the skeleton has another critical
job, protector of soft tissue and proximal organ structures. The skull
plays sentry for the brain, the rib cage encircles and cradles the heart
and lungs, and the vertebrae protect and support the spinal cord.
Bones serve as sites for the attachment of muscles. It may not seem
so, but bone is a very busy tissue, supplied with nerves and blood
vessels. Throughout life, bone cells repair, remold, and rejuvenate in
response to stresses, strains, and fractures. A typical long bone, such
as the arm or leg bone, has a cavity surrounded by a dense area.
The dense area contains compact bone; the cavernous area contains
blood vessels and nerves surrounded by spongy bone. Far from
being weak, spongy bone is designed for strength. And recall that
bone marrow is embedded deep within the bones. Thus, bones are
the production site of red marrow, the specialized tissue that
produces red and white blood cells. The cavity of a long bone also
contains yellow marrow, which is the fat-storage tissue that is a
body’s fail-safe nutrition source. Think of Thomas (Case Study 3.4),
who along with growth was harboring cancer in his bone marrow.

Most bones begin as cartilage. In long bones, growth and calcification

(hardening) begin in early childhood and continue through
adolescence. Growth hormones and thyroid hormones interact with
the skeletal system to stimulate bone growth during childhood,
illuminating the construct of body as network. Androgens, which are
responsible for the adolescent growth spurt, stimulate bone growth
during puberty until late adolescence, when these same androgens
terminate height.

Bones are joined together at joints. Recall the discussion of flexion

and extension, which occurs when muscles act on moveable joints.
Thus, long bones and their corresponding joints are what permit
flexible body movement unless other systems, such as the nervous
system, malfunction. Joints are classified according to the amount of
movement they permit. Bones of the cranium, which are sutured
together, are examples of immovable joints. Joints between the
vertebrae are slightly movable. Freely movable joints, which connect
two bones separated by a cavity, are called synovial joints. These
may be hinge joints (knee and elbow that pivot in one plane) or ball-
and-socket joints (attachment of the femur to the hipbone that rotate
in three planes) named for their structure and potential range of
motion. Figure 3.5 shows the structure of the knee joint. Because
these joints move, they are lubricated by synovial fluid and thus get
their additional moniker.
Description

Figure 3.5 Structure of the Knee Joint

Bones in a joint are held together by ligaments, while tendons

connect muscle to bone. The ends of the bone are capped by
cartilage, a softer and more pliable material than bone, which
provides added strength and support to the joint. Friction between
tendons and ligaments and between tendons and bones is eased by
fluid-filled sacs called bursae. Inflammation of the bursae is called
bursitis. As we age, synovial joints are the ones most prone to
arthritis and thus breakdown. As joint lubrication decreases and
bones gradually lose their protective covering, pain and mobility
impairment may result from bone-on-bone destruction, raising the
need once again for the cyborg joint implant that today is considered
part of typical medical care.

Because of the commonly held perspective that individual

independence is most desirable, it is common to hear those who may
benefit from exterior environment devices to reject them, either to
become unnecessarily sedentary or to be ridiculed due to the stigma
of being impaired. Sedentary lifestyles have serious negative
consequences as evidence continues to highlight movement as
critical to the health of all embodied systems and functions (Wang &
Ashokan, 2021).

Examples of devices that may be suggested for use by individuals

with atypical mobility include manual wheelchairs, motorized
wheelchairs, motorized scooters, and other aids that enhance or even
make possible movement, participation, and navigation. In suggesting
devices, the social worker should be attentive to stigma that
accompanies the term assistive and the medicalized appearance and
limited function of many products named assistive technology. An
important social work agenda, already initiated, is the collaborative
design, development, branding, and promotion of innovative well-
designed, highly functional mobility devices (DePoy & Gilson, 2014;
DePoy et al., 2019; Mobella, 2022).

While the most commonly held perspective of disability is one of

medical deficiency, contemporary disability studies challenge this
belief. DePoy and Gilson (2011, 2014, 2022a) have theorized
disability as disjuncture, the failure to complete a wanted or required
task due to an ill fit between body and context. Thus, using this
perspective, disability is ubiquitous and an equal opportunity
phenomenon, understandable because all have failed at a task and
thus all are, have been, and will be disabled from this definitional
standpoint. Such ubiquity provides great potential for innovative
response.

Consider Cheryl (Case Study 3.1), for example. Her prosthetic

devices restored her motor functioning and thus eliminated task
failure to navigate. Louise (Case Study 3.5) used multiple devices,
initially starting with a non-stigmatized wheeled suitcase for balance
when traveling with Stewart (how innovative). She then moved to the
use of a well-accepted hiking stick for balance, proceeding to the
additional support of a rollator, and then relying on a wheelchair when
she was no longer able to control her movements.

Reproductive System

Although reproductive health researchers, health care practitioners,

and the general public often assume that the only way a pregnancy
has occurred is that a cisgender male has had unprotected vaginal
sexual intercourse with a cisgender female, that is not true (Moseson
et al., 2020). Consider Shay and Terry (Case Study 3.3), who
pursued parenthood first by investigating surrogacy and in vitro
fertilization (IVF). In 2018, it was estimated that more than 8 million
babies had been born globally as a result of IVF or other advanced
fertility treatments (European Society of Human Reproduction and
Embryology, 2018). Two of the most common fertility treatments are
intrauterine insemination (IUI) and IVF. IUI involves collecting healthy
sperm and inserting it directly into a uterus. IVF involves collecting
eggs from ovaries and fertilizing them by collected sperm in a lab or
elsewhere outside a human body.

Juan and Belinda, both cisgender and heterosexual, are at an age

when many people no longer think of themselves as sexual beings.
However, recent studies found that almost one-half of U.S. men and
one-fourth of U.S. women age 60 and over engage in some type of
sexual activity (WebMD, 2022). While there are physiological and
anatomical changes in the vagina and the penis, satisfying sexual
activity is not only possible but often desired by many older adults.
After menopause, females no longer need to use birth control to
avoid pregnancy. They also lose lubrication and vaginal length. For
males, erection may become problematic. After age 40,
approximately 40% of males experience some bouts of erectile
dysfunction with that number increasing over the age span. However,
contemporary life brings change. For example, if an individual does
not possess cardiac and allergic contraindications, pharmaceuticals
can be safely used to assist couples of all genders to engage in
intercourse. Other types of sexual intimacy are prevalent in the lives
of senior citizens including oral sex and masturbation (WebMD,
2022). Juan and Belinda aspire to include sexual intercourse in their
sexual repertoire as they explore their new relationship.

Sexuality and gender are multifaceted and fluid. It is important that all
people, no matter their sexual and gender identities, have respectful
and helpful reproductive health experiences. At birth, each newborn
is assigned a sex, usually based on external genitalia, recorded as
female, intersex, or male. Cultures have developed binary gender
roles to be played by people in different assigned sex categories
(leaving intersex individuals to choose a side of the binary). Not all
cultures have recognized gender as binary, but most have done so in
recent times (DePoy & Gilson, 2018). Increasingly, it is understood
that gender identity can be consistent with or different from the sex
assigned at birth. An individual may identify as male, female, both,
neither, or something else—and can change that identity from time to
time. Transgender is an umbrella term for people with a gender
identity different from the one associated with the sex assigned at
birth. It may be a binary transgender identity (male or female) or a
nonbinary identity that could be a blend of male and female, or
neither male nor female. Sexual identity, distinct from gender identity,
refers to an individual’s choice of sexual partners. An individual may
be heterosexual, gay, lesbian, bisexual, pansexual, asexual, queer,
among other sexual identities. There is a broad set of social
categories that represent people who do gender and sexuality outside
of the dominant cisgender, heterosexual socially created categories.
A recent Gallup poll found that 7.1% of the U.S. population identifies
as LGBT (Jones, 2022). Given the many combinations of gender and
sexual identities that can come together in romantic or sexual
relationships, not all sexual activity involves both female and male
reproductive systems and can, therefore, lead to reproduction. It is
also important to note that many people engaged in cisgender,
heterosexual sexual activity intend to avoid reproducing.

For all the diversity and fluidity of sexuality and gender, it is generally
understood that human reproduction happens when an egg cell
unites with a sperm cell, in whatever way that is accomplished. There
are reports, however, of mouse embryos being created without an
egg, without a sperm, and with neither egg nor sperm. Synthetic
mouse embryos have been created from stem cells, but Willyard
(2022) reports that it will be very difficult to accomplish this in
humans. So, for now, human reproduction occurs when an egg cell
from the female reproductive system unites with a sperm cell from the
male reproductive system, and there are a number of ways that can
happen.

Unlike the other systems of the body, the reproductive system —the
biological system by which humans reproduce—is not the same for
all humans. There are two human reproductive systems, one known
as the male reproductive system and the other known as the female
reproductive system. Both the female reproductive system and the
male reproductive system are needed to reproduce. Each
reproductive system includes both external and internal organs, and
each produces gametes, the cells that combine to form a new human.
The female reproductive system also has the structures and functions
to nourish a developing fetus (Mader & Windelspecht, 2020). Let’s
look first at the male reproductive system.

As Figure 3.6 shows, the external male organs are the penis and
scrotum. Internal organs consist of the testes, the tubes and ducts
that serve to transfer the sperm through the reproductive system, and
the organs that help nourish and activate sperm and neutralize some
of the acidity that sperm does not like to encounter in the vagina. The
penis functions as a conduit for both urine and semen.
Description

Figure 3.6 The Male Reproductive System

Externally, one can view the shaft and the glans (often referred to as
the head or tip) of the penis. The shaft contains three cylinders. The
two largest are called the corpa cavernosa (singular: corpus
cavernosum). During healthy sexual arousal, these structures
become engorged with blood and stiffen, creating an erection. The
corpus spongiosum, the third cylinder, contains the urethra. It
enlarges at the tip of the penis to form a structure called the glans.
The ridge that separates the glans from the shaft of the penis is
called the corona. The frenulum is the sensitive strip of tissue
connecting the underside of the glans to the shaft. At the base of the
penis is the root, which extends into the pelvis.

Three glands are part of the feedback loop that for most males
maintains a constant level of male hormones in the bloodstream. The
primary functions of the testes , or male gonads, are to produce
sperm (mature germ cells that fertilize the female egg) and to secrete
male hormones called androgens. Testosterone is one of the most
important hormones, in that it stimulates the development of the sex
organs in the male fetus and the later development of secondary sex
characteristics such as facial hair, male muscle mass, and a deep
voice. Testosterone also lives in females, strengthening bone and
lean muscle, while also energizing sex drive (Mader & Windelspecht,
2020). The two other glands in the reproductive system feedback
loop are the hypothalamus and the pituitary gland. Both secrete
hormones that serve a regulatory function, primarily maintaining a
constant testosterone level in the blood.

Before we continue, and because of the relevance of this information

to reproduction, let’s pause to briefly overview information about
heredity and genetics. For humans, chromosomes come in pairs, one
member from the male and one from the female, which are
transferred at fertilization. Each individual has 22 pairs of uniquely
shaped autosomal chromosomes complimented by a 23rd pair, the
sex chromosomes (XX or XY). In the early stages of their
development, sperm cells are called spermatocytes. Each contains
46 chromosomes, including both an X and a Y chromosome that are
designed to determine biological sex. The X chromosome (female) is
larger than the Y (male) chromosome. As the spermatocytes mature
and divide, chromosomes are reduced by half, and only one (either
the X or Y) sex-determining chromosome is retained. The mature
sperm cell is called the spermatozoan. This cell fertilizes the female
egg (ovum), which contains only X chromosomes. Thus, the
spermatozoan is the determining factor of the child’s biological sex.
(Females have two X chromosomes, and males have one X and one
Y chromosome.) Chromosomes are threadlike bodies found in the
nucleus of a cell that contain the DNA molecule, with each being
composed of many genes, or individual segments or subunits of
DNA. Any gene that appears at a specific site on a chromosome is
called an allele (one member of a pair). Genes carry the code or set
of instructions for a specific trait (characteristic). These traits
comprise the physical, biochemical, and physiologic makeup of every
cell in the body.
Most commonly we refer to genes as either dominant or recessive. A
dominant gene is one that expresses its effect in the cell regardless
of whether its allele on the matching chromosome is the same or
different from the dominant gene (a gene in one strand of DNA that is
stronger than the corresponding gene in another strand of DNA),
whereas a recessive gene is a gene in one strand of DNA that is
weaker than the corresponding gene in another strand of DNA, the
effect of which is not evident unless its paired allele on the matching
chromosome is also recessive. Recessive genes can be passed on to
offspring. Louise’s daughter was the recipient of the unwanted gift of
Huntington’s disease. When the matching genes for a trait are
different, the alleles are heterozygous. When the genes for a trait are
the same (both dominant or both recessive), the alleles are
homozygous. Any trait carried on a sex chromosome is considered to
be sex linked. Most sex-linked traits are carried on the X
chromosome. Sex-linked traits appear almost exclusively in males,
and most of these traits are recessive. Other traits are expressed
differently in males and females even though the genes that control
the traits are located on non-sex-linked chromosomes.

Of particular interest for professions such as social work is

Bonduriansky’s (2018) observation that contemporary discussions of
heredity have moved away from a “hard heredity” model associated
with classical Mendelian genetics that recognizes heredity as traits
passed from a biological parent to the offspring regardless of the
exterior environment. Before proposing the importance of knowledge
of genetics in social work practice, we return to the reproductive
system to complete that discussion. Again, the web of complexity and
interaction is visible among both proximal and distal phenomena.

Before ejaculation, the sperm pass through a number of tubes and

glands, beginning with a testis, proceeding through a maze of ducts,
and then to an epididymis, which is the convergence of the ducts and
serves as the storage facility for sperm in a testicle. Each epididymis
empties into the vas deferens, which brings the mature sperm to the
seminal vesicles, small glands that lie behind the bladder. In these
glands, a nourishing and activating fluid combines with the sperm
before the mixture is carried through the urethra to the outside of the
penis. The prostate gland, through which the urethra passes,
produces and introduces the milky fluid that preserves the sperm and
neutralizes the alkalinity found in the female reproductive system.
Cowper’s glands also make their contribution to the seminal fluid
before it leaves the male.

However, even if there is early ejaculation and the Cowper’s glands

do not have time to secrete fluid, viable sperm exist in the ejaculate
and can fertilize the female egg. Early withdrawal of the penis from a
vagina therefore does not prevent the passage of some viable sperm
cells. Pregnancy can thus occur even if the male withdraws before
orgasm. It is also important to know that sperm only compose about
1% of the ejaculate (3 to 5 milliliters of fluid total), but this small
percentage packs a punch as it contains from 200 million to 400
million sperm. The number of sperm decreases with frequent
ejaculation and advancing age.

Figure 3.7 shows the external female sex organs. They include the
pudendum, also called the vulva, which consists of the mons veneris,
the fatty tissue below the abdomen that becomes covered with hair
after puberty; the labia majora and minora; the clitoris; and the
vaginal opening. Unlike the male, the female has a physical
separation between excretion and reproductive organs. Urine passes
from the bladder through the urethra to the urethral opening, where it
is expelled from the body. The urethra is located immediately in front
of the vaginal opening and is unconnected to it.
Description

Figure 3.7 The Female External Sex Organs

The labia majora, large folds of skin, contain nerve endings that are
responsive to stimulation and protect the inner genitalia. Labia minora
join the prepuce hood at the top that covers the clitoris. These
structures, when stimulated, engorge with blood and darken,
indicating sexual arousal. Resembling the male penis and developing
from the same embryonic tissue, the clitoris is about 1 inch long and
¼ inch wide. However, unlike the penis, the clitoris is not directly
involved in reproduction but serves primarily to produce sexual
pleasure. The vestibule located inside the labia minora contains
openings to the urethra and the vagina. It is also a site for arousal
because it is rich in nerve endings sensitive to stimulation.

Internal structures of the female reproductive system, shown in

Figure 3.8 , include the vagina, ovaries, fallopian tubes, cervical canal
(cervix), and uterus. The vagina connects with the external sexual
structures. Composed of three layers and shaped cylindrically, the
vagina both receives the penis during heterosexual intercourse and
functions as one birth canal (notwithstanding alternative forms of
delivery) through which the child passes from the uterus to the distal
world. Because of its multiple functions, the vagina has the flexibility
to expand and contract and to change its climate from dry to
lubricated. The cervix is the lower end of the uterus and protrudes
into the vagina. It maintains the chemical balance of the vagina
through its secretions.

Description
Figure 3.8 The Female Internal Sex Organs

The uterus , also called the womb, serves as the pear-shaped home
of the developing fetus for the approximately 9-month stay between
conception and birth. The innermost of its three layers, the
endometrium, is the tissue that builds to protect and nourish the
developing fetus. If pregnancy does not occur, the endometrium is
shed monthly through the process of menstruation. If pregnancy does
occur, the well-muscled middle layer of the uterus produces the
strong contractions necessary at birth to move the fetus out of the
uterus, into the vaginal canal, and then into the distal world. The
external layer protects the uterus within the body.

The fallopian tubes connect the ovaries to the uterus and serve as a
conduit for the ova (egg cells) from the ovaries to the uterus. Located
on either side of the uterus, the ovaries have two major functions: the
production of ova and the production of the female sex hormones,
progesterone and estrogen.

Until recently it was believed that females were born with the total
number of ova they would ever possess. However, several studies,
although hotly debated, have suggested that females may make new
eggs throughout their reproductive years (Schleunes, 2020).

Estrogen facilitates sexual maturation and regulates the menstrual

cycle in premenopausal females. The benefits of estrogen in post-
menopausal females, who can only obtain it from taking a
supplement, are debatable. Some argue that estrogen maintains
cognitive function and cardiac well-being in older females. However,
estrogen supplements (also called hormone replacement therapy
[HRT]) have been associated with increasing breast and uterine
cancer risk, among other problems. Progesterone, although less
discussed in the popular media, is critically important in preparing the
uterus for pregnancy. It also is a regulator of the menstrual cycle.

Female breasts are considered to be secondary sex characteristics

because they do not have a direct function in reproduction. However,
mammary glands contained in the breast produce milk that is
discharged through the nipples and may be the primary nutrition
source for the neonate. The nipples are surrounded by the aureoles
and become erect when stimulated. The size of the mammary glands
is incidental to breast size and milk production. Rather, breast size is
a function of the fatty tissue within the breast and can be changed by
a skilled surgeon if so desired by the breast owner.

Social work counseling may benefit Belinda, who is tenuous about

herself as sexually attractive at the age of 72. Certainly, social work
has a huge influence on promoting healthy gender identity, sexuality,
and reproduction in all levels of individual to macro practice.

While it is beyond the scope of this chapter to discuss sexual activity

among diverse genders and sexual orientations, we urge you to
consider this important area and the implications for social work
practice.

Genetics. As promised, let’s briefly return to the topic of genetics. In

1990, the National Institutes of Health and the Department of Energy
joined forces with international partners to sequence the human
genome, the complete set of DNA in the human body, in the Human
Genome Project (HGP). Since its inception in 1990, this work has
progressed exponentially. In April 2003, researchers announced that
they had mapped the complete human genome (National Human
Genome Research Institute, 2022). The initial primary goals of the
HGP were “(i) to identify all genes of the human genome (initially
estimated to be 100,000); (ii) to sequence the approximately 3 billion
nucleotides (segments) of the human genome; (iii) to develop
databases to store this information; (iv) to develop tools for data
analysis; (v) to address ethical, legal, and social issues; and (vi) to
sequence a number of ‘model organisms’” (National Human Genome
Research Institute, 2022).

This knowledge has provided researchers and health care

professionals with new strategies for diagnosis, treatment, and
prevention of a variety of diseases and conditions. It is estimated that
the HGP has enabled identification of more than 1,800 disease
genes, with more than 2,000 genetic tests for human conditions
(National Human Genome Research Institute, 2022). Continued work
on the HGP is intended to allow individualized analysis of each
person’s genome, leading to bespoke strategies of intervention,
prevention, and “preemptive medicine.” The National Institutes of
Health National Human Genome Research Institute (2022) has also
identified “the increasing ability to connect DNA variation with non-
medical conditions, such as intelligence and personality traits.” This
discovery could challenge humanness, providing social work with a
new area of practice, ethical, policy, and social implications of the
HGP. Moreover, the recent proliferation of home DNA testing such as
Ancestry and 23andMe opens the universe of genetic discovery to
the lay person. These developments do not come without debates,
ethical dilemmas, scams, and policy challenges, again an important
and contemporary domain of social work concern. Given the mission
of social work to embrace diversity, equity, and inclusion, it is
incumbent upon social workers to reexamine beliefs and practices
that are and will be reshaped by the advancement of the HGP,
genetic medicine, and readily available genetic and DNA history. For
example, teasing apart the “right to choose to have a child” versus
“abortion as eugenics” should be a major ethical debate engaged by
social work, particularly when juxtaposing diversity preservation and
health benefits. Questions such as which interior traits should be
eliminated, how this action should occur, by whom, overseen by
whom, and who makes the rules are critical bioethical concerns.
Moreover, economic disparity poses a set of major considerations
considering who might afford interventions and genetic manipulations
that at this point in time are expensive. The negative and positive
effects of commercial DNA testing in which discovery of unknown
ancestry and health conditions may be illuminating, deeply disturbing,
or just plain hooey is a potent and growing area for social work
intervention.

Finally, given the current abortion debates and reversal of Roe v.

Wade, ethics related to genetics, childbearing, and sexuality are a
major social work concern.

Critical Thinking Questions 3.4

How does the Human Genome Project change the nature of
reproduction and parenting decisions that may be guided by social
workers in genetic counseling sessions? What do you see as the
potential benefits and harms of the Human Genome Project for
social, racial, and economic justice; human rights; equity; and social
inclusion?

Interactions of Exterior (Distal) Environments and Interior (Proximal) Health

Environment

Public health experts have long noted the association of poor health
outcomes, in all body systems, with low income, low education,
unsanitary housing, inadequate health care, unstable employment,
and unsafe physical environments (Infurna et al., 2021; Lassale et al.,
2022; Zambrana & Williams, 2022). Until recently, however,
researchers have made little attempt to move beyond association to
understand the causal reasons behind this empirically supported
connection of socioeconomic status and health. Researchers have
also begun to examine how other forms of social marginalization,
discrimination, and exclusion are contributing to other types of
disparities, such as those based on race, gender, and sexuality.

By the mid-1990s, researchers in several countries began to examine

how health is causally related to socioeconomic status. In the United
States, that research effort became much more focused in 1997,
when the MacArthur Foundation established the Research Network
on Socioeconomic Status and Health. This network is
interdisciplinary, including scholars from the fields of biostatistics,
epidemiology, economics, medicine, neuroscience,
psychoneuroimmunology, philosophy, psychology, and sociology.
Beginning in 2000, research on health inequalities related to
socioeconomic status, oppression, and discrimination in the United
States increased significantly (MacArthur Foundation, 2022). The
COVID-19 pandemic magnified these issues and fractures in equity
and health.

In the past decade or so, biomedical researchers have proposed an

ecobiodevelopmental model for studying health and disease across
the life course, and their research has greatly enriched and expanded
our ability to understand how exterior environments interact with the
interior health environment to produce health disparities (Roberts &
Fishbein, 2019; Weber & Harrison, 2019). This model views human
behavior as developing from the biological embedding of conditions in
the social and physical environments. As reported in Chapter 1 of this
book, biological embedding occurs when life experiences change the
biological processes and affect later health and well-being. At the
most basic level, genes interact with the physical environment and
with societal systems of advantage, disadvantage, inclusion, and
exclusion to produce health disparities (Aristizabal et al., 2020;
Traniello & Robinson, 2021). Researchers draw on neuroscience,
molecular biology, geonomics, developmental psychology,
epidemiology, sociology, and economics to consider how early life
experiences and environmental circumstances can leave a lasting
impact on brain architecture and long-term health.

One major focus of ecobiodevelopmental research is on the ways

that early toxic stress disrupts brain development as well as
development in other biological systems. One example of this
research is the Adverse Childhood Experiences (ACE) Study initiated
by the health maintenance organization Kaiser Permanente and the
U.S. Centers for Disease Control and Prevention. The original study
found that as the number of adverse childhood experiences
increased, so did the likelihood of risky health behaviors, chronic
physical and mental health conditions, and early death (Felitti et al.,
1998). The original study considered five categories of adverse
childhood experiences: physical abuse, sexual abuse, or emotional
abuse; physical or emotional neglect; violence against the mother;
living with household members who were substance abusers,
mentally ill or suicidal, or ever imprisoned; and parental separation or
divorce. Researchers across cultures have found an accumulation of
ACEs to be associated with mental health problems in middle
adulthood and old age (see H. Chen et al., 2021; Y. Chen et al.,
2021).

Other researchers have found early life stress, such as economic

deprivation, discrimination, and social exclusion, to be associated
with mental and physical health problems, including reduced head
circumference and height deficits, and impairments in learning and
behavior, including problems in linguistic, cognitive, and social-
emotional skills, decision-making, working memory, self-regulation,
and mood and impulse control (Abajobir et al., 2017; Bejaković et al.,
2021; Shonkoff et al., 2012). Adversity may begin in the prenatal
period, either in the form of undernutrition or as exposure to maternal
stress, and stress often accumulates over time in a chain of risks.
Damage to the central nervous system results in behaviors that
create problems in interpersonal relationships, and interpersonal
problems create further damage to the central nervous system.
Although epidemiological research has consistently found racial
disparities in physical and mental health, it is only in recent years that
epidemiologists have begun to explore the role racism, both structural
and interpersonal, plays in the consistent finding that African
Americans have poorer health, more disease, than their white peers
(Bailey et al., 2017; Garcia, 2022; Goosby et al., 2018; Paradies et
al., 2015; Zambrana & Williams, 2022). Research also finds that
LGBTQ+ people are at higher risk for several health disparities that
“have roots in social stigma, discrimination, rejection, violence,
minority stress, and other challenges” (Ruedas et al., 2021, p. 365).

Given social work’s commitment to human rights and social, racial,

economic, and environmental justice, public health research and
practice is an important social work domain. Health literacy and
health information technology (HIT) are critical factors in health status
(positive and negative). There are many definitions of health literacy,
but most center on the skills and competencies to access,
understand, and apply health information to promote one’s own good
health (Levin-Zamir & Bertschi, 2018). In 2020, the U.S. Centers for
Disease Control and Prevention (2022b) updated its definition of
health literacy to include both a proximal individual level and a distal
organizational level of literacy. They define personal health literacy as
the “ability to find, understand, and use information and services to
inform health-related decisions and actions for themselves and
others” (paragraph 2). Organizational health literacy is defined as
equitably enabling individuals to “find, understand, and use
information and services to inform health-related decisions and
actions for themselves and others” (paragraph 3). The important
addition of organizational health literacy puts responsibility on public
health organizations to guarantee equitable access to health
information and health services to all segments of a geographic
population, no matter their language, level of education, or sensory
and motor capabilities. Health equity is the goal.

Public health researchers also investigate two other aspects of health

literacy, media health literacy and ehealth literacy (Levin-Zamir &
Bertschi, 2018). Media health literacy is the ability to identify, critically
analyze, and use health information from a variety of types of media,
including both nondigital media (television, print, radio, etc.) and
digital media (Internet, social media, and mobile tools). e-Health
literacy, a subset of media health literacy, is the ability to find,
understand, analyze, and apply health information from electronic
sources.

There was great concern about health literacy during the COVID-19
pandemic. The title of a May 2020 commentary in the health journal
The Lancet was “COVID-19: Health Literacy Is an Underestimated
Problem.” As noted by Paakkari (2020), the author of the
commentary, the pandemic called for people to obtain and use
information to modify their behavior very quickly in a time when the
available knowledge was incomplete, complex, and sometimes
contradictory, and when false information was often presented.
Understanding of methods to prevent the spread of communicable
diseases is an essential piece of health literacy that is crucial during
such pandemics. Paakkari (2020) suggests that there is an ethical
component to health literacy for preventing the spread of
communicable diseases. Such ethical issues as human rights and
personal freedom, individual responsibility, social responsibility, and
justice for high-risk groups and the health workforce must be
considered. Unfortunately, there was also a political component to
health literacy regarding COVID-19, and that posed a considerable
problem for the public health community. Nevertheless, health literacy
in general and e-health literacy specifically were found to contribute
to compliance with preventative practices during COVID-19 among a
variety of populations (Bergman et al., 2021; Li et al., 2021; Patil et
al., 2021; Riser et al., 2020).

Health information technology (HIT) is changing the nature and

practice of health care and provides a potential avenue for further
leveling the playing field and diminishing the negative associations
among socioeconomic status, poverty, other forms of marginalization
and exclusion, and health outcomes. Technology ubiquity is woven
into the health care fabric in multiple ways and can be accessed by
anyone with the necessary technology. The continuum from simple
static sites that provide knowledge through receipt of health care
through remote technologically mediated interaction is compelling in
the capacity to improve health even for individuals who are not able
to travel on-site to a health care facility or office (Mayo Clinic, 2022b).
And as a result of the pandemic, telehealth and virtual health are
becoming ubiquitous, for social workers as well as other health
providers (Shelton et al., 2021). Further, big data analytics and
geographic methods of research provide the opportunity for fast
discovery, informing immediate and long-term public health needs
(Pastorino et al., 2019). Big data are datasets with greater capacity
than typical database software “to capture, store, manage, and
analyze” very large amounts of data (Pastorino et al., 2019, p. 23).
Increasingly, individuals can access their integrated medical
information by logging onto a health portal and viewing tests,
diagnoses, and interventions as they are documented. Social workers
can play an important role, helping people navigate and understand
health information technologies (Stanhope & Staussner, 2017). The
digital divide presents a major challenge to health equity.
Biological health and illness greatly impact human behavior.

© Jupiterimages/Polka Dot/Thinkstock

Critical Thinking Questions 3.5

How can social workers improve their own health literacy? What are
some ways they can assist clients to improve their health literacy?
How can social workers be involved in HIT to achieve the goal of
decreasing health disparities?

Implications for Social Work Practice

This discussion of the interior (proximal) biological person suggests

several principles for social work assessment and intervention:

Develop a working knowledge of the body’s interior (proximal)

environmental systems, their interconnectedness, and the
complex, elegant, and networked ways they interact with other
dimensions of human experience.
In assessments and interventions, recognize that interior
(proximal) environmental conditions of health and illness are
influenced, and not in a trivial manner, by the exterior (distal)
environmental social, political, cultural, virtual, and economic
context.
Recognize that the exterior (distal) environmental meanings
attached to health and illness may influence not only the physical
experience but also the values and socioemotional responses
assigned to health and illness.
In assessment and intervention activities, look for the ways
exterior environments and the range of human experiences
affect biological functions and vice versa. This is a nonlinear
relationship, so awareness of complex circuitry is essential.
In assessment and interventions, evaluate the reciprocal
influence of physiology, cognitive performance, emotional
comfort, and overall well-being.
 In assessment and intervention, consider the ways in which one
person’s interior (proximal) environment health status is part of a
network affecting a host of other individuals as well as the
intellectual, theoretical, and practice arena of social work.
Multiple social work roles are relevant in practice related to the
health of the biological system, including the roles of researcher,
clinician, educator, case manager, service coordinator,
prevention specialist, and policy advocate. New roles are
emerging, providing opportunity for social work to capture our
creativity and innovation within the context of the social work
mission.
Stay current with theory, empirical, knowledge, political, social,
and cultural trends and approaches, particularly as technology
changes the nature of health, the body, the human, and social
work intervention with bodies as they evolve and are redefined.

Chapter Review

Key Terms

Antibodies
Antigens
Atria
Autoimmune response
Axon
Blood pressure
Cardiovascular system
Endocrine system
Immune system
Musculoskeletal system
Nervous system
Neuron
Neuroplasticity
Neurotransmitters
Nonspecific immunity
Organizational health literacy
Personal health literacy
 Posthumanism
Reproductive system
Specific immunity
Synapse
Testes
Transhuman
Uterus
Ventricles

Active Learning

1. You have been asked by the local public middle school to teach
youth about the experience of living with one of the following
conditions: Long COVID, brain injury, diabetes, HIV, high blood
pressure, or multiple sclerosis. Locate literature and web
resources on your chosen topic, select the material you wish to
present, and prepare a presentation in lay terms that will be
accessible to the youth audience.
2. Working alone or in small groups, define humanness in light of
contemporary technology and redefinitions of the human body.

Descriptions of Images and Figures

Back to Figure

In the lateral view of the brain. The uppermost layer is labeled the
cerebral cortex. The upper front part of the brain is labeled the frontal
lobe, immediately behind this is the parietal lobe. The temporal lobe
is on the side lower below both the frontal and parietal lobes. The
occipital lobe is at the back of the brain. The cerebellum is the lowest
part of the brain and the occipital lobes. The brain stem is the vertical
cylindrical part in front of the cerebellum.

Back to Figure

The neuron has the following structure.

The cell body is the large circular structure with a large nucleus in the
center and finger-like projections the dendrites on all the sides. The
axon is the long cylindrical structure that emerges from the cells body.
It ends will small branches with bulbous end labeled axon terminals.
The direction of the impulse is from the cell body towards the axon
terminals. This axon terminals synapse with another neuron’s cell
body. The gap or junction between the axon terminal and receiving
neuron is a synapse. The bulbous end of the axon terminals has
neurotransmitters within synaptic vesicles. The receiving neuron has
pockets called the receptors. The synaptic vesicles release the
neurotransmitters into the synapse for it to reach the receptors.

Back to Figure

The ovary via Estrogen sends inhibitory signal to the hypothalamus

and pituitary. The hypothalamus sends facilitatory signal via GnRH to
the pituitary. The pituitary via LH sends facilitatory signals to the
ovaries.

Back to Figure

The blood from the body enters the right atrium via two blood vessels.
This blood then moves to the right ventricle. From the right ventricle
the deoxygenated blood moves out via two blood vessels or the
pulmonary arteries to reach the lungs on either side. The pulmonary
veins from the lungs take the oxygenated blood to the left atrium.
From the left atrium the blood moves to the left ventricle. From the left
ventricle the blood moves out of the heart via the cane-shaped aorta
to the body. The ventricles and the atrium are separated by a septum.

Back to Figure

The lateral view of the cross-section of the knee joint presents the
following structures. The femur is the long upper bone with a convex
end. It is articulated with the long lower bone tibia with an almost flat
surface. Both the ends of the bone are lined with cartilage at the point
of joining. The joint is surrounded by a joint cavity. There are large
muscles behind the femur and tibia. The patella, a small bone is in
front of the convex surface of the femur attached to a tendon above.
In front of the patella is a thin bursa. There is a ligament below the
patella. There is a bursa between the ligament below the patella and
the upper end of the tibia. There is fat between the muscles behind
the knee joint.

Back to Figure

The lateral cross-sectional view of the male pelvis presents the male
reproductive organs. The urinary bladder is inside the pelvis in front
of the rectum. The prostate gland is just below the bladder. The
urethra exits from the bladder continues through the prostate and
enters the penis. The corpus cavernosum is the muscular part of the
penis and the conical tip is the glans of the penis, it is covered by
prepuce or foreskin. The scrotum hangs below the penis. The vas
deferens emerge from the scrotum reach the seminal vesicle and
together reach the prostate.

Back to Figure

From top, the following structures are seen. The mound on the top is
the mons pubis. Down in the midline uppermost bulbous part is the
clitoris. Below the clitoris is the urethral opening and the vaginal
opening (dilated). The inner covering surrounding these central
structures is the labium minus and the outer covering is the labium
majus. The anus is the opening located below these openings in the
midline. The perineum is the space between the vaginal opening and
the anus.

Back to Figure

The central triangular structure is the uterus. The lowermost opening

of the uterus is the vagina which continues as the cervical canal. The
inner lining of the uterus is the endometrium. The two tubes that
emerge from the upper sides of the uterus is the fallopian tube. At the
end of the fallopian tubes are the ovary.
4 The Psychological Person: Cognition, Emotion, Personality,
and Self

Jeanne M. Koller

Learning Objectives

4.1 Recognize one’s own cognitive and emotional reactions to

two case studies.
4.2 Define cognition, emotion, personality, and self.
4.3 Compare six theories of cognition: Piaget’s theory of
cognitive development, the information processing framework,
Bandura’s social learning/social cognitive theory, Gardner’s
theory of multiple intelligences, Salovey and Mayer’s theory of
emotional intelligence, and theories of moral development and
reasoning.
4.4 Contrast physiological and cognitive theories of emotion.
4.5 Compare four approaches to personality (trait approaches,
cognitive-affective theories, the Pancha Kosha theory, and
biological approaches).
4.6 Understand the differences between Western culture and
Eastern culture approaches to self, and the ways they may be
bridged.
4.7 Describe three evidence-supported interventions: Eye
movement desensitization and reprocessing (EMDR), cognitive-
behavior therapy (CBT), and dialectical behavior therapy (DBT)
for changing cognitions and emotions.
4.8 Apply knowledge of cognition, emotion, personality, and self
to recommend guidelines for social work engagement,
assessment, intervention, and evaluation.

Two Case Studies of Cognition, Emotion, Personality, and Self

There is much diversity in human cognition, emotion, personality, and

self. In this chapter, we will consider two case studies to help us think
about theory and research, but each human has their own unique
configuration of cognition, emotion, personality, and self.

Case Study 4.1: Janna Smith, Unemployed and Worried

Janna Smith is a 38-year-old Native American heterosexual

cisgender female (personal gender pronouns she/her) who has come
to the counseling center after losing her job as a department manager
at a local store. Janna has a high school education and has been a
single mother after her husband died suddenly 6 years ago in an
automobile accident. She is now quite worried about paying her bills
and taking care of her 16-year-old son, Michael, and 14-year-old
daughter, Olive. Janna is not sure when she will be able to get a new
job. She resides on the Navajo Nation Reservation, and finding work
there is challenging. The unemployment rate on the reservation is
quite high compared with the unemployment rate for the United
States as a whole (Maxim et al., 2022; United States Bureau of Labor
Statistics, 2022). Even when working she barely made ends meet,
and she wonders what will happen to her and her children now that
she is unemployed.

Janna is also concerned that she will become more depressed. She
already feels her mood is low and she has less enjoyment in her
activities. As a teen she struggled with major depression and was
suicidal on more than one occasion. Mental health was not something
people talked about much in her home, neighborhood, or school, so
she felt very alone. However, after a suicide attempt and
hospitalization she was referred to mental health services and began
to improve.

The depression reemerged after the sudden and traumatic death of

her husband. She also began to suffer with what was later diagnosed
as post-traumatic stress disorder (PTSD). Janna had been in the car
with her husband at the time of the accident. Afterwards, she found
herself avoiding the area where the accident occurred, flinching every
time she heard a loud noise, having flashbacks about the scene of
the accident or a vision of her husband immediately after the
accident, and having frequent nightmares. Most of these symptoms
have since subsided, although she still periodically has flashbacks
and is sensitive to loud noises.

Fortunately, Janna never became suicidal after her husband’s death;

she felt she could not “do that” to her children and she “pushed”
herself to take care of herself, her home, and her children. Up until
now she reports that her mood has been stable, and she has had no
trouble functioning in day-to-day life for about four years. She is
fearful, though, that she will “slip into” a major depression again and
that is why she is seeking help now.

Janna doesn’t understand why bad things keep happening to her.

She thinks that it must be her destiny to struggle in life and suggests
this must be because she is a bad person. As a child, compared with
her three younger siblings, Janna was always getting into trouble at
home and at school. She was the “rebellious” one and was oftentimes
“fresh”—especially when dealing with her father. Although he was a
kind man, Janna was angry that he worked so much, and she felt he
was not as available as he “should” be to his wife and children. Janna
admits she hated her father as a child and now thinks this is why she
is having troubles in her own life.

Janna also has supports and strengths. She is proud of her heritage,
is bilingual (speaking English and the Navajo language), and has
family and extended family supports in place. Although she had a
strained relationship with her father in her youth, they get along well
now. Janna has always been very close with her mom and younger
siblings. She also has good relationships with her children, and they
are doing well socially, emotionally, and academically despite
contending with the death of their father. Up until losing her job
recently, Janna has always been able to maintain employment and
reports she has been a reliable and conscientious employee with a
strong work ethic. Janna never used illicit drugs, never smoked
cigarettes, and drinks alcohol infrequently. She reports being in good
overall health and is not on any medications.

Case Study 4.2: Charles Miller, Making a New Start

Charles Miller is a 68-year-old African American heterosexual
transgender male (personal gender pronouns he/him). Charles has
joined a support group at a mental health center for people aged 50
and older who identify as transgender and/or gender
nonbinary/gender diverse. All support group members must also be
seen for an individual consultation to see if there are other services
the client may benefit from at the center or through other local
resources. The social worker assigned to meet individually with
Charles gathered the following assessment information and
suggested that, in addition to attending the group, some individual
counseling may be helpful for Charles. Charles agreed with that plan.

Charles’s sex assigned at birth was female (name given at birth was
Charlene), and he grew up living life as Charlene until 6 years ago
when he retired from work. Charles was born and raised in an urban
area of New Jersey where he lived with his mother, father, and sister.
His father died suddenly and traumatically at age 42 from a heart
attack. Charles and his sister were ages 18 and 16, respectively, at
the time of their father’s death. The entire family was shaken, and
Charles almost didn’t go to college as a result. He thought he should
stay at home, work, and help take care of his mom and sister.
However, his mom insisted he go to college as this was something
his dad would have wanted.

Charles did attend college and sailed through, graduating in the top
10% of his class. He was the first college graduate in the family, and
his mom and family were thrilled. After obtaining his BA degree he
taught in a local elementary school and was considered by students
and colleagues to be a wonderful instructor. During his late 20s,
Charles met and fell in love with Lorraine. They did not pursue having
children themselves but have been active aunts with each of their
siblings’ children. Their relationship, which was identified as a lesbian
relationship at the time, was not shared with Charles’s workplace for
fear of termination or other consequences to his work. To his
colleagues, Charles was a happily single female who preferred not to
socialize with colleagues outside of the workplace. At home, Charles
was “out” with all his family and friends as a lesbian. Lorraine was the
owner of her own restaurant and was out at her workplace. At times
she was hurt that no one at Charles’s workplace knew about her.
Lorraine was never able to attend the annual work parties at the
school where Charles worked and did not even attend Charles’s
retirement party. This is still an issue for Lorraine today, but according
to Charles, she has accepted it and “moved on.”

Once retired, Charles decided it was time to live as his “authentic

self.” Lorraine has been fully supportive, and they plan to legally
marry within the year. Although Charles does not think he will seek
gender-affirming bottom surgery, he has taken the following steps
important to him: (1) legally changing his name from Charlene to
Charles and changing all forms of identification to reflect this name
change, (2) taking medications for his transition under the directions
of a physician at a local health center, (3) obtaining gender-affirming
top surgery, and (4) sharing his new identity with his closest family
members and friends. Three family members from one family unit—
Uncle Joe, Aunt Gwen, and Cousin Natalie—have cut him out of their
lives and describe him as disgusting. Fortunately, though, Charles’s
mother, sister, other extended family members, and closest friends
have been encouraging and accepting. Although Charles and
Lorraine are upset and disappointed with Uncle Joe’s, Aunt Gwen’s,
and Cousin Natalie’s reactions, they were not surprised. They have
tried to focus on the supports they do have in their lives.

Charles and Lorraine are actively preparing to sell their house in New
Jersey and move to a smaller house in North Carolina for their
retirement years. Lorraine recently sold her restaurant business and
is looking forward to having more free time for her hobbies and social
activities. Charles and Lorraine know people in the LGBTQ+
community living in North Carolina and already have connections at a
local LGBTQ+ community center there. This year will be quite hectic
with all the work necessary to sell a house, buy a house, move, and
get married. They agree this may be a time-consuming undertaking,
but they want to start the process.

Although eager to start a new chapter of his life, Charles is feeling

overwhelmed and is having some mild anxiety when thinking of all
that is happening. Recently, he has been having trouble sleeping. He
is waking in the middle of the night, thinking about his long to-do list,
and worrying if everything will be alright. During the day he
sometimes feels “out of sorts” and complains of exhaustion. Charles
also feels his mood is down and can’t understand why since he has
so much to look forward to this year. He isn’t sure how much of his
low mood is related to lack of sleep or so many life changes.

Charles has been in therapy on and off over the years and always
found it helpful. The last time he was in therapy was approximately 7
years ago, and he loved that therapist, who is now retired. Charles
and Lorraine agreed he needed to find a new therapist, and he
learned about this support group through some friends. He is eager to
be in the group but thinks he could benefit from individual
psychotherapy too.

Charles also has supports and strengths. Charles and Lorraine are in
a strong positive long-term relationship, and both have supportive
family members and friends. They are financially stable and own their
own house, which will be sold to purchase a new home in North
Carolina. Based on real estate costs in the two states and the recent
sale of Lorraine’s restaurant, Charles and Lorraine will likely be able
to pay for a new house in North Carolina and have money to spare.
They also have a built-in support system of friends and the LGBTQ+
community center in North Carolina. Both are in good health and
have no history of substance use problems.

Cognition, Emotion, Personality, and Self: An Introduction

Janna Smith’s and Charles Miller’s challenges reflect their personal

psychologies, cognitions and emotions, and the physical and social
environments in which they live. In this chapter we will revisit the lives
of Janna and Charles as we learn about the psychological person
and four integral components involved in understanding the human
psyche: cognition, emotion, personality, and self. The psychological
person, though, cannot be seen as an entity unto itself; each person
exists in the larger context of their community and is influenced by
culture and other aspects of their environment.
To examine the psychological person, we must first become familiar
with psychology’s roots, biases, and limitations. Psychology defined
broadly is the “study of the mind and behavior” (American
Psychological Association, 2022a, para. 1). It is important to note that
the study of psychology has been dominated by Western ideology. In
fact, some argue that until the 20th century the field of psychology
was a Western product (Sigdel & Shrestha, 2021). In more recent
years there has been growing emphasis on the role culture plays in
cognition, emotion, personality, and sense of self, and this has led to
the field becoming more inclusive of non-Western viewpoints and
narratives, ushering in what has been described as multicultural
psychology in the 1990s (Sigdel & Shrestha, 2021). While this shift
has created space for ideas and voices from other cultures about how
humans think and behave, more needs to change. The field is still
dominated by research conducted by Western thinkers, focused on
Western participants, and has not facilitated the centering of non-
Western voices, whereby collapsing Indigenous psychologies within
the larger framework of psychology (Bhatia & Priya, 2019).

Additionally, the field has become more aware of the interconnectivity

and interplay between emotion and cognition. Traditionally, emotion
and cognition were seen as two distinct domains—the emotional
brain and the cognitive brain—based on philosophically based
theoretical models. Contemporary perspectives, influenced by
neuroscience and medical imaging techniques such as functional
magnetic resonance imaging (fMRI), have found the idea that
cognition and emotion are two distinct domains to be flawed (Okon-
Singer et al., 2015). Instead, cognitions and emotions interact with
each other in complex ways that are not yet fully understood. New
insights about the mind and elements of cognition have also provided
ideas about the origins of mental illness and the potential for
predicting the early onset of psychiatric disorders.

When studying any phenomenon such as psychology, terminology is

important but also ever-changing. As you read the following
definitions, keep in mind that no matter how we define and
understand these terms today there may be other ways to understand
these concepts, and understanding will evolve over time.
Cognition can be broadly described as how we know and make
sense of the world. Cognition refers to the thinking processes that
help us understand our surroundings. Cognitive awareness and
executive control (the ability to monitor and control one’s behavior)
are thought to be related to cognitive development (Demetriou &
Spanoudis, 2017). However, cognitive processes are not always
conscious and available for reflection (Revelle, 2012). Thought
processes can be conscious or preconscious (see Chapter 2 in this
book for definitions of these terms). Cognition involves taking in
information from the multifaceted environment, so it follows that
individual cognitive development takes place in a cultural context.
Emerging cognitive research provides evidence for the role of culture
on frontal lobe processes, but it is not clear at what point in the life
course these cross-cultural differences emerge (Medina et al., 2019).

Although related, intelligence and cognitive development are

separate constructs and first developed as two distinct subdisciplines
of psychology. This historical division in the study of intelligence and
cognitive development may have happened because there had been
no commonly accepted theoretical constructs to unite them
(Demetriou & Spanoudis, 2017). In recent years, though, the study of
cognitive development and intelligence came together in the field of
cognitive psychology. The process of translating cognitive
developmental milestones into intellect may be one way of seeing
how these constructs relate to each other. Intelligence has been
described as “rapid and accurate problem solving” (Jung & Chohan,
2019, p. 163), but there is much debate about the construct of
intelligence—both how to define it and how to measure it. We will see
evidence of this debate when we explore Gardner’s (1983) notion of
multiple intelligences and Salovey and Mayer’s (1990) theory of
emotional intelligence later in the chapter.

Emotion is a complex reaction pattern involving experiential,

behavioral, and physiological elements, by which an individual
attempts to deal with a personally significant matter or event
(American Psychological Association, 2022b). It is a feeling state that
involves changes in sensations in our bodies when experiencing a
particular stimulus. Some view emotion as a universal construct,
occurring across all cultures, and as largely biologically based.
Neurotransmitters and various structures in the brain have been
found to be involved with generating emotions, leading many to focus
on the neurobiological underpinnings of emotions (Singh et al., 2021).
You may want to review Chapter 3 in this book for a discussion of
neurotransmitters and brain structures.

Currently, research is showing cultural differences in some aspects of

emotion such as emotional arousal, how emotions are felt, how
emotions are expressed, and so on (Lim, 2016). These cultural
differences can be seen when exploring Western individualistic
cultures in contrast to Eastern collectivist cultures (Lim, 2016). For
example, research by Shao et al. (2015) found that emotion
perception is more universal across cultures, but emotion
understanding and emotion regulation are more culture specific.
Across cultures, emotion perception can be thought of as the
person’s ability to accurately recognize and appraise the emotional
expressions of others (Gurera & Isaacowitz, 2019). Emotional
understanding is understanding the nature and causes of emotion,
and emotion regulation is the ability to modulate an emotion or a set
of emotions (American Psychological Association, 2022c).

Personality can be defined as an individual’s characteristic patterns of

thinking, feeling, and behaving (Mulders et al., 2018). The word
personality is derived from the Latin word persona, which refers to the
mask that performers wear to act out different roles. This origin of the
word personality captures one aspect of personality, our public face
and how others see us. However, personality consists of many other
attributes, including psychological characteristics, physiological
characteristics, emotional characteristics, and expressiveness.

An individual’s personality tends to be relatively consistent over time.

Although generally stable, personality is not etched in stone, and it is
possible for personality to change. As with cognition and emotion,
culture influences personality. Indigenous personality is a perspective
that suggests that personality can only be understood and interpreted
within the context of culture (Worthy et al., 2020).
Self is the integration of all the elements of cognition, emotion, and
personality into a cohesive notion of one’s identity. Within the
European-American paradigms of psychology, the self is oftentimes
characterized as an autonomous and separate unit, but in other
cultures—such as Chinese, the Māori of New Zealand, and others—
the self is fundamentally interconnected with the world. The concept
of the extended self challenges the notion of the self as largely ego-
centric, preferring a more ex-centric approach that does not center
the internal person (Rua et al., 2017). Medina et al. (2019) explain
that one of the most basic cultural dimensions is how people perceive
the self. The perception of self can be described as independent
and/or interdependent. Individualistic cultures focus on an
independent self while collectivistic cultures focus on an
interdependent self. In addition, the self is oftentimes thought of as
comprising three selves: the individual self, the relational self, and the
collective self. These concepts and related cultural considerations will
be reviewed in greater detail later in the chapter.

Over the years, understanding of the brain, its functioning, and its
relationship with cognition, emotion, personality, and self has grown.
Specific fields of inquiry, including neuroscience and the study of
artificial intelligence (AI), have expanded knowledge of the brain.
Concurrently, there has been recognition that external factors in the
environment influence cognitive development, emotional
development, personality development, and sense of self.

Peoples’ social identities, including their culture, race, ethnicity,

sexual orientation, and gender identity, along with family, social, and
regional norms impact development. Racism, heterosexism,
cisgenderism, sexism, ageism, ableism, and other forms of prejudice,
oppression, and discrimination can negatively influence lived
experiences and personal psychologies. Further, early traumatic life
events, otherwise known as adverse childhood experiences (ACEs),
can impact childhood and adult development and have been linked to
various cognitive and emotional challenges later in adulthood (e.g.,
chronic health problems, compromised academic performance,
mental illness, and substance abuse; Centers for Disease Control
and Prevention, 2022).
Before exploring theories of cognition, emotion, personality, and self,
it is important to understand the strengths and shortcomings of stage
theories. Stage theories are, and have been, popular in attempts to
explain emotional, cognitive, personality, self, and moral human
development in humans. Stage theories are constructs used to
describe steps (stages) of growth. Examples in the areas of cognition
and moral reasoning are Piaget’s theory of cognitive development in
children and Kohlberg’s six stage theory of moral development.
These theories have endured over time, yet they have been criticized
regarding both their content and the use of stages themselves.
Stages can be seen as useful heuristics, but they do not capture
developmental variations within the person and between persons
(Hopkins, 2011). Stage theories also tend to make the assumptions
that each person travels through a linear fixed or prescribed path,
rather than emphasizing development as a dynamic interaction
between individuals and their environments (Pelaez et al., 2008).

Importantly, though, these limitations are not true of all stage theories.
Contemporary life span and life course theories are all about the
dynamic interactions between individuals and the environment. The
basic definition of the life course perspective is a dynamic interaction
of person and environment. This theoretical perspective includes the
impact of historical era, culture, advantage, disadvantage, as well as
common life experiences—and suggests that the life course is a path
with twists and turns, not a straight path.

Critical Thinking Questions 4.1

Think about Janna Smith (Case Study 4.1) and Charles Miller (Case
Study 4.2). Now consider the role of culture and the impact of cultural
and social identities on their lives. How are their identities and lives
similar? How are their identities and lives different? What obstacles or
challenges may they have faced because of their identities? What
have served as their strengths? Looking at the current social climate
in the United States, what biases may they encounter when seeking
mental health services? How might biases impact psychological
assessment, diagnosis, and intervention?
Theories of Cognition

Janna Smith (Case Study 4.1) thinks it must be her destiny to

struggle in life because she is a bad person. Charles Miller (Case
Study 4.2) has methodically developed and executed four steps he
decided were necessary for his transitioning process. Janna’s and
Charles’s thoughts (cognitions) influence their lives and experiences.
Theories of cognition look to explain how our thoughts and thinking
processes develop and how they relate to our emotions and
behaviors.

For some cognitive theorists, thoughts are seen as the underlying

cause of our emotions and behaviors. However, due to the complexity
of the relationship between cognitions and emotions it is certainly
debatable which comes first—or whether they show up at the same
time. We are still learning more about how emotions and cognitions
influence each other in the workings of our brains. Many theories
have been developed to understand cognitions. In the following
section, five theories are reviewed: Piaget’s stage theory of cognitive
development, the information processing framework, Bandura’s social
learning/social cognitive theory, Gardner’s theory of multiple
intelligence, and Salovey and Mayer’s theory of emotional
intelligence. In addition, theories of moral development and reasoning
will be explored.

Piaget’s (Stage) Theory of Cognitive Development

Swiss psychologist Jean Piaget (1896–1980) had an overarching

goal to explore how knowledge about the world grows and proposed
that children’s ways of thinking are initially entirely different from
adults’ modes of thinking (Smith, 2022). Observations of Piaget’s own
nephew and daughter, as well as other children, shaped the theory.
Rather than seeing children as “mini adults,” Piaget proposed that
cognition and intelligence develop through a series of four stages: (1)
sensorimotor stage, birth through 2 years of age when children
become aware that the outside world exists separately from
themselves; (2) preoperational stage, age 2 through 7 years of age
when children are thinking at a symbolic level but are not yet using
logical cognitive operations; (3) concrete operational stage, age 7
through 11 years of age when children’s thinking is characterized by
logical cognitive operations permitting logical reasoning; and (4)
formal operational stage, 11 years of age and older when youth gain
an ability to think in an abstract way and use abstract reasoning to
consider concepts beyond what is physically observed, to recognize
patterns, analyze ideas, synthesize information, and solve problems
(Piaget, 1951, 1953, 1966).

Piaget’s framework includes four core concepts: schemas,

assimilation, accommodation, and the notion that children and adults
are active learners. Schemas are different categories of learning that
are used to understand the world around us; Piaget proposed that
schemas are the building blocks of knowledge. Assimilation is the
process that occurs when a learner encounters a new idea and must
fit that idea into what they already know (their existing schemas). For
example, when a child sees a cat for the first time, they may initially
assimilate it to their schema of “dog,” a four-legged animal.
Accommodation is a more substantial level of learning and involves a
process by which a person learns to reshape existing schemas to
accommodate new information. For example, the child is told by a
parent that the cat they see is not a dog and the child learns that not
all four-legged animals are dogs. Piaget also proposed that children
are active learners and can initiate their own learning processes.

Piaget’s theory of cognitive development asserts that children must

master one stage of development before they can move to the next
stage’s learning and that all children must pass through the four
stages in the same order. Piaget also believed that the developmental
process was an interplay between nature (genes) and nurture
(environmental influences). Play, and providing stimulating play
environments, was an important tenet of Piaget’s work.

Piaget’s theory has numerous strengths and has been influential for
many years. In recent years, Piaget’s theory has been applied to non-
human species to identify common patterns in cognitive development
across species. For example, sensorimotor cognition is considered a
key element that lays the foundation for developing cognitive skills in
a number of species. In their study of ravens, Jacobs et al. (2019)
found that the developmental pattern of ravens mirrored the pattern of
12 other mammal and bird species, with differences found in the rates
of development.

There are also criticisms of Piaget’s theory. Much of the theory

derives from observations of a small number of children and, as
Gardner (2011) explains, Piaget’s “monolithic emphasis upon a
certain form of thinking” ignores other forms of cognitive competence
(p. 21). Piaget has also been criticized for not putting enough
emphasis on the way the social environment is involved in cognitive
development. Finally, as mentioned earlier, there have been criticisms
of the idea of discrete developmental stages (see Wyer, 2019).

If we were to apply Piaget’s concept of schema when working with

Janna Smith (Case Study 4.1) we might want to explore Janna’s
schema of “bad person,” the role it plays in Janna’s struggles, and
how that schema could be revised through a process of
accommodation. If the concept of schema was used in our
understanding of Charles Miller (Case Study 4.2), the gender binary
schema might be explored. Gender schema theory, proposed by
Sandra Bem in 1981, is a cognitive development theory of gender.
Briefly, Bem (1981) proposed that self-concept gets assimilated to the
gender schema and results in sex typing. Sex typing can be
understood as the societal process that informs us about what is
seen as masculine and what is seen as feminine. Bem (1981)
speculated that this process is partially a result of society’s
“insistence on the functional importance of the gender dichotomy” (p.
354). Charles’s cognitive schema of gender may have created
challenges for him across his life span.

In the United States and other countries, there has been a gradually
growing recognition that gender identity exists beyond the binary of
male and female, and is fluid, flexible, and subject to change. People
who do not feel that the traditional binary gender categories describe
them, and do not subscribe to the gender binary, may identify as
gender nonbinary, gender diverse, gender nonconforming,
genderqueer, or may use another term of identity. Individuals who
identify as transgender are those whose gender identity is different
from the sex they were assigned at birth. They may identify as
belonging in a binary category of (transgender) man or (transgender)
female, may not identify as either male or female, or may identify as a
combination of male and female (LGBTQ Nation, 2022). The topic of
gender schema is discussed several places throughout the book, in
discussion of queer theory in Chapter 2 and in the discussion of
gender as a cultural construction in Chapter 8.

Information Processing Framework

Piaget’s theory focused on the process of cognitive development. In

contrast, the information processing framework (IPF) focuses on how
information is stored in memory, different types of memory, and how
cognitive processes are organized. The development of the
computer, and the analogy between the mind and the computer, led
to this approach of understanding human cognitive processes. The
IPF likens individuals’ cognitive processes to how a computer works.
Put simply, information is made available in the environment and is
transformed and/or altered through a series of processing systems.
Information can be considered, from a metaphysical perspective, to
be everything in existence (Vuong, 2023).
Information processing theory would suggest that the information
these children are receiving from the book flows through their senses
to their minds, which operate much like computers.

©iStockPhoto.com/SDI Productions

In the first stage of the IPF, stimuli or events are sensed and attended
to. Information received by the sensory system is then provided with
meaningful interpretation based on memories of past experiences
(Wickens & Carswell, 2021). Inputs from the environment are
processed, integrated, and stored, allowing the information to be
used to adapt in the present moment and in the future (Wickens &
Carswell, 2021). When people process information, they are
influenced by emotional and motivational factors (Lawless, 2019). In
addition, people process different types of information all at the same
time. For example, when people observe an object they may notice
color, motion, shape, and depth and must process all of this
information at once to interpret and understand the multifaceted
details about the object, a process known as parallel processing.
At each stage of information processing, people filter out some
information. As we currently live, individuals are overloaded with
information from smart devices and the Internet. The rapid rate at
which we are exposed to information can negatively impact our ability
to maintain focus (Xiong & Proctor, 2018). To offset these issues,
trainers and educators use strategies to increase the chance that
their audience will retain the presented material. Strategies include
breaking up information into smaller digestible parts, making the
information meaningful, connecting the dots between current lessons
and previous lessons to help optimize material being stored in long-
term memory, and repetition of content in different formats (Lawless,
2019). For example, if Charles Miller (Case Study 4.2) wanted help
managing his extensive to-do list for selling a house, buying a house,
moving, and getting married, it could help to break down the steps of
each transition with him, create small manageable steps, and provide
the information to him in different formats, such as giving him a
handout and discussing it with him verbally.

There are multiple models within the IPF, but most are comprised of
three core components: information stores, cognitive processes, and
executive cognition (Bouchrika, 2022). Information stores are the
different places in the brain where information is stored as memory.
Cognitive processes are the ways in which individuals transfer
information among different memory stores (Bouchrika, 2022).
Executive cognition is an individual’s awareness of how they process
information; it is akin to the term metacognition, which is thinking
about one’s own thinking (Bouchrika, 2022; Chick, 2023).

Three IPF models are briefly reviewed here: (1) the multi-store model,
(2) the multicomponent model of working memory, and (3) the
embedded processes model. The multi-store model, also known as
the modal model, was developed by Atkinson and Shiffrin in 1968.
Atkinson and Shiffrin (1968) proposed three separate parts of human
memory: the sensory register (sensory memory), short-term memory,
and long-term memory. Sensory information received by an individual
first enters the sensory register (sensory memory) and is not
maintained there for long; it decays and then is forgotten if not
attended to. If the sensory input is attended to, it enters the short-
term memory store, also known as working memory. A small amount
of information can be held in short-term memory for a small amount
of time and processed for problem solving. Brain processes can
move a short-term memory to long-term memory where it can be
stored indefinitely and retrieved and transferred back to short-term
memory when needed (Atkinson & Shiffrin, 1968; McLeod, 2021).
Long-term memory can be lost due to biological processes such as
brain tumor, cancer treatment, head trauma, insufficient oxygen, or
brain infection. See Figure 4.1 for a diagram of Atkinson and Shiffrin’s
multi-store model of information processing.

Description

Figure 4.1 Atkinson and Shiffrin’s Multi-Store Model of Information

Processing

Source: Based on Atkinson, R. C., & Shiffrin, R. M. (1968). Human

memory: A proposed system and its control processes. In K. Spence
& J. Spence (Eds.), The psychology of learning and motivation:
Advances in research and theory (Vol. 2, pp. 89–195). Academic
Press.
The Atkinson and Shiffrin model has stimulated a large amount of
research. Many memory models have been developed over the past
50 years (Malmberg et al., 2019). Two of those memory models
focusing on working memory are reviewed here: the Baddeley and
Hitch model (1974) and Cowan’s model (1999, 2005).

Baddeley and Hitch (1974) offered a multicomponent model of

working memory. They proposed that working memory (WM) involves
the storage and manipulation of information needed for varied
cognitive activities. Working memory is considered one of the most
essential cognitive abilities, used in such daily tasks as remembering
a phone number, following a story line in a movie, doing a math
calculation, and remembering how to get from one place to another
(Slana Ozimič, 2020). Baddeley and Hitch (1974) initially proposed a
three-component model of working memory: the phonological loop,
the visuo-spatial sketchpad, and the central executive center
(Baddeley, 2003). The model was expanded in 2012 and a fourth
component, the multimodal episodic buffer, was added (Baddeley,
2003, 2012). The phonological loop is responsible for processing
verbal and acoustic input; the visuo-spatial sketchpad processes
visual and spatial information; the episodic buffer deals with both
visual and speech-based information, binding information from both
as well as from long-term memory, acting in a way as a backup store;
and the central executive controls the entire memory system and
manages the transfer of information from one memory storage
system (sensory memory, short-term memory, long-term memory) to
another (Baddeley, 2000, 2012; Demir, 2021; Slana Ozimič, 2020).

Cowan (1999, 2005) proposed the embedded-processes model,

which provides a general description of the working memory system,
describing the processes involved rather than focusing on the types
of stored information (Slana Ozimič, 2020). Cowan (2005) argued
that there are various types of information that may be stored in
working memory beyond visuo-spatial and verbal representations and
wanted to describe a system that is exhaustive with nothing left out
even if it meant having the model remain vague in certain areas.
There are two main elements of Cowan’s model: activated memory
and focus of attention, which both exist in long-term memory.
Activated memory involves information in long-term memory that is
currently in an activated state. Focus of attention is the portion of
activated memory that is currently in conscious awareness. New
cognitive links are formed between items that are activated at the
same time.

Bandura’s Social Learning/Social Cognitive Theory

The previous cognitive theories focus on learning through mental

(cognitive) processes. Behaviorism (also known as traditional
learning theory), in contrast, focuses on learning using reinforcement
and repetition to shape behavior, which influences cognitive learning.
Social learning theory (SLT), developed by Albert Bandura (Bandura
1977; Bandura et al., 1961) is seen by some as a “bridge between
behaviorism and (the) cognitive approach” (Rumjaun & Narod, 2020,
p. 85). SLT asserts that behavior, cognition, and environmental
factors all interact to shape learning, and none of these three factors
plays a dominant role in the learning process (Nolen, 2022). This
dynamic and reciprocal interaction of the person, environment, and
behavior is termed reciprocal determinism and is the central concept
of Bandura’s theory (LaMorte, 2019).

Bandura agreed with the behaviorist learning theories of classical

conditioning and operant conditioning (see Chapter 2 in this book for
discussion of these theories) but believed that people also think about
their behavior and the consequences of their behavior. Bandura
initially proposed four mediational processes that occur in learning:
(1) attention (paying attention to the behavior), (2) retention
(remembering the behavior), (3) reproduction or behavioral capability
(being able to perform a previously performed behavior), and (4)
motivation or expectations (anticipating the consequences of
performing a behavior) (Bandura, 1986; McLeod, 2016).

The principle of vicarious learning or modeling, the learning of

behavior through the processes of observation and imitation, is
another of Bandura’s central ideas. An example of modeling might be
a child observing a parent responding to an upsetting situation by
slamming a book down on the table. The child pays attention to this
behavior, encodes it, and later may copy the behavior by slamming a
book down when upset. If this behavior is reinforced the child will
likely continue to slam a book down when upset. Reinforcement of a
behavior can be external or internal. For example, wanting approval
from parents would be considered external reinforcement, and the
child being pleased about getting approval from the parents is an
example of internal reinforcement. Reinforcement of a behavior can
also be positive or negative. Parents expressing approval of a child’s
behavior in some way, such as giving praise, is an example of
positive reinforcement. An example of negative reinforcement is when
a child who wants to avoid nagging about doing their homework does
their homework as soon as they get home.

In 1986, Bandura renamed the theory social cognitive theory (SCT),

asserting that learning occurs in a social context and emphasizing
both the external and internal social reinforcement of behavior.
Internal processes are seen in SCT as leading to behavioral
outcomes, and key internal motivational processes include goals,
self-evaluations of progress, self-efficacy, social comparisons, values,
outcome expectations, attributions, and self-regulation (Schunk &
DiBenedetto, 2020). Self-efficacy refers to the person’s confidence in
their ability to perform a behavior successfully (LaMorte, 2019).
Thinking about Charles Miller (Case Study 4.2) in the context of SCT,
we can expect that he may experience learning in the social context
of a support group at the LGBTQ+ center. Additionally, his counselor
can help him draw on self-efficacy evidenced in the successful
execution of his plan for transitioning. See Chapter 2 in this textbook
for more information about Bandura’s work.

Gardner’s Theory of Multiple Intelligences

American psychologist Howard Gardner (1943– ) developed a theory

of multiple intelligences (MI) in the 1970s and 1980s and first
published the book Frames of Mind: The Theory of Multiple
Intelligences in 1983. The theory of multiple intelligences asserts that
there are many ways people may be intelligent. Gardner developed
the idea that people have a number of relatively independent mental
faculties or multiple intelligences. Rather than seeing people as
having one cognitive center in the brain that acts as a computer and
results in a single area of intelligence, Gardner asserts that we have
relatively autonomous computers in the brain resulting in distinct
areas of intelligence.

Gardner (2013) argues that modern schooling primarily focuses on

and values only two areas of intelligence: verbal-linguistic and logical
mathematical. In contrast, Gardner (2013) proposes that people have
other important intelligences. Currently Gardner (2013) identifies
eight intelligences: (1) musical-rhythmic, (2) visual-spatial, (3) verbal-
linguistic, (4) logical-mathematical, (5) bodily-kinesthetic, (6)
interpersonal (social), (7) intrapersonal (understanding of self), and
(8) naturalistic (ability to make consequential distinctions in the world
of nature). Social workers need both intrapersonal and interpersonal
intelligences, and we might think of which other intelligences are
helpful in different social work roles. With increasing attention to non-
talking social work interventions, do musical-rhythmic, visual-spatial,
and bodily-kinesthetic intelligences have increasing relevance?
Which intelligences might be particularly useful to Janna Smith (Case
Study 4.1) and Charles Miller (Case Study 4.2) as they try to cope
with current challenges?

Gardner (2013) suggests that there may be additional areas of

intelligence, such as existential intelligence beyond the eight domains
already identified; but for a new intelligence to be added to the MI
theory, Gardner argues that it must meet certain inclusion criteria.
The inclusion criteria to be an intelligence are: (1) have a distinct
neural structure and functioning that is distinguishable from other
human faculties, (2) have a distinct developmental trajectory, (3) have
some basis in evolutionary biology, (4) be able to be captured in
symbol systems, (5) be supported by evidence from psychometric
tests of intelligence, (6) be distinguishable from other intelligences
through experimental psychological tasks, (7) demonstrate a core
information processing system, and (8) be seen in relative isolation in
prodigies, savants, and so on (Davis et al., 2011; Gardner, 1983).
Gardner’s multiple intelligences should not be confused with learning
styles. Gardner explains that style and intelligence are different
psychological constructs. While it is possible to integrate the idea of
learning style with intelligence, one should not conflate the two
(Gardner, 2013). Gardner (2013) explains that learning style refers to
the typical or preferred way of approaching learning, and intelligence
refers to abilities and capacities. For example, an individual may have
a high level of visual-spatial intelligence yet may prefer kinesthetic
learning activities, such as going on a class trip or participating in a
simulation game rather than watch a video in class.

There has been much interest in the theory of MI among educators,

which Gardner had not initially anticipated. Gradually, Gardner started
considering how things could be done differently in education based
on MI theory (Gardner, 2012). In one commentary, Gardner discussed
concerns regarding high-stakes testing (Education World, 2000).
Gardner suggested we should ask four questions when deciding
whether to use a standardized exam: (1) Does the exam focus on
something important?; (2) Does it test the desired skill directly?; (3)
Are teachers prepared and do they have the resources to help
students acquire the required skills?; and (4) Could students who do
well on one type of test do well on a different sort of exam that
presumably tests the same skill? Gardner also advised that we
proceed with caution when choosing to use high-stakes exams of
dubious quality whose meaning and consequences can be potentially
damaging to the student (Education World, 2000). Finally, Gardner
suggested that we should value the development of knowledge and
skills that are not easily evaluated by a single test (Education World,
2000).

Despite the popularity of MI theory and its applications in education,

there have been debates about whether there is evidence to support
it. Critics argue that there is a lack of strong empirical evidence
supporting the notion of multiple unrelated intelligences (Ferrero et
al., 2021; Waterhouse, 2006). Others have found supporting evidence
(Shearer & Karanian, 2017). In an analysis of 318 neuroscience
studies, Shearer and Karanian (2017) found neuroscience evidence
that each of the eight intelligences identified by Gardner possess
neural coherence that is clear, distinct, and aligned with neural
correlates.

We might ask if MI theory is applicable or relevant for social work

education, social work licensure, and the social work profession. As
you may know, the United States uses standardized exams
developed and administered through the Association of Social Work
Boards (ASWB) for social work licensure for MSW graduates and for
those seeking clinical licenses after the required supervised clinical
hours post-MSW. The ASWB is a regulatory body whose primary
responsibility is disseminating exams for social workers at various
levels. Initially named the American Association of State Social Work
Boards (AASSWB), the association gave its first social work licensing
exam in 1983 to social workers in New York, Virginia, and Oklahoma,
but today it tests more than 50,000 candidates annually (Association
of Social Work Boards, 2022a). The ASWB exams currently serve all
50 states, the District of Columbia, the U.S Virgin Islands, the U.S.
Territory of Guam, the U.S. Commonwealth of the Northern Mariana
Islands, and all 10 Canadian provinces.

Social work licensing exams can be considered high-stakes testing

because the consequences of failing and benefits of passing are
large. Preparing for the exam takes time and can also be costly if an
individual purchases an exam prep handbook, takes prep courses,
hires a tutor, and more. Taking the exam itself costs money, and each
time an individual fails they must wait a certain amount of time, pay
again, and retake the exam. If employers seek MSW-level social
workers, most prefer (or require) that employees be licensed. Passing
the licensure exam is required to officially practice MSW-level social
work in most states. Thus, employment prospects may be directly
impacted by an individual’s test results.

Questions have been raised about the use of standardized exams for
social work licensing, including whether exams are necessary and if
existing exams are valid measures of social work competencies. Until
August 5, 2022, the ASWB did not provide demographic data related
to exam pass rates. These data, once released, showed significant
disparity in pass rates based on race and ethnicity, age, and primary
language. Between 2018 and 2021, white test-takers, young test-
takers, and those for whom English is their primary language had
higher average pass rates than other groups (Association of Social
Work Boards, 2022b).

Critical Thinking Questions 4.2

Think about MI theory and Gardner’s recommendations related to the

use of standardized exams. Do you think there should be
standardized exams for social work licensure? If so, how should the
ASWB (or another regulatory body), social work education, and the
profession deal with the significant disparities between various social
groups? If the exams were eliminated, how should social work
competency be assessed? What might Gardner say about the use of
standardized exams to assess a profession as diverse as social
work?

Salovey and Mayer’s Theory of Emotional Intelligence

The initial concept of emotional intelligence (EI) was introduced in

1990 by researchers Peter Salovey and John Mayer. Salovey and
Mayer (1990, 2004) explained that emotional intelligence involves two
of Gardner’s intelligences, an awareness of self (intrapersonal
intelligence) and an awareness of others (interpersonal intelligence).
It also involves the idea that cognition and emotion are interrelated,
and that emotional intelligence influences an individuals’ behaviors,
relationships, and decision-making (Brackett et al., 2022). Emotional
intelligence (EI), in brief, is how people understand their own and
other people’s emotions and the emotional information around them.
EI is a people-centered intelligence compared with intelligences such
as linguistic, spatial, and mathematic-logical intelligences (Caruso et
al., 2019). How important do you think EI will be for Charles Miller
(Case Study 4.2) as he listens and shares with others in a support
group?

Mayer and Salovey (1997) proposed a four-branch model of EI.

Specifically, they asserted that there are four emotion-related abilities
that comprise EI: (1) perception/expression of emotion, (2) use of
emotion to facilitate thinking, (3) understanding of emotion, and (4)
management of emotion in oneself and others (Brackett et al., 2022).
Mayer and colleagues (2002) developed performance measures of
EI. One of the most used measurement tools is the Mayer-Salovey-
Caruso Emotional Intelligence Test (MSCEIT) (Mayer et al., 2002),
which has been found to have reasonable reliability. The MSCEIT
evaluates EI through a series of 141 Likert-scale objective and
interpersonal questions. The test is self-administered, takes about 30
to 45 minutes, and covers two areas: experiential (recognizing
emotions, comparing them with other sensations, and determining
how they interact with thought) and strategic (understanding
emotional meanings, implications for relationships, and how to
manage them) (MHS, 2023).

The idea of emotional intelligence was further popularized in 1995 by

the American psychologist Daniel Goleman in the best-selling book
by that name. There are now many models of EI and according to
Goleman and Boyatzis (2017) these models are sometimes grouped
together and labeled emotional quotient (EQ). Goleman and Boyatzis
(2017) prefer the label EI, and their current focus is on EI within the
workplace. They describe EI as being comprised of four domains,
with 12 competencies nested within the domains. The domains are:
(1) self-awareness, (2) self-management, (3) social awareness, and
(4) relationship management. The competencies within each domain
are as follows:

1. Self-awareness domain. Competency: emotional self-awareness.

2. S elf-management domain. Competencies: (1) emotional self-
control, (2) adaptability, (3) achievement orientation, and (4)
positive outlook.
3. Social awareness domain. Competencies: (1) empathy and (2)
organizational awareness.
4. Relationship management domain. Competencies: (1) influence,
(2) coach and mentor, (3) conflict management, (4) teamwork,
and (5) inspirational leadership.
Goleman and Boyatzis (2017) recommend that individuals look at
themselves (self-ratings) and the views of others who know them well
to learn more about their strengths and areas of difficulty. Coaching,
according to Goleman and Boyatzis (2017), is the most effective
method for improving areas of difficulty. See Table 4.1 , which
summarizes descriptions of the theories of cognition and intelligence
discussed in this section.

Table 4.1

Theories of Moral Development and Reasoning

Janna Smith (Case Study 4.1) has positive relationships with her
parents, siblings, and children, and she has been a reliable and
conscientious employee—yet she judges herself to be a bad person.
Charles Miller (Case Study 4.2) believed he should stay home, work,
and help take care of his mom and sister after his father died. How
have Janna’s and Charles’s moral development, moral reasoning,
and moral judgments impacted their views of themselves and
decisions they have made? This section will explore moral
development and moral reasoning, and how they may impact moral
judgments and moral actions.

Moral reasoning is the cognitive component of morality; it is how we

think about and perceive what is right and what is wrong. Moral
development is the process of formulating moral reasoning. Moral
judgments are evaluations or opinions about whether an action is
good/right or bad/wrong. Moral actions are the transformation of
intent and desire to do the right thing into reality; according to Ghandi,
moral actions should be free from fear or compulsion (Ghandian
Institutions, 2023). For example, a person steals money. Where an
individual is in the process of moral development will influence their
cognitions and moral reasoning about stealing money. Using moral
reasoning, they will assess whether stealing is right or wrong. If it is
determined that stealing is wrong, they will make a moral judgment
that the person should not have stolen the money. Intervening factors
such as the social context and the relationship to the person add
complexity to the moral reasoning process and may influence the
moral judgments that are made. Social workers encounter issues of
moral reasoning on many levels, including understanding clients and
their decision-making in certain contexts and evaluating our own
reactions and ethical and professional decision-making.

Classic paradigms of moral development are found in Freud’s

psychoanalytic model, evolutionary psychology, and cognitive
developmental theorists such as Kohlberg and Piaget. According to
Vozzola and Senland (2022), Freud and many of the evolutionary
psychologists view morality as irrational adjustments to the
expectations and demands of their environments. Cognitive
developmentalists have a different view of morality, focusing on
conscious rational decision-making, which can transcend the
conventions of society. We will first review Kohlberg’s classic
cognitive model of moral development before discussing other
theories.

Building on Piaget’s work, Lawrence Kohlberg developed a theory in

the 1960s that identified six stages of moral development based on
the notion of justice (Kohlberg, 1963, 1964; Kohlberg & Kramer,
1969). The six stages are divided into three levels: the
preconventional level, during which children don’t have their own
personal code of morality and their decisions are shaped by the
consequences of following or breaking rules and the standards held
by adults; the conventional level, during which individuals accept
social rules about what is right and what is wrong; and the
postconventional level, during which individuals live by their own
ethical principles. Over the years, Kohlberg revised the stages and
levels a few times.

Kohlberg’s model uses invariant fixed progressive stages of moral

judgment. Strengths of this theory include its simplicity and its
comprehensiveness. It addresses the structure rather than content of
morality and challenges the idea of moral relativism (Vozzola &
Senland, 2022). One criticism of the theory is that it places too much
emphasis on moral reasoning and is disconnected from moral
behavior and moral judgment (Çam et al., 2012; DeTienne et al.,
2021).

Kohlberg’s theory has also been criticized because local and cultural
ideas are ignored (Çam et al., 2012; Goldschmidt et al., 2021;
Lafmejani, 2019). As a result, higher stages of moral development
have not been found to be universal across different cultures
(Bedford & Yeh, 2019; Goldschmidt et al., 2021; Lafmejani, 2019).
For example, children in Chinese societies are taught that elders
deserve respect, a moral position known as filial piety. How children
treat their elders in the Confucian ethical system is a measure of the
children’s moral worth (Bedford & Yeh, 2019). Filial piety research
studies using Kohlberg’s model yields unscorable responses related
to filial piety, raising doubts about the universal applicability of
Kohlberg’s stages (Bedford & Yeh, 2019).

Another criticism of Kohlberg’s theory is related to gender. Kohlberg

did not include girls when developing a model of moral development,
and the theory is criticized for having a male bias (Walsh, 2019).
Carol Gilligan (1977) challenged Kohlberg for using only male
research participants, expressing concern that when using Kohlberg’s
stages, females score predominantly at stage 3 (concerns about
being a good person) and males score predominantly at stage 4
(adhering to norms and laws of society). These scores indicate that
males reach higher levels of morality than females. To address this
issue Gilligan (1977) proposed an alternative theory of moral
development. Instead of a focus on the concept of justice, Gilligan
believed that women tend to consider other’s care, well-being, and
protection and introduced the concept ethic of care. Gilligan
emphasized the difference between the ethic of care and the ethic of
justice and created a three-stage model that was meant to fit more
accurately with the moral development of females (Çam et al., 2012).

Individuals progress through Gilligan’s three stages of moral

development fueled by changes in their sense of self rather than
merely by their cognitive capability. The three stages in Gilligan’s
model are the preconventional level, with the goal of individual
survival; the conventional level, with the goals of care and self-
sacrifice, equated with goodness; and the postconventional level, with
the goals of universal care and avoidance of hurting others (Gilligan,
1977). Gilligan’s work was groundbreaking and sparked debate in the
field of moral development.

Over the years, Gilligan’s model too has been critiqued. One concern
is that Gilligan based the model on small samples of females. There
is some agreement in the field that the claims of the theory exceed
the evidence (Vozzola & Senland, 2022). Considering the work of
both Kohlberg and Gilligan, Vozzola and Senland (2022) encourage
us to avoid getting stuck in the justice/ethic of care debate and
instead look at the contributions each theorist has made to
understanding moral development. See Table 4.2 for a comparison of
Gilligan’s and Kohlberg’s models.

Table 4.2
Considering Kohlberg’s and Gilligan’s models of moral development,
we are left with the question “does gender matter in moral
development, moral reasoning, moral judgments, and moral actions?”
Research findings are inconsistent, and some of the inconsistency is
related to which variable is studied. For example, although some
studies find differences between men and women in relation to moral
judgment (Çam et al., 2012), other research finds that men and
women do not differ in the development of moral reasoning
(Fujisawa, 2021). In Li’s (2023) review of experimental studies, no
significant differences in moral choices were found based on age or
gender. However, women were more likely than men to have a moral
preference for care in moral reasoning, to show different moral
reasoning in different contexts, and to have more flexible and
complex reactions (Li, 2023). In a meta-analysis of studies of gender
differences in prosocial behaviors, actions that benefit others, Xiao et
al. (2019) found that male and female adolescents are more similar
than different in prosocial behaviors, and the gender differences that
do occur vary by type of prosocial behavior and geographic region.

There is also evidence that moral judgments and moral behaviors are
influenced by and sensitive to culture. According to Hu et al. (2018),
understanding and construction of moral issues varies significantly
based on cultural backgrounds and unique multicultural experiences.
Geography, social class, and ecology are cultural background factors
that influence moral judgments and behaviors. Using a cultural
psychology lens, Hu et al. (2018) explain how moral judgments and
behaviors are influenced by between-culture variations, within-culture
variations, and multiculturalism. Similarly, Schein (2020) argues that
moral judgments are made within a specific context that includes
who, what, where, when, and relationships between actors, and there
is a gap between research studies focused on morality and morality
that is experienced and contextualized.

Context is of paramount importance when considering the

development of prosocial behaviors (PBs). The study of PBs has
been evolving over the years, and understanding PBs can be
important for understanding moral development. Carlo and Padilla-
Walker (2020) assert that early conceptions of prosocial behavior
tend to view the behaviors in a unidimensional way and see the
behaviors as global. In contrast, they support a more nuanced
multidimensional approach to the study of PBs and prosocial
development that includes relationship to the target, the situation,
motives, culture, and development over time (Carlo & Padilla-Walker,
2020).

Now reconsider the situations of Janna Smith (Case Study 4.1) and
Charles Miller (Case Study 4.2). Where do you think Janna’s moral
judgment that her father “should” have been more available to his
wife and children fit in with Kohlberg’s and Gilligan’s theories? What
about the pride Janna takes in being a loving and caring mom to her
children? What does that say about her stage of moral development?
What about Charles’s moral judgment that he should have stayed
home to take care of his mother and sister after his father died? How
do you see that judgment fitting with the Kohlberg and Gilligan
theories? Does one of the models fit better than the other when
focusing on Janna? For focusing on Charles?

Turiel (1977, 1983) developed another model of moral development,

known as domain theory, moral domain theory, or the social domain
theory (SDT). Turiel (1977, 1983) makes distinctions among moral,
conventional, and personal domains. The moral domain relates to
universal principles of right and wrong that impact the welfare and
rights of others; the conventional domain is concerned with actions
that are right or wrong according to social rules and expectations, and
the personal domain is concerned with individual preferences and
values. Social contexts such as friendships involve coordination
across domains, and as people age, they may reason differently
about multifaceted and complex issues (Social Domain Theory
International Colloquium, 2023).

In Turiel’s model, children develop concepts in the conventional

domain of social convention by participating in activities in their
families, schools, the community, and other systems. This social
convention domain focuses on rules children think are mandatory,
and these rules provide order for various social settings and provide a
guide for social interactions (Çam et al., 2012). Turiel (2015) asserts
that adolescents and adults do not simply accept the norms,
standards, or values of their group. Instead, they have flexibility of
thought and look at their social situations to consider multiple factors
before arriving at decisions. Research findings on issues related to
social inclusion, social exclusion, honesty, and deception provide
support for the idea that individuals are active agents in their
decision-making (Turiel, 2015). There are also inconsistent findings in
the research on social domain theory (Lourenço, 2014; Rottman &
Young, 2015; Smetana, 2006; Yoo & Smetana, 2022).

Lourenço (2014) suggests that the various theories of moral

development should be viewed as complimentary and not as
alternative views. Garrigan et al. (2018) propose moving toward an
integrative framework for understanding moral decision-making and
moral development. They propose a social information processing–
moral decision-making (SIP–MDM) framework that integrates
theories and findings from developmental psychology and social
neuroscience. In their more complex model than the cognitive models
presented by Kohlberg and Gilligan, Garrigan et al. (2018) identify
four major components of SIP–MDM: cognitive, affective/emotional,
social, and other. The cognitive component includes working memory,
perspective taking, attention, abstract reasoning, schemas/scripts,
attributions, and self-control. The affective/emotional component
includes empathy, emotion regulation, emotion recognition, and
intuition. The social component includes social functioning,
competence, skills, peer interactions, socialization, socioeconomic
status, culture, parenting, and family functioning. The other
component includes brain development, temperament, personality,
and social information processing. These four components are woven
together in a six-step process that moves from environmental cues to
moral behavior: (1) encoding environment cues, (2) interpretation of
the environmental cues, (3) clarification of goals, (4) constructing a
response, (5) moral decision, and (6) moral behavior enactment.
Figure 4.2 presents a visual representation of the SIP–MDM
framework.
Description

Figure 4.2 The Social Information Processing–Moral Decision-Making

Framework

Source: Garrigan, B., Adlam, A. L. R., & Langdon, P. E. (2018). Moral

decision-making and moral development: Toward an integrative
framework. Developmental Review, 49, 80–100.

Theories of Emotion

Janna Smith (Case Study 4.1) is concerned that she will become
depressed—“feel low.” She has felt suicidal in the past and fears she
may experience despair and hopelessness again. Charles Miller
(Case Study 4.2) reports feeling overwhelmed, anxious, out of sorts,
and down. He is unsure why his mood is low since he is finally
moving forward with living fully as himself. In describing their
concerns, Janna and Charles are each telling us something about
their emotional lives.
Emotions and cognitions are interrelated and are interwoven within
the fabric of the brain (Okon-Singer et al., 2015). Emotions can be
understood as states (e.g., feeling angry) or as processes. In a
simplistic explanation of emotional processes, the early part of the
emotional process takes place between when we perceive the
stimulus and when the body responds to the stimulus. The latter part
of the emotional process is the bodily response (e.g., increase in
heart rate, short and rapid breathing).

Emotions are different than moods; moods last longer and are not
necessarily caused by a specific stimulus. Mood can be thought of as
a group of persisting feelings that can influence future evaluations,
feelings, and actions (Amado-Boccara et al., 1993). Emotions, in
contrast, are responses to internal (e.g., a memory) or external stimuli
(e.g., an interpersonal confrontation) and tend to be brief (perhaps
lasting only a few minutes or less). Emotions and moods can impact
each other; moods can impact a person’s evaluation, cognitive state,
and emotional response to the stimuli, and emotions can potentially
turn into a mood state (DBT Center, 2017). The term affect is
oftentimes used interchangeably with the term emotion, but affect is
the physiological expression of emotions, often described in terms of
positive affect or negative affect. In other words, affect is how an
individual expresses their emotion and/or mood.

Emotions are often characterized as either primary or secondary.

Primary emotions are considered universal basic emotions (or core
emotions) that are expressed and recognized across cultures. The list
of primary emotions varies based on the theorist but typically includes
fear, anger, joy, sadness, disgust, contempt, and surprise (American
Psychological Association, 2023a). Secondary emotions are
considered to be socially constructed, stemming from primary
emotions but requiring social experience for their construction
(American Psychological Association, 2023b). For example, pride,
typically considered a secondary emotion, may be the result of the
primary emotion of joy coupled with the experience of receiving
accolades from others (American Psychological Association, 2023b).
Here, a boy experiences joy from the kiss of his mother.

© iStockphoto.com/Alexander Hafemann

Theories of emotions can be grouped in various ways. We will look at

theories of emotion classified into two main categories: noncognitive
or physiological theories and cognitive theories. Physiological
theories look to biology and automatic physiologic reactions to stimuli
in the environment as the sources of emotions. Cognitive theories
focus on the cognitive process of experiencing emotion, both before
and after the emotion is experienced.

Noncognitive Physiological Theories of Emotion

There are many noncognitive physiological theories of emotion. Four

are discussed here: the James and Lange theories of emotion, the
Cannon-Bard theory of emotion, Izard’s differential emotions theory,
and Davidson’s theory of six emotional dimensions.
James and Lange Theories of Emotion

William James developed a theory of emotion in 1884 asserting that

physiological arousal instigates the experience of emotion (James,
1884). James emphasized somatic (bodily) reactions to stimuli, and
the approach is considered a somatic feedback loop theory.
Independently of James, Carl Lange developed a theory of emotion in
1885. Lange (1885) asserted that the vasomotor center that regulates
cardiac and blood circulation functions is the cause of emotions, and
that “we owe all the emotional side of our mental life, our joys and
sorrows, our happy and unhappy hours, to our vasomotor system”
(James & Lange, 1922, p. 73). Lange’s conception of emotion was
like James’s theory but was more narrowly focused on the circulatory
system. Both James’s and Lange’s theories argue that emotions
occur due to physiological responses to an event or stimulus. In other
words, the physiological response occurs before the emotional
response is processed and labeled. Although there are some
differences in the two theories, they are often grouped together as the
James-Lange theory of emotion because of their similar focus on
emotions as physiological responses. To better understand their
perspective, here is an example of the James-Lange theory of
emotion:

Abbie is on a sidewalk in a busy city. Suddenly a car jumps the

curb (external stimulus) narrowly missing Abbie. Immediately,
Abbie’s heart starts racing and their body begins to tremble and
shake. Next, Abbie consciously processes the quickened heart
rate and shaking and decides that they were afraid (i.e.,
experienced the emotion fear). The theory would also assert that
if we could somehow raise Abbie’s heart rate and get Abbie’s
body to shake without this stimulus, Abbie would still register the
emotion of fear. In sum, Abbie experiences they are afraid
because their heart rate is racing, and their body is shaking
[example adapted from Cherry (2022) and Nickerson (2023)].

Cannon-Bard Theory of Emotion

In 1927, Walter Cannon wrote a critical examination of the James-
Lange theory and offered an alternative theory. Cannon (1927)
proposed that the optic thalamus is the region in which the neural
organization for different emotional expressions reside. In contrast to
James and Lange, Cannon believed that the brain simultaneously
triggers the physiological reactions and the subjective experience of
emotion. In 1928, Philip Bard contributed evidence supporting this
alternative view. To understand the key differences in the James-
Lange and the Cannon-Bard theories, let’s revisit Abbie’s event and
describe it according to the Cannon-Bard theory of emotion:

Abbie is on a sidewalk in a busy city. Suddenly a car jumps the

curb (external stimulus) narrowly missing Abbie. Immediately
Abbie’s heart starts racing and their body begins to tremble and
shake. Abbie consciously feels afraid (i.e., experiences the
emotion fear), but this experience of emotion occurs at the same
time, not in response to the quickened heart rate and shaking.
Instead, Abbie feels fear because their thalamus has been
triggered by the car jumping the curb. The theory would also
assert that if we could somehow disable Abbie’s physiological
reactions to the car jumping the curb, Abbie would still feel the
emotion of fear. In sum, Abbie experiences they are afraid
because their thalamus was triggered when the car jumped the
curb narrowly missing them [example adapted from Cherry
(2022) and Nickerson (2023)].

Izard’s Differential Emotions Theory (DET)

Carroll Izard’s theory of differential emotions asserts that emotion

plays a causal role in behaviors. Emotions are viewed as the principal
motivation system and as the personality processes that give
meaning and purpose to our existence (Izard, 1977). Izard (1977)
proposed that there are 10 primary and distinct emotions: interest,
joy, surprise, sadness, anger, disgust, contempt, fear, shame, and
guilt. Izard (1977) considers these emotions as primary because they
are assumed to have innate neural substrates, innate and universal
expressions, and unique feeling-emotional states (Izard, 1977). Each
emotion has unique motivational properties, and the different
emotions may activate, amplify, or attenuate each other. Further,
different emotions lead to different inner experiences and different
behavioral consequences (Izard, 1977). Izard believed that these
primary emotions cannot be reduced to more simple or basic
emotions but might be combined to produce other emotions. Basic
emotions are seen by some researchers as universal and related to
the basic instinctual needs of our bodies (Gu et al., 2019). Emotions,
according to differential emotions theory (DET), originate in our
neurophysiology, are instinctual and hardwired, and influence our
cognitions and behaviors. In the example of emotions related to
experiencing anxiety, Izard and Blumberg (1985) hypothesized that
children or adults who experience tremendous anxiety have variable
patterns of emotions, with fear as the basic emotion in the pattern.

Over the years Izard made changes and additions to DET. In 2007,
Izard proposed a new paradigm regarding basic emotions and
emotion schemas. The new paradigm assumed continual emotion
(emotion is always present) as a factor organizing consciousness and
influencing the mind and behavior. In 2011, Izard distinguished
between first-order emotions and emotion schemas, asserting that
first-order negative emotions are attributable primarily to infants and
young children in distress and older adults facing an emergency.
Emotion schemas are schemas produced by emotions interacting
with cognitions. The interaction of the emotion and cognition
motivates decision-making and behaviors. Emotion schemas are
triggered by cognitive appraisal processes and involve higher-order
cognitions, such as thoughts connected with values and beliefs, and
thus are highly impacted by social cognitive development (Izard et al.,
2011).

A recent study tested the effects of different basic emotions on risky

judgment and decision-making (JDM; Matsumoto & Wilson, 2022).
The researchers examined the effects of experimentally eliciting five
different discrete emotions (anger, disgust, fear, happiness, and
sadness), and a neutral emotional condition on the same risky
judgment and decision-making task. Elicitation of a neutral emotional
state produced the lowest risk scores and being emotionally elevated
in general increased risk scores. Although all emotions elevated risk,
sadness produced the highest risk.

Davidson’s Theory of Six Emotional Dimensions

Advances in brain imaging have changed how we think about the

physiology of emotions and how the mind works. The
electroencephalogram (EEG), which measures electrical activity in
the brain, is one example of a test that has influenced and expanded
understanding of the brain. For instance, Lutz et al. (2008) assessed
brain activity using EEG data in Buddhist monks who were masters in
meditation and EEG data from healthy student volunteers. They
found that meditating strengthened the connections among regions of
the brain related to attention, motivation, and empathy for the monks
(Lutz et al., 2008). These findings, along with other related studies,
were the basis of Richard Davidson’s theory of emotion and assertion
that people can change their emotional style.

Davidson’s theory of six emotional dimensions was laid out the in the
2012 book The Emotional Life of the Brain (Davidson & Begley,
2012). Based on neuroscientific research, the theory describes six
distinct emotional dimensions, each having a defined and measurable
neural signature. An individual’s unique combination of these
dimensions comprises their emotional style, which is the essence of
how they respond to experiences (Center for Healthy Minds, 2022).
The six dimensions of Davidson’s theory are: resilience, outlook,
social intuition, self-awareness, sensitivity to context, and attention.
Each dimension exists on a continuum and is thought to be
influenced by both genetics and experience. Based on Davidson’s
work, an emotional style questionnaire (ESQ) was developed, tested,
and validated (Kesebir et al., 2019). The ESQ has been translated
into and validated in Persian (Nazari & Griffths, 2022), German
(Jekauc et al., 2021), Polish (Gasiorowska et al., 2022), and Italian
(Malandrone et al., 2022). The six dimensions are described in the
following paragraphs.

The resilience dimension refers to the ability to recover from negative

emotion. Someone who quickly recovers from negative emotions may
lack the motivation to overcome challenges (e.g., “don’t worry, be
happy”). Conversely, being slow to recover after a setback may keep
the individual ruminating over something that already occurred. Of
note, resilience about small events is predictive of resilience about
large, catastrophic events. Individuals who quickly regain emotional
equilibrium after a minor challenge tend to also recover more quickly
after bigger life problems. As a result, this dimension is closely linked
to an individual’s psychological well-being. Emotional resilience is
associated with increased connectivity between the prefrontal brain
regions and the amygdala (Kesebir et al., 2019).

The outlook dimension involves the ability to sustain a positive

emotion, such as joy, pride, or awe over time (Kesebir et al., 2019).
Individuals at the high extreme of the outlook spectrum tend to be
positive and enthusiastic, and their positive emotions persist longer
than for those on the lower end of the spectrum. The key feature of
this dimension is the ability to sustain positive emotions, not simply
the ability to experience positive emotions. Like emotional resilience,
this emotional dimension is associated with psychological well-being.

The social intuition dimension is an individual’s ability to read

nonverbal social cues and infer social information from others’
emotional signals (Kesebir et al., 2019). Those high on this dimension
show empathy and compassion whereas individuals low on this
dimension have difficulty understanding nonverbal cues and inferring
others’ emotional states, which can negatively impact their
interpersonal relationships. Extreme insensitivity to nonverbal social
cues characterizes people on the autism spectrum (Kesebir et al.,
2019). Social intuition has been found to be associated with high
activation of the fusiform gyrus and amygdala in the brain (Kesebir et
al., 2019).

The self-awareness dimension is the ability to perceive one’s own

physiological and emotional states, an ability that assists in regulating
emotions. Kesebir et al. (2019) explain that the region of the brain
related to this dimension is the insula, which “serves as the brain’s
monitoring station for everything below the neck and within the body”
(p. 4). Higher levels of insula activity are associated with high levels
of self-awareness.

The sensitivity to context dimension refers to how attuned an

individual is to the social context when responding emotionally and
behaviorally (Kesebir et al., 2019). Those high on this dimension will
modify their responses based on implicit social rules and social
expectations. According to Kesebir et al. (2019), the hippocampus
region of the brain and interconnected structures help individuals
assess context and adjust behavior.

The attention dimension is the ability to stay focused and not be

distracted (Kesebir et al., 2019). Those low on this dimension may be
more easily distracted by stimuli in the environment, and those high
on this dimension maintain clear focus. Typically, attention is
regarded as a cognitive ability, not an emotional style. Kesebir et al.
(2019) propose that “emotional stimuli (as opposed to sensory
stimuli) command an untoward share of our attention, and the ability
to filter out emotional distractions is closely linked to psychological
well-being” (p. 5). Selective attention is associated with heightened
activation in the prefrontal cortex and parietal cortex.

Davidson believes that people can work on and change their

emotional styles through training and wants neuroscience findings
about how to do that to be accessible to lay people. Toward that end,
Davidson founded the Center for Healthy Minds at the University of
Wisconsin–Madison. The center aims to help people flourish in their
lives through meditation and other forms of mental training programs
and conducts research related to this mission.

Cognitive Theories of Emotion

There are various cognitive theories of emotion, but they all include a
component not emphasized in the physiological theories—the role of
cognition and cognitive processes in emotion. Some cognitive
theories assert that emotion is purely a cognitive process and others
assert that emotions are a result of both physiological and cognitive
processes. Ali (2016) reminds us, though, that theories of emotion do
not have to be mutually exclusive; we can place emotions on a
continuum from least cognitive to highly cognitive, and on a
continuum from basic to complex. Four cognitive theories of emotion
are discussed here: the Schachter-Singer two-factor theory of
emotion, Lazarus’s cognitive appraisal theory of emotion, Weiner’s
attribution framework of the emotional process, and LeDoux and
Brown’s higher-order theory of emotional consciousness.

The Schachter-Singer Two-Factor Theory of Emotion

The Schachter-Singer (1962) two-factor theory of emotion draws on

the James-Lange and Cannon-Bard theories but asserts that
emotional states are a function of both physiological arousal and a
cognition appropriate to this state of arousal (the two factors). There
are three propositions of the Schachter-Singer theory: (1) in a state of
physiological arousal for which an individual has no immediate
explanation, they will label this state and describe their feelings in
terms of the cognitions available to them; (2) in a state of
physiological arousal for which an individual has a completely
appropriate explanation, no evaluative needs will arise and the
individual is unlikely to label their feelings in terms of available
alternative cognitions; and (3) given the same cognitive
circumstances, the individual will react emotionally or describe their
feelings as emotions only to the extent that they experience a state of
physiological arousal (Schachter & Singer, 1962, p. 379). Thus,
emotion is experienced as a combination of exposure to stimuli,
physiological arousal, cognitively labeling the emotion, and
experiencing the emotion.

Lazarus’s Cognitive Appraisal Theory of Emotion

American psychologist Richard Lazarus (1966) advanced a theory of

emotion that connected cognitive appraisal to emotions. The basic
premise of appraisal theories of emotions is that emotions are
adaptive responses to individuals’ appraisals (judgments) of the
environment and how it will impact their well-being and survival.
Lazarus proposed the concept of cognitive appraisal with Susan
Folkman in their book Stress, Appraisal, and Coping (Lazarus &
Folkman, 1984) and in 1991 Lazarus proposed a multidimensional
appraisal theory of emotion. This theory asserts a specific sequence
involved in experiencing emotion: (1) cognitive appraisal, (2)
physiological response, and (3) action (Lazarus, 1991). Cognitive
appraisal involves the consideration of two factors when experiencing
an environmental stressor: (1) primary appraisal considers the extent
of the threat of the stressor to the individual, and (2) secondary
appraisal assesses the available resources to cope with the stressor
by either minimizing it, eliminating it, or tolerating it. The primary and
secondary appraisals occur simultaneously and work in concert in the
appraisal process (Sincero, 2012).

Lazarus tried to address two questions—the nature of our appraisals

and the antecedent conditions of these appraisals. In other words,
why do we have certain responses and emotions when we are
exposed to specific environmental stressors? One of the strengths of
Lazarus’s theory is that it helps explain why people respond and react
to the same event in various ways (Ali, 2016). In a given situation,
different people will react in different ways because they make
different cognitive appraisals about the situation. Figure 4.3 illustrates
how the Schacter-Singer and Lazarus cognitive theories of emotion
compare with the noncognitive James-Lange and Cannon-Bard
physiological theories.
Description

Figure 4.3 Comparison of Four Theories of Emotion

© iStockphoto.com/FOTOFORCE; © iStockphoto.com/SDI
Productions

Weiner’s Attribution Framework of the Emotional Process

Attribution theory was first developed by Fritz Heider in 1958, and

over 20 years later Bernard Weiner (1985) developed a model of
attribution that is now one of the most popular theories of attribution
(Shrestha, 2017). Heider (1958) argued that people have an innate
desire to understand the causes of things that happen. Weiner (1985)
proposed that people develop causal explanations, known as
attributions, for why particular incidents or behaviors occur, and these
causal attributions influence emotional responses. Some people
develop a positive or optimistic attributional style about their
perceived success or failure in the situations they face, and other
people develop a negative or pessimistic attributional style.
Attributional styles affect motivation for effort in challenging situations.

According to Weiner’s model of academic achievement (Weiner,

2010), students’ achievement can be influenced by their causal
attributions. Causal attributions can be divided into dispositional
attributions (something about the individual caused the event or
behavior) and situational attributions (something about the
environment caused the event or behavior). The model of academic
achievement argues that learners who attribute success to internal
factors such as ability become more motivated, and learners who
attribute success to external factors such as ease of task become
less motivated (Ngunu et al., 2019). Attributing failure to more
unstable but controllable causes such as effort increases hopefulness
and an individual’s expectations that they have a chance for change
and success (Ngunu et al., 2019). For example, if Charles Miller
(Case Study 4.2) attributed his success as a schoolteacher to his
ability and efforts that he made, he would be more motivated as a
teacher than if he attributed his success to the fact that it was easy
work and had little to do with his efforts.

LeDoux and Brown’s Higher-Order Theory of Emotional Consciousness

As we have read, there is debate about whether emotions are
cognitive states or if they are innately programmed into our brain’s
subcortical circuits. Joseph LeDoux and Richard Brown view
emotions as higher-order states embedded in cortical circuits, like
other states of consciousness (LeDoux & Brown, 2017). They assert
that the brain mechanisms that give rise to emotions are the same as
those that give rise to conscious cognitive experiences. The
difference is the kind of inputs processed by the cortical network.
Thus, they argue that emotions are cognitive states, not innate, and
result from the gathering of information. LeDoux and Brown (2017)
propose that emotion schema are learned in childhood and retrieved
from long-term memory to be used to categorize emotional situations
throughout life. Table 4.3 provides descriptions of the physiological
and cognitive theories of emotion presented in this chapter.

Table 4.3
Connection of Positive Emotions and Affect With Happiness and Well-Being

Do positive emotions contribute to our happiness and well-being?

The answer may be yes. In their review paper, Alexander et al. (2021)
point out that neurophysiological correlates of positive emotions
contribute to psychological and physical well-being in numerous and
intersecting ways. Developmental, social, and environmental factors
impact individuals’ positive emotions throughout the life span.
Importantly, like Davidson and Begley (2012), the authors report that
brain networks are modifiable and certain contemplative practices
such as meditation can yield positive emotions (Alexander et al.,
2021).
Based on their review, Alexander et al. (2021) propose a conceptual
model of the psychological correlates of positive emotions that
influence happiness and well-being (see Figure 4.4 ). Cognitive
control and social relationships (gray boxes) represent individual
differences related to the experiences of positive emotions (black
circle). Activities, strategies, and interventions are behaviors that are
intentional to influence happiness and well-being. Happiness and
well-being (blue boxes) represent outcome variables. All of these
variables are influenced by development, environments, and social
contexts across the life span (multicolored arrows). The authors
include an image of the human brain in the background to show that
the psychological constructs are implemented in the central nervous
system yet cannot be reduced to specific brain regions. In their
conclusion, Alexander et al. (2021) emphasize the importance of
actively engaging in behaviors such as cultivating healthy
interdependent social relationships, play, activity in green spaces,
and meditation and contemplative practices that are associated with
happiness and well-being.

Description
Figure 4.4 A Conceptual Model of the Psychological Correlates of
Positive Emotions That Influence Happiness and Well-Being

Source: Figure 1, R. Alexander et al. (2021). The neuroscience of

positive emotions and affect: Implications for cultivating happiness
and wellbeing. Neuroscience and Biobehavioral Reviews, 121, 220–
249.

Critical Thinking Questions 4.3

Think about Janna Smith’s (Case Study 4.1) and Charles Miller’s
(Case Study 4.2) emotions and decisions to seek help. If we were to
use Davidson’s framework to assess and understand Janna and
Charles, what dimensions (resilience, outlook, social intuition, self-
awareness, sensitivity to context, and attention) may be potential
areas of struggles for them? What dimensions may be potential
sources of strength for them? How might they work on changing their
emotional styles?

Using Alexander et al.’s (2021) conceptual model of positive

emotions, happiness, and well-being, what activities, strategies, and
interventions can Janna and Charles engage in to increase their
positive emotions and enhance their levels of happiness and well-
being?

Theories of Personality

The case studies at the beginning of this chapter provide some

picture of the personalities of Janna Smith (Case Study 4.1) and
Charles Miller (Case Study 4.2) over time. Do you see stability in their
thinking, feeling, and behaving over time, or do you see evidence of
some personality change or fluctuation? Do you see evidence of both
rational and automatic (without thinking) responses to stressful
situations? Do you see evidence of behaviors being influenced by
beliefs and goals? Do you see any patterns of responding differently
in different types of situations?
There are numerous theoretical frameworks that focus on the
construct of personality. Each looks at the possible forces that shape
personality. Like all complex constructs, understanding of personality
should be derived from a variety of viewpoints. At the beginning of
this chapter, the notion of Indigenous personality was mentioned. An
Indigenous psychology approach to understand personality
incorporates a cultural perspective in the development of concepts
and theories (Bedford & Yeh, 2019). Please keep this important
concept in mind when thinking about the theoretical models
discussed here and how they may or may not apply to the clients you
serve.

Theories of personality can be grouped based on their overarching

perspectives. Most frequently they are grouped into six categories:
trait, psychoanalytic/psychodynamic, humanistic, social cognitive,
behaviorist, and biological. See Table 4.4 for some of the central
ideas of these six perspectives. This section will overview trait
perspectives, cognitive-affective theories, and an Eastern-based
model. Biological influences on personality and mental illness will
also be discussed. Chapter 2 in this book provides an overview of the
psychodynamic and humanistic-existential approaches.

Table 4.4
Trait Perspectives of Personality

Hans Eysenck (1944) proposed a theory of personality based on

work in a psychiatric hospital in London in the 1940s. Eysenck initially
identified two dimensions of personality, introversion/extroversion and
neuroticism/stability and later added a third dimension,
psychoticism/normality. Over the years, Eysenck wrote about the
ongoing study of personality, and in a 1977 interview with David
Cohen he acknowledged that the earlier-identified three dimensions
are not the final story (Corr, 2016). Eysenck has been a controversial
figure in psychology mostly due to fringe-like standpoints about race
and intelligence, parapsychology, and astrology (Corr, 2016).
Although we will not delve into these concerns here, it is important to
understand that they are parts of Eysenck’s professional work and
stances.
Raymond Cattell (1965) also looked at personality traits but argued
that personality was more complex and involved than Eysenck’s three
dimensions of behavior. Cattell differentiated between source traits
(traits that are less visible to other people) and surface traits (traits
that are obvious and visible to most other people). Cattell (1965)
developed the 16 Personality Factors (16 PF) test, comprised of 160
questions, with 10 questions related to each dimension.

Gordon Allport’s initial trait theory of personality was introduced in

1937 and revised in 1961. Allport (1937, 1961) asserted that
personality is discrete, discontinuous, and constantly changing and
growing. People are unique (or discrete) from each other and have
different personalities over time—one personality from childhood
(more related to reflexes and biological urges) and one from
adulthood (more psychological). Allport grouped personality traits
(which number 4,000) into those shared by others and those unique
to the person, the personal disposition. These personal dispositions
are further divided into three categories: cardinal dispositions, central
dispositions, and secondary dispositions (Kelland, 2023). Cardinal
dispositions are those that dominate an individual’s life, cannot
remain hidden, and is how the person is known. Central dispositions
are those aspects of personality that capture what we are like- what a
friend might say about us or what might be mentioned in a letter of
recommendation. Secondary dispositions are less consistent and less
often called into play (Kelland, 2023).

The above trait theories led to the emergence of the five-factor model
(FFM) of personality and five-factor theory (FFT), proposed by
McCrae and Costa in 1985 and 1987 and now commonly referred to
as the Big Five personality traits. The Big Five personality factors are
seen as the building blocks of personality. The factors are: (1)
openness to experience, (2) conscientiousness, (3) extraversion, (4)
agreeableness, and (5) neuroticism. These factors can be
remembered with the mnemonic device OCEAN.

Initially McCrae and Costa (1987) saw FFT as a grand theory

because they felt it provided a universal explanation of how a person
functions across their life span. They sought to evaluate the FFT
across cultures and have encouraged other researchers to do the
same. Research results have been mixed. Some research supports
the cross-cultural application of FFT (see Benet-Martínez & John,
1998; Costa et al., 2019; Piedmont et al., 2002) and some research
questions its validity when applied across cultures (e.g., Laajaj et al.,
2019).

Costa et al. (2019) reviewed the research that studies personality

traits across the life span. They found that individuals show
personality continuity from middle childhood to old age. They also
found that cross-cultural studies find broad agreement that
neuroticism and extraversion decline while agreeableness and
conscientiousness increase over the life span (Costa et al., 2019).
Costa et al. (2019) offer FFT as a framework to understand both trait
and non-trait aspects of personality and recognize there is more to
understanding individuals than understanding their personality traits
(McCrae & Costa, 2021).

Building on the work of McCrae and Costa, another trait approach—

the HEXACO model of personality—emerged from studies conducted
by researchers such as Hahn et al. (1999) and Ashton et al. (2000).
An additional sixth factor consistently emerged from these studies,
honesty-humility, and a model incorporating that factor was
developed (de Vries et al., 2019). The HEXACO model has been
tested for cross-national stability and is being used in many countries
and languages to study personality (see Garćia et al., 2021;
Thielmann et al., 2020) and the HEXACO model may be more
applicable than the Big Five model in collectivist cultures (Kawamoto,
2019). There are some criticisms of the HEXACO model, particularly
regarding the distinction between the honesty-humility factor and the
agreeableness factor. Ashton and Lee (2020) assert there is evidence
to support the structure of the HEXACO model and Thielmann and
Zettler (2020) suggest more evidence is needed.

The description of the six HEXACO personality factors are presented

in Table 4.5 along with the descriptions of the Big Five personality
traits. The factors extraversion, conscientiousness, and openness to
experience are quite similar in both models; agreeableness is similar
but not identical in the two models; and the factor of emotionality in
HEXACO is similar to but also different from the factor of neuroticism
in the Big Five model.

Table 4.5

Source: Hutchison, E. (2024). Middle adulthood. In L. Charlesworth &

E. Hutchison (Eds.), Dimensions of human behavior: The changing
life course (pp. 415–474). Sage.

Earlier in the chapter it was noted that individuals who have

experienced adverse childhood experiences (ACEs) may be
impacted by those experiences not just during childhood but
throughout adulthood as well. Using data from a longitudinal study,
the Midlife Development in the United States (MIDUS), a total of
6,323 adults with at least one ACE were analyzed for their scores in
generativity, personality traits, and affect (Grusnick et al., 2020). The
authors explored if ACEs were associated with an individual’s
personality, emotions, and affect using the FFM of personality as the
basis to assess personality traits.

Grusnick et al. (2020) found that ACEs have a unique adverse

influence on both emotions and personality. Greater adverse impacts
were seen with higher ACE scores and with ACE abuse type. Related
to the Big Five personality traits, ACEs were associated with higher
levels of neuroticism (at all ACE scores), increased levels of
openness to experience (by ACE abuse type but not by ACE score
thresholds), and lower levels of conscientiousness and
agreeableness (Grusnick et al., 2020). This study found similar
associations between ACEs and personality traits as found in
previous research (Hovens et al., 2016; Pos et al., 2016).

Conversely, protective childhood experiences (PCEs), also known as

protective and compensatory experiences (PACEs), can buffer the
negative impact of ACEs on adult physical, mental, and relational
health (see Morris et al., 2021; Morris & Hays-Grudo, 2023). Two
general domains of PACEs have been identified: supportive
relationships and enriching resources. In the domain of supportive
relationships, Morris and Hays-Grudo (2023) identify: (1)
unconditional love from a caregiver, (2) having a best friend, (3)
volunteering in the community, (4) being part of a group, and (5)
having a mentor. In the domain of enriching resources, they identify:
(1) living in a safe home where needs are met, (2) getting a quality
education, (3) having a hobby, (4) being physically active, and (5)
having rules and routines. PACEs can buffer the negative effects of
ACEs on adult physical and mental health and have been associated
with greater resiliency (Morris & Hays-Grudo, 2023). McCauley and
McCullough (2022) found that childhood adversity is associated with
increased empathy in adulthood, and childhood exposure to
supportive relationships and enriching resources is associated with
agreeableness, honesty-humility, altruism, and empathy in adulthood.
Cognitive-Affective Theories of Personality

This section will briefly overview two cognitive-affective theories of

personality: Epstein’s cognitive-experiential self-theory and Mischel
and Shoda’s cognitive-affective personality system. Epstein’s
cognitive-experiential self-theory of personality (CEST) is a theory
that synthesizes concepts from psychodynamic theory, cognitive
science, and learning theory (Epstein, 2003). The basic idea of CEST
is that people use two interactive information processing systems that
run parallel to each other using different rules. One of the systems is
conscious and rational and the other system is preconscious and
automatic. According to Epstein (2003), psychotherapeutic change in
personality can occur in three ways: (1) using the rational system to
correct the automatic system, (2) learning directly from an emotionally
significant experience, and (3) communicating with the automatic
system. This approach to personality is similar to the dual processing
learning theory discussed in Chapter 2.

Mischel and Shoda’s (1995) cognitive-affective personality system

seeks to explain why a person may behave differently across different
situations even though their personality is considered stable and
invariant. This theory proposes that individuals differ in two qualities:
(1) their accessibility to cognitive-affective mediating units such as
encodings, beliefs, and goals; and (2) the way these units are
organized to interact with each other and with the psychological
features of the situations they are experiencing (Mischel & Shoda,
1995, p. 246). Studies related to individuals’ responses in different
situations yield some evidence that people are not only characterized
by stable individual differences in personality but also by stable
patterns of situation-behavior relationships (Mischel et al., 2002). In
other words, patterns emerge such that a person does X when
situation A occurs but does Y when situation B occurs. These “if/then”
profiles constitute what the authors call an individuals’ behavioral
signatures.

Pancha Kosha Theory of Personality: An Eastern-Based Theory

Writing from India, Satpathy (2018) notes that while most of the
accepted theories of personality have been developed in the West,
there are theories of personality that have been popularized in the
East. Satpathy provides details about one of those models: the
Pancha Kosha theory of personality. The Pancha Kosha theory posits
that the mind–body system is a complex structure involving five
sheaths that comprise human personality. These sheaths are located
one inside the other like a set of Russian nesting dolls, with the
sheath of the physical body being outermost and the sheath of bliss
being innermost (Satpathy, 2018). The five sheaths of personality are
(1) the material body sheath (Annamaya Kosha), (2) the vital energy
or breath sheath (Pranamaya Kosha), (3) the mind or mental sheath
(Manomaya Kosha), (4) the intellectual sheath (Vijnamaya Kosha),
and (5) the bliss sheath (Anandamaya Kosha) (Satpathy, 2018, p.
33). Annamaya is nourished by food, Pranamaya is nourished by
bioenergy, Manomaya is nourished by education, Vijnamaya is
nourished by ego, and Anandamaya is nourished by emotions.

Satpathy (2018) explains that the theory of Pancha Kosha presents a

way to transform or transcend from a lower self to the highest self
and in that way change the personality. Personality is dynamic, not
static. Pancha Kosha theory is interested in ways to make the
transformation from the lower self to the higher self, to open new
ways for achieving bliss. The five sheaths can be thought of as levels
of consciousness, a concept that is explored further in the discussion
of transpersonal theories in Chapter 6, The Spiritual Person. Satpathy
(2018) argues that there is a need for developing more Indigenous
psychologies so that theories can be culture specific.

Biological Influences on Personality and Mental Illness

Janna Smith (Case Study 4.1) is concerned that she may become
depressed in this period of unemployment. She has struggled with
major depression, suicidality, and trauma reactions in the past.
Charles Miller (Case Study 4.2) is feeling overwhelmed, has mild
anxiety symptoms, has been having trouble sleeping, feels down and
out of sorts, and complains of exhaustion.
For the past few decades, researchers have been asking questions
about the biological influences on such cognitive and emotional
symptoms. How we think about and make sense of emotions,
cognitions, personality, sense of self, and mental illness is changing.
Advancements in medical technology have resulted in data that can
be collected more quickly and at a finer resolution than ever before.
Along with the increased ease of obtaining data has been a growth of
experimental design studies conducted to enhance understanding of
genetics and brain structure and function. See Table 4.6 for a
summary of types of medical technologies to explore biological
influences on personality and mental illness.

Table 4.6
The field of personality neuroscience is providing evidence of
interrelationships of genetics, brain processes, personality, and
mental illness (referred to as psychopathology by researchers in the
field). Research in this field is finding that the major dimensions of
psychopathology closely parallel the major dimensions of personality
as framed by the Big Five personality traits (Latzman et al., 2021).
McNaughton (2020) suggests that psychiatric disorders can be
thought of as extreme manifestations of personality dimensions.
When people’s behaviors become maladaptive and interfere with
daily life, their patterns reflect their configuration of personality traits.
Extremes in the neural system functioning associated with specific
personality traits are predicted to be risk factors for corresponding
types of psychopathologies, but much more research is needed to
understand these connections (DeYoung & Blain, 2020). Increasingly,
psychopathology is being understood as having dimensions rather
than as symptom patterns used in the Diagnostic and Statistical
Manual (discussed shortly). Perlstein and Waller (2022) remind us
that research also shows that the genetic pool in a population
influences the environment, and the environment affects how genes
are expressed in biological functioning, cognitions, emotions, and
behaviors. We cannot leave environmental influences out of the
conversation about personality and psychopathology. See Chapter 1
in this book for a discussion of the role of epigenetics and biological
embedding in human behavior.

Magnetic resonance imaging (MRI) tests and positron emission

tomography (PET) scans have been used to learn about various
psychiatric diagnoses and how to predict diagnoses based on test
results. Rashid and Calhoun (2020) found some promising results in
their review of 250 studies that used multivariate brain network
features from one or more neuroimaging modalities to predict mental
illness, based on understanding of the biological risks for mental
illness. The studies they reviewed were related to the following 10
diagnoses listed in the Diagnostic and Statistical Manual of Mental
Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013):
attention-deficit hyperactivity disorder, autism spectrum disorder,
major depressive disorder, bipolar disorder, obsessive compulsive
disorder, post-traumatic stress disorder, seasonal affective disorder,
social anxiety disorder, substance dependence, and schizophrenia.
The authors caution that although there has been much progress in
this area, there are two major challenges: the phenotypic (observable
characteristics) heterogeneity that characterizes subtypes of
psychiatric diagnoses and the small sample sizes used in many of the
reviewed studies.

Biology appears to be only one piece involved in mental illness.

There are overlapping risk factors for mental illness, and the
mediating processes are not well understood. A longitudinal study
following youth since birth identifies a combination of three factors
that seem to be predictive of susceptibility to early-onset psychiatric
problems: early life adversity, midbrain dopamine autoreceptors, and
adolescent externalizing temperament traits, particularly tendencies
toward impulsivity and trouble with emotion regulation (Iqbal et al.,
2022). This three-factor model of early-onset psychiatric disorders
identifies those with a lifetime history of disorders in the DSM–5 with
an overall accuracy of 90.4%, which is a more powerful predictive
model than each individual factor alone. Additionally, traumatic stress
suffered at any age has been associated with lasting changes in
certain areas of the brain (i.e., amygdala, hippocampus, and
prefrontal cortex) and with increased cortisol and norepinephrine
responses to subsequent stressors (Bremner, 2022).

Social workers employed in mental health, substance use, and other

clinical settings become well-versed in the symptom patterns of
psychiatric “disorders” and the use of the Diagnostic and Statistical
Manual of Mental Disorders (DSM) for making mental health
diagnoses. The DSM has been the primary reference used in the
United States for the characterization and diagnosis of mental illness
since 1952. The manual has undergone various developments and
changes since its inception. The most recent edition of the DSM is
the fifth edition, text revision (DSM-5-TR; American Psychiatric
Association, 2022).

Social workers understand that labels do not fully and adequately

describe individuals. Instead, social workers strive to understand
individuals’ challenges beyond diagnostic labels and explore how
they are coping and functioning within their environments. Toward
that end, social workers aim to conduct complete and holistic
assessments of individuals that include understanding cultural, social,
and other environmental aspects of their clients’ lives. Thus, there are
times when the social workers’ person-in-environment perspective
may be at odds with some clinical settings’ reliance and emphasis on
the use of the DSM and diagnoses to understand client situations
(Walsh, 2019).

Theories of the Self

In Case Study 4.2, Charles decided it was time to live as his

“authentic self” once he retired. He first chose to reveal his authentic
self to select people but has now been living fully and openly as
Charles. As you read about the concept of self, consider Charles’s
journey and his lived experiences.

Earlier in this chapter, self was defined as the integration of all the
elements of cognition, emotion, and personality into a cohesive notion
of one’s identity. Yet, there are many ideas and theories about the
construct of self and currently no consensus about the existence of
the self and what it represents. To complicate matters, commonly
mentioned overlapping concepts include consciousness, personal
identity, and self-consciousness. In Western philosophy, many have
posited the existence of a human self (Dimkov, 2020). For example,
French philosopher Descartes asserted that the self represents an
intuitive beginning of cognition, Freud conceived of the self as a
submersion of the ego in the id, and some contemporary
neuroscientific research attempts to locate the human self in the brain
using the concept self-referential processing (Dimkov, 2020).

Some theorists and researchers indicate that the self is made up of a

collection of selves and that context influences the self that is
operating at a given moment in time (Chen, 2019). The working self-
concept according to Chen (2019) is the individual’s array of stored
self-knowledge that is active in the current context. The self refers to
the person that an individual subjectively experiences as the self, and
self-concept has more specific social-cognitive connotations and
refers to stored self-knowledge (Chen, 2019). Chen (2019) also
examines the concept of authenticity. According to Chen (2019),
common views of authenticity include being aware of one’s internal
states, experiencing those internal states as one’s own, and acting in
alignment with those internal states. Consider Charles Miller from
Case Study 4.2. Prior to coming out as a transgender man and
beginning the transitioning process, we may expect that some of his
external behaviors were not in alignment with his internal states.

Some theorists and researchers indicate that context influences the

self that is operating at a given moment in time.

©iStock/Rawpixel

In Chapter 2 of this book, the concept of self showed up in several

Western-based theoretical perspectives. In symbolic interaction
theory in the social constructionist perspective, the self is constructed
through interactions with others situated in historical and social
contexts (Mead, 1934/1962). In the psychodynamic perspective,
object relations theory considers how others become a part of the self
(Winnicott, 1958, 1960), and self-psychology theory focuses on the
kinds of life experiences that contribute to a cohesive mature self
(Flanagan, 2022) Psychodynamically oriented social workers have
recently used object relations and self-psychology theories to write
about anti-racist social work—focusing on how splitting “the self” from
“the other” has been an essential component of white supremacy and
other marginalizing belief systems (Malamed, 2021; Rasmussen &
Garran, 2022; Woods, 2020). In the learning perspective, Bandura
(1977, 1986) writes about self-efficacy as a sense of personal
competence. In the humanistic-existential perspective, self-
actualization is the highest order of personal needs (Maslow, 1950).
Rogers (1973, 1978, 1986) writes of self-awareness, and May (1967,
1981) writes of alienation from the authentic self, an idea which
resonates with Charles Miller’s (Case Study 4.2) description of his life
before his decision to transition. Bridging Western thought and
Eastern thought, relational and intersubjective theories in the
psychodynamic perspective propose that the basic human drive is for
relationships with others, and the self develops and matures through
emotional connectedness in mutually empathic relationships.

How is Eastern thought about self different from Western thought?

Simply put, Eastern philosophy largely denies the concept of an
independent self. For example, in Confucianism the self is conceived
of as a relational self that is dependent on all other selves, and
Buddhism argues that the self is an illusion and does not exist apart
from other states of consciousness (Dimkov, 2020). Thus, culture and
other aspects of who we are influence how we understand the
concept of self. We can look to the Indigenous people of New
Zealand, the Māori, for an example of what the self means in their
culture. The notion of the extended self was mentioned briefly at the
beginning of the chapter. In contrast to the idea that the self is largely
“egocentric” (internal), some cultures view the self as extending
beyond the body. Rua et al. (2017) explain that Māori identities exist
in relationship to something else. The ex-centric self includes the
environment, and we can only understand our self when we realize
we are living in both an internal space and an external space (Rua et
al., 2017). In other words, there is an interconnectedness between
the self and the pluralistic nature of what it means to be human.
This notion that the self is intertwined with the rest of the world—the
oneness hypothesis—provides a more expansive view of the self.
The self is seen as being connected with other people, creatures, and
things. The oneness hypothesis can be found in many traditions,
especially East and South Asian traditions, but can be challenging to
some Western thinkers and those who presume that the scope of the
mind stops at the boundaries of one’s body (Harrison et al., 2018).
Both Western and Eastern perspectives, to some extent, recognize
both the independent self and the communal self, but they differ
considerably in where the emphasis is placed.

Another perspective of self is that the self has three parts: the
individual self, the relational self, and the collective self (Nehrlich et
al., 2019; Sedikides et al., 2013). The collective self identifies with
valued social groups. In a sample of U.S. adults, Nehrlich et al.
(2019) found that there is a self-hierarchy in which people value their
individual self the most, value their relational self less than the
individual self, and value their collective self the least. Zhu et al.
(2016) examined the self-hierarchy in China, wondering if the
motivational primacy of the individual self would be present in a
collectivist society. Their study supports the idea that the individual
self is also at the top of the three-tier self-hierarchy in Chinese culture
(Zhu et al., 2016). Various studies conducted over the years generally
support the three-tiered hierarchy in both Eastern and Western
cultures (see Gaertner et al., 2012). Other studies, however (see
Zajenkowska et al., 2021), find that the importance of the individual
self does not differ significantly from the importance of the relational
self. In their study of people living in the community and people living
in prisons, Zajenkowska et al. (2021) found that age and place of
living impact the relative importance of selves.

These various and sometimes conflicting ways of thinking about self

remind us that cultural humility is vital in our social work relationships
regardless of setting and services provided. Given the increasing
diversity of our nation and our world, and our awareness that culture
influences our lived experiences, social workers must be constantly
learning about themselves and others. One must be open to the
other, recognizing that each person brings something to the table.
Cultural humility involves the use of an intersectionality lens that
recognizes the many layers of personal identities and the numerous
vectors of oppression and privilege. Cultural humility will receive
further attention in Chapter 8, Cultures, in this book. Intersectionality
was discussed in Chapters 1 and 2 in this book and will receive
attention in other chapters of the books as well.

Critical Thinking Questions 4.4

Review again the case vignettes of Janna Smith (Case Study 4.1)
and Charles Miller (Case Study 4.2). What adverse childhood
experiences (ACEs) and protective childhood experiences (PACEs)
have each experienced? How have those lived experiences in
childhood potentially influenced the development of their current
personalities and well-being? Have they experienced traumatic stress
as adults? If so, how has that stress potentially impacted regions of
their brains and their brain chemistry?

Now, consider Charles and his decision to live as his authentic self.
Which of the theories of self discussed in this section help you to
understand Charles’s journey of self and what it has meant to him
over the years? How do you think that Charles might think of his
gender transition from the perspective of the theory you selected?

Cognitions, Emotions, Personality, Self, and Evidence-Supported

Interventions (ESIs)

The social workers providing services to Janna Smith (Case Study

4.1) and Charles Miller (Case Study 4.2) will want to use the best
available interventions. The Council on Social Work Education’s
(2022) Educational Policy and Accreditation Standards state that
“social workers understand methods of identifying, analyzing, and
implementing evidence-informed interventions” (p. 12). Evidence-
based practice (EBP) is a multistep process that includes using
research findings along with client preferences to plan interventions.
Evidence-supported interventions (ESIs) are specific interventions
that, based on outcome evaluations, have shown some evidence of
effectiveness in intervening in specific types of client situations. When
reading outcome studies, remember that the interventions are
validated for specific purposes and with specific populations only.
Also, outcome studies assume that the intervention being tested is
used in the way it was researched and are validated with large group
research or a series of small group studies (University of Missouri,
2022).

The United States Substance Abuse and Mental Health Services

Administration (SAMHSA) provides valuable information about
evidence-based practice and evidence-supported interventions for
serving different populations and treating different mental health
diagnoses. For example, in their 2021 evidence-based resource
guide focused on college students with anxiety, depression, and
suicidal thoughts, they found strong evidence for the effectiveness of
cognitive-behavioral therapy (CBT) and moderate evidence for the
effectiveness of dialectical behavior therapy (DBT) (SAMHSA, 2021).
Eye movement desensitization and reprocessing (EMDR) has been
found to be effective with post-traumatic stress disorder (PTSD) (de
Jongh et al., 2019). EMDR, CBT, and DBT will be briefly reviewed
here. Connections between these selected ESIs and theories of
cognitions and emotions are made.

Shapiro’s Eye Movement Desensitization and Reprocessing (EMDR)

Francine Shapiro, PhD, was the originator and developer of eye

movement desensitization and reprocessing (EMDR). Unlike
traditional talk therapies, EMDR looks to help people assess and
reprocess stored memories to an adaptive resolution. Dr. Shapiro
noticed that her own eye movements had a desensitizing effect on
her own upsetting thoughts and memories, and she began to conduct
studies to explore this phenomenon in 1989 (EMDR Institute, 2020).
She found that using eye movements or other bilateral rhythmic left-
right stimulations (e.g., tones, taps) while a client thinks about
aspects of a traumatic memory shifts the client’s strong negative
emotions and beliefs about the event to feeling they have
transformed; they survived and are strong. This improvement occurs
without speaking in detail about the traumatic event as one would in
other psychotherapy approaches.

Earlier in the chapter we learned about theories of cognition drawing

from the information processing framework. Recall that this
framework focuses on how memories are stored and cognitive
processes are organized. Understanding the basic ideas of human
information processing is germane to understanding EMDR. Shapiro
developed an information processing theory and an adaptive
information processing (AIP) model, hypothesizing that people have
an information processing system that processes aspects of
experiences and stores memories in an accessible and useful form.
Learning occurs when new associations are merged with previously
stored memories (EMDR Institute, 2020). When a traumatic event
occurs, information processing about the event may be incomplete,
resulting in the memory being triggered by similar situations. The
person may feel like they are reliving the traumatic event. People
diagnosed with PTSD as well as those who have memories of small-t
traumas, such as being teased as a child, can benefit from EMDR.
The EMDR intervention helps to link the traumatic memories with
other more adaptive information, learning takes place, and the
experience is now stored with more adaptive emotions (EMDR
Institute, 2020).

The eight-phase protocol of EMDR involves history taking (phase 1),

preparing the client (phase 2), assessing the target memory (phase
3), processing the memory to adaptive resolution (phases 4–7), and
evaluating intervention results (phase 8) (American Psychological
Association, 2017). Processing the memory can be completed within
one to three sessions and does not include extended exposure to the
memory and trauma. The EMDR intervention has been studied
extensively since it was developed and has been found to be an
effective intervention for PTSD, and emerging evidence indicates that
it is an effective intervention with persons experiencing psychosis and
disorders that are comorbid with PTSD (de Jongh et al., 2019).

Beck’s Cognitive-Behavior Therapy (CBT)

If we accept the premise that our thinking (cognitions) influences our
emotions and behaviors, we may be inclined to use the cognitive-
behavior therapy (CBT) model to focus on clients’ automatic
thoughts. The initial CBT psychotherapy model was developed in the
1960s by the American psychiatrist Aaron T. Beck, MD (1963, 1964).
At the time, it was named “cognitive therapy” and was a structured
short-term intervention for depression (J. S. Beck, 2020). The
cognitive therapy model proposed that how we think about a situation
influences our emotional reactions and our behavior. If our thinking is
irrational (I can’t do anything right), this could lead to a certain
emotion and behavioral response (quitting before being done with the
job). Beck renamed this model cognitive-behavior therapy (CBT), but
the cognitive model is at the core of CBT.

Beck proposed that there are three levels of cognitions, and each can
be adaptive or maladaptive (J. S. Beck, 2020). At the most surface
level are automatic thoughts (I can’t do this). At the intermediate level
there are underlying assumptions (If I try to pass this test, I’ll just fail),
and at the deepest level are core beliefs about yourself, others, or the
world (I’m not smart). Beck asserts that to achieve lasting
improvement in mood and behavior, work must occur at all three
levels of cognition.

The first major clinical trial to test CBT was in 1977 and involved
comparing the effectiveness of antidepressant medications with CBT
for depression. CBT was found to be just as effective as medication
as an intervention with depression and twice as effective in
preventing relapse (Beck Institute, 2022). CBT became more and
more popular as more studies supported its effectiveness with
depression, and ultimately with other mental health challenges
including anxiety (Power et al., 1990) and body-image dissatisfaction
(Butters & Cash, 1987). In those early days, however, there were not
enough practitioners trained in CBT.

Along with his daughter Judith Beck, PhD, a psychologist, Aaron

Beck founded the Beck Institute for Cognitive Behavior Therapy in
1994 to meet the need to train more practitioners in CBT (Beck
Institute, 2022). Judith Beck wrote the seminal textbook Cognitive
Therapy: Basics and Beyond in 1995. This textbook is still considered
essential in understanding CBT, and the third edition was published in
2020. Aaron T. Beck died in 2021, and Judith Beck is now the current
president of the Beck Institute

Linehan’s Dialectical Behavior Therapy (DBT)

The dialectical behavior therapy (DBT) model was originally

developed by Dr. Marsha Linehan to intervene with individuals at risk
for suicide and those diagnosed with borderline personality disorder
(BPD) (SAMHSA, 2021). DBT is a comprehensive, multi-diagnostic
behavioral intervention that has roots in CBT, social learning theory,
and behavioral principles (Dimeff & Linehan, 2001). Dimeff and
Linehan (2001) explain that in the 1970s, due to many failed attempts
to apply CBT with clients who were chronically suicidal, modifications
made to CBT formed the basis of DBT.

A key component of DBT is bringing together acceptance and change

to achieve better results. The notion of acceptance is drawn from
principles of Eastern Zen and Western contemplative practices
(Dimeff & Linehan, 2001, p. 1). Acceptance and change seem to be
two forces in conflict with each other (the dialectic), yet these
opposites can coexist. Unlike CBT which focuses on changing
problematic thoughts, feelings, and behaviors, DBT focuses more on
mindfulness and accepting the truths upon which thoughts, feelings,
and behaviors are based. The goal is for the client to achieve a
balance between empathy and acceptance of themselves and a
focus on changing problem behaviors (Linehan, 2014).

DBT consists of highly structured individual psychotherapy, group

skills training, and phone coaching to address the application of
coping skills (Dimeff & Linehan, 2001). The four major skills that are
the focus of DBT are: (1) mindfulness, (2) distress tolerance, (3)
interpersonal effectiveness, and (4) emotion regulation. Linehan
refers to these four skills as the active ingredients of DBT. These four
skills focus on bodies, cognitions, emotions, and social relationships.

Critical Thinking Questions 4.5

Think about Janna Smith (Case Study 4.1). Imagine that you are
assigned as Janna’s clinical social worker. Would EMDR be an
appropriate approach to use with Janna? If so, what might be the
focus (i.e., what might be the target memory to be reprocessed)? If
EMDR helped Janna with reprocessing this target memory, how might
it potentially help her in her current life?

If you used CBT with Janna, instead of or along with using EMDR,
what might be some of the automatic thoughts, underlying
assumptions, and beliefs to receive attention? If you were able to
work with Janna at all three levels of cognition (automatic thoughts,
underlying assumptions, and core beliefs), do you think she would
feel better? Explain your answer. In addition to CBT, what other
approaches or interventions might also be helpful to Janna?

Implications for Social Work Practice

The study of the psychological person as a thinking and feeling being

with a personality and a self has many implications for social work
practice:

Consider and examine how the organization where you work

understands clients’ cognitions, emotions, personality, and
notions of self; the theoretical frameworks and any sources of
information that guide the assessment process; and the nature of
the interventions used.
Recognize that culture influences the development of and
understanding of cognitions, emotions, personality, and notions
of self.
Choose interventions that are well-matched with the client’s
situation, agency setting, and client expectations.
Practice cultural humility in processes of engagement,
assessment, and intervention in all practice situations.
Recognize the intersectionality of identities involved in client
stories and development of the self.

Chapter Review
Key Terms

Accommodation (cognitive)
Affect
Assimilation (cognitive)
Authenticity
Cognition
Emotion
Emotion schemas
Emotional intelligence
Intelligence
Mood
Moral actions
Moral development
Moral judgments
Moral reasoning
Personality
Primary emotions
Psychology
Schemas
Secondary emotions
Self
Working self-concept

Active Learning

1. Reread the two case studies about Janna Smith (Case Study
4.1) and Charles Miller (Case Study 4.2). Working alone or in
small groups, answer the following questions: What are Janna’s
and Charles’s primary concerns? Identify some of their patterns
of thinking (cognitions) and feelings (emotions). What theories
presented in the chapter are most helpful to you in thinking about
their challenges and why? If the theories are not helpful, what
are they lacking?
2. Thinking again about Janna Smith and Charles Miller, how has
societal viewpoints impacted their lived experiences across their
life spans? How have these lived experiences influenced their
 cognitions and emotions, and their development of personality
and self?
3. Consider how our own sense of morality and moral reasoning
influence our work with clients. Are moral reasoning and social
work ethical decision-making related to each other? How are
they similar, and how are they different? Prepare a short analysis
you could present to your classmates about the relationship of
social work ethics to theories of moral reasoning and moral
judgments.
4. How might drawing upon specific theories of cognition, emotion,
personality, and self influence a social worker’s selection of
interventions to help their clients? Provide at least four examples
of how specific theories would influence social work interventions
with Janna Smith and Charles Miller.

Descriptions of Images and Figures

Back to Figure

The flow of information processes through the memory is the

following sequence:

Sensory information consisting of sights, sounds, tastes, smells,

and touch.
Sensory memory. This could be forgotten. Attention to it leads to
short-term memory that could also be forgotten. When brain
processes it, it is in long-term memory from where it could be
lost. The information can also be retrieved from long-term
memory to short-term memory.

Back to Figure

The diagram shows a two-way link between the following:

Cognitive component and affective emotional component,

Affective emotional component and social component,
Social component and other component,
Other component and cognitive component,
 Cognitive component and social component,

The interconnected closed loop linking of the steps is depicted as

follows:

Step 1: Encoding environment cues and step 2: interpretation of

environment cues,
Step 2 and step 3: clarification of goals,
Step 3 and step 4: Constructing a response,
Step 4 and step 5: moral decision,
Step 5 and step 6: moral behavior enactment,
Step 6 and step 1: encoding environment cues,

Each step is linked two-way to the four components as well.

Back to Figure

There is a time lapse between seeing a spider and a woman’s

reaction.

In James-Lange theory, arousal by spider creates heart pounding,

sweating that leads to fear which is an emotion.

By Cannon-Bard theory, arousal by spider creates both heart

pounding, sweating and the emotion of fear at the same time.

By Schachter-Singer two-factor theory, arousal by spider creates

heart pounding, sweating and a cognitive label as I am scared. All
these together leads to the emotion of fear.

By Lazaru’s cognitive appraisal theory, arousal by spider leads to

appraisal that leads to fear or heart pounding and sweating.

Back to Figure

The model shows two-way correlation between the following:

Cognitive control and positive emotions,

Social relationships and positive emotions,
Happiness and positive emotions,
Well-being and positive emotions,
Activities, strategies, and interventions that cultivate positive
emotions contributes one-way to cognitive control, and also to
the link between positive emotions and happiness, and to the link
between positive emotions and well-being.
5 The Psychosocial Person: Relationships, Stress, and Coping

Cory Cummings, Tawanda L. Hubbard, and Joseph Walsh

Learning Objectives

5.1 Analyze one’s own emotional and cognitive reactions to a

case study.
5.2 Describe four types of theories (relational theory, attachment
theory, feminist theories, and social identity theory) of self in
relationships.
5.3 Summarize the role of stress, crisis, and traumatic stress in
human behavior and in interpersonal relationships.
5.4 Analyze the interactions of biological, psychological, social,
and spiritual processes of coping with stress.
5.5 Critique interdisciplinary perspectives (medical,
psychological, sociological, anthropological, public health, and
social work) on coping, especially as they relate to understanding
of what is considered “normal” or “abnormal.”
5.6 Apply knowledge of self in relationship, stress, and coping to
recommend guidelines for social work engagement, assessment,
intervention, and evaluation.

A Case Study About the Psychosocial Person

Case Study 5.1: Dan’s Dilemma

Dan Lee is a 24-year-old single Chinese American male

undergraduate student working toward admission into medical
school. He came to the counseling center to get help with his feelings
of anxiety, tension, sadness, and anger related to academic
challenges and ongoing interpersonal conflicts.

Dan has done well through most of his academic career but has been
having difficulty concentrating on his studies and was in danger of
failing a course he needed to pass in order to stay on track for
medical school. He is specifically preoccupied with perceived
personal slights from several friends, his sister, and his mother. Dan
told the social worker, Spencer, that he needed help learning how to
get these significant others to behave more responsibly toward him
so that he could focus more intensively on his own work. Dan
reported that he also had been diagnosed several years ago with an
auditory processing disorder, which meant he, at times, is slow to
process other people’s verbal communications and prepare his
responses to them. Dan’s goal is to be able to focus on his studies so
that he can perform well academically and achieve admission to
medical school.

Spencer, the social worker, is a U.S.-born white male, several years

older than Dan, who has some understanding of the Chinese value
system in which Dan was raised. He likes Dan, appreciating his
intelligence, his motivation to get help, and his ability to articulate his
concerns, but Spencer also observes that Dan demonstrates a
striking rigidity in his attitudes toward others.

Dan is the older of two children (his sister is 22) born to a couple who
grew up in Taiwan and moved to the United States before the children
were born. His father, a surgeon, and his mother, a homemaker,
divorced when Dan was 7. Dan and his sister lived with their mother
after the divorce and have had only occasional contact with their
father. Dan has internalized the values of his family and culture; he
understands that he needs to assume primary responsibility for the
well-being of his mother and sister while also achieving high social
status for himself. He also exhibits the cultural value of obedience to
authority and sees himself as the family’s primary authority figure,
being the only male member at home. While a student at a diverse
university, Dan has maintained cultural ties through his membership
in a church that serves the Chinese American community.

Dan reported that he frequently provides directives to his mother and

sister (e.g., how they should spend their time, with whom they should
associate, work decisions). He described these decisions as clear or
obvious and would become very frustrated when they deviated from
these directives. Regarding his friends, who are mostly limited to
casual contacts at school and at his volunteer job at a community
health center, Dan felt that whenever there was a conflict or
misunderstanding it was always “their fault.” He felt disrespected at
these times and became so preoccupied with these “unjust slights”
that he couldn’t concentrate on much else for days afterward. Dan
gave one example of a friend who had arrived more than 20 minutes
late on two occasions for scheduled social outings. The second time
he demanded that the friend apologize for being irresponsible and
insensitive, and when the friend did not do so to Dan’s satisfaction,
the relationship ended.

Dan had warmer feelings toward his peers at church, all of whom are
Asian Americans. He spent most of his Sunday afternoons there,
participating in social events and singing in the choir. Dan was also in
regular contact with an ex-girlfriend, mostly by e-mail but occasionally
by phone. He had broken up with her 6 months earlier; although she
hoped they would resume a romantic relationship, Dan did not think
this would happen.

Spencer, while validating Dan’s feelings, believed that his goals,

especially as they related to interpersonal relationships, were
unrealistic. He hoped Dan would eventually come to perceive that his
influence over others was limited, that people might respect him even
as they did not always agree with his advice, and, most basically, that
people have different ideas regarding what is best for them. He
shared his concerns with Dan, who was willing to consider other ways
of assessing situations despite feeling skeptical of the utility of this
process. Spencer used some psychodynamic and cognitive
interventions during their year of working together, but he
experienced most success with a series of behavioral interventions.

Spencer helped Dan to use relaxation techniques and to consider the

environments in which he was best able to focus on his studies. They
determined, for example, that Dan was best able to concentrate
during the middle of the day and when there were people around him.
They set up a schedule of study in the medical library, where Dan
could sit at a table with other students (whom he did not necessarily
know). Spencer rehearsed deep-breathing activities with Dan, which
helped calm his anxieties, and he further suggested that Dan study
after a physical workout, when his body was calmer (Dan enjoyed
swimming). Spencer also suggested that physical activity might help
him release some of his anger after an interpersonal conflict.
Although Dan noted little progress for several months, Spencer was
encouraged by the fact that he continued coming in faithfully, week
after week.

Dan never articulated openly that his ideas about the appropriate
behavior of others were anything but “correct,” but over time he
reported fewer conflicts with his sister, mother, and peers, and his
study habits and grades improved to the point that he was admitted to
medical school. After a year of weekly sessions, Dan decided to
terminate the therapy because of his busy medical school schedule.
During their final session together, he said to Spencer, “I don’t know
how much I’ve gotten out of this, but I know you tried to help, and I
appreciate that.”

Reviewing the intervention with his supervisor, Spencer regretted that

he had felt such frustration with Dan, but he believed he had been
able to contain those feelings. Further, despite Dan’s ongoing
misgivings about the quality of the intervention, he had continued
meeting with Spencer for a full year and eventually demonstrated
behaviors evident of improvement. It seemed that Dan had reached a
higher level of adaptability even though it wasn’t so apparent to him.

The Self in Relationships and Relationships in the Self

This chapter covers how the psychosocial person manages

challenges, develops, and functions in the context of interpersonal
relationships and sociocultural environments, calling attention to the
role of a person’s relationship patterns in navigating life experiences
and managing stress. We look at common processes by which we all
try to cope with the stressors encountered in life. As Dan understood
but had trouble at times addressing, the ability to create, sustain, and
utilize significant relationships with other people is key to successful
coping and adaptation. With this focus in mind, we will consider four
theories that are instrumental in understanding how individuals live in
and navigate relationships and social environments: relational theory,
attachment theory, feminist theories, and social identity theory. These
theories provide social workers with a conceptual framework to
understand the human need for nurturing in early relationships and
the role of early nurturing in developing relational templates that are
instrumental in creating and sustaining healthy relationships across
one’s life course.

Relational and Intersubjective Theories

Relational theory integrates the psychodynamic and interpersonal

theoretical perspectives, which focus on relationships as the driving
force of personality development (Berzoff, 2022). In relational theory ,
the basic human tendency (or drive) is for relationships with others,
and our personalities are structured through ongoing interactions with
others in the social environment. This theory has substantial value in
recognizing and supporting diversity in human experience and
humanizing differences instead of pathologizing them.

Relational theory assumes that all patterns of behavior are learned in

the give-and-take of relational life and are adaptive ways of
negotiating experience in the context of our need to elicit care from,
and provide care for, others. Serious relationship problems are seen
as self-perpetuating because we all tend to preserve continuity in our
interpersonal worlds. In other words, we are attracted to what is
familiar and what is new could be threatening because it lies beyond
the bounds of our experience in which we recognize ourselves as
cohesive beings.

For social work practice, the relational perspective enriches the

concept of empathy by adding the notion of mutuality between the
social worker and the client. The ability to participate in a mutual
relationship through empathic communication contributes to the
client’s growth. Contrary to traditional analytic notions of neutrality
and objectivity, the relational-oriented social worker utilizes
themselves professionally, expressing a range of thoughts and
feelings “at the moment” with the client to facilitate their mutual
connection. The intervention focuses on here-and-now situations in
the client’s life, including what happens between the social worker
and the client. The social worker utilizes the therapeutic relationship
to create in vivo or real-time experiences to help the client. According
to Segal (2013), change occurs through a process of supportive,
respectful mutuality and reciprocal meaning making between the
client and social worker in the relationship. Relational theorists
encourage the social worker’s natural, authentic manner of
engagement, the strategic use of self-disclosure, and the
encouragement of the client to provide feedback on the quality of
services regularly. The social worker also avoids relegating the two
parties to dominant and subordinate roles.

To expand on these points, relational theory significantly focuses on

the intersubjective basis of self-development (Schore, 2021;
Storolow, 2013). There is mutual recognition of the self and the other
as people with unique experiences and perspectives; each person
influences the other in conscious and unconscious ways.
Intersubjective theory proposes that as early as infancy, humans
have the capacity to be aware of and receptive to the thoughts and
feelings of others, to synchronize their brains with others; this ability
is further developed in early relationships with caregivers (Schore,
2021). In addition, in relational and intersubjective theories, all
interactions are put into the cultural and social contexts in which they
occur. A relational, intersubjective approach does not imply a neglect
of appropriate boundaries in the social worker–client relationship, for
the social worker must maintain a clear sense of self while engaged
in the emotional and cognitive integration necessary for empathy to
be effective. The intervention process features many enactments or
discussions about how the social worker and client relationships
relate to one another. Through this process, the client gradually
becomes able to recognize other people’s uniqueness, developing
capacities for sensitivity and a value of difference. The client is freed
from the “pull” of problematic relationship patterns. The social worker
provides a corrective relational and emotional experience for the
client.
Researchers who investigate evidence-based practice techniques do
not always focus on the significance of the social worker–client
relationship. Still, there is considerable evidence of its importance in
literature reviews. For example, Sommers-Flanagan (2015)
developed a practice model based on such a review that incorporates
the factors of congruence and genuineness, the working alliance,
unconditional positive regard or radical acceptance, empathic
understanding, the ability to manage relationship ruptures, and
managing countertransference. Cameron’s (2014) common factors
model includes the social worker factors of well-being, acceptance,
genuineness, and empathy, and the social worker–client interactional
factors of relationship engagement, engagement in change work,
productive direct and indirect communication, and collaboration. The
assumptions of relational theory are also consistent with the findings
of the American Psychological Association (APA) on the significance
of the social worker–client relationship. The APA has systematically
evaluated the significance of the practitioner–client relationship in
determining intervention effectiveness and concluded that several
relationship variables used in practice were demonstrably effective
(the alliance in individual and family therapy, cohesion in group
therapy, empathy, and collecting client feedback), and others were
probably effective (attention to goal consensus, collaboration, and
positive regard) (Norcross & Wampold, 2011). In addition, three other
relationship elements (congruence/genuineness, repairing alliance
ruptures, and managing countertransference) were deemed
promising.

Relational theory aligns with social work’s core values of the

importance of human relationships, integrity, dignity, and worth of a
person, service, competency, and social justice (National Association
of Social Workers, 2021; Segal, 2013). It is a theory that social
workers on the micro, mezzo, and macro levels can utilize to
engender solidarity across different aspects of social work not limited
to the micro level. For example, a relationally oriented social worker
who works on the mezzo and macro levels can use this theoretical
approach to design and implement programs that attend to
collaboration, respectful mutuality, and meaning making between
individuals, families, and social workers in service delivery (Segal,
2013).

Relationships with significant others are resources for coping with

stress.

© iStockphoto.com/Charday Penn

Attachment Theory

Research has demonstrated how close relationships matter the most

to humans (Finlay, 2016). When intimate relationships fail us, and we
cannot meet our needs, our functioning in other aspects of our life
can suffer. If close relationships are the core place where we learn
who we are and develop psychologically, emotionally, and socially,
these attachment-based relationships have the power to harm us,
constrict our growth, nurture our development, and facilitate our
healing. We need to look at our early relationships to understand the
significance of attachment-based relationships and how relationship
patterns are formed. Early brain development is influenced by
attachment interactions with the early caregiver, setting the stage for
future brain function (Lally & Mangione, 2017). All children seek
proximity to their parents and develop attachment styles suited to the
types of parenting they receive. Please keep in mind that even
though there is a universal tendency to form attachments, both
attachment and caregiving behaviors may vary in their unique forms
across cultures but share a common underlying function of
establishing or maintaining safety and connection (Stern et al., 2022).
It may be helpful to consider one model of parent–child attachment
here. Ainsworth and colleagues (1978) identified three infant
attachment styles—secure, anxious-ambivalent, and avoidant. A
fourth attachment style was identified later—the disorganized type
(Madigan et al., 2006).

Securely attached infants act somewhat distressed when their parent

figures leave but greet them eagerly and warmly upon return. Parents
of securely attached infants are sensitive, accepting, consistently
available, and responsive. Securely attached children are
unconcerned about security needs and are thus free to direct their
energies toward nonattachment-related environmental activities.
Infants who are not securely attached must focus on maintaining
attachments to inconsistent, unavailable, or rejecting parents rather
than engaging in exploratory behaviors. Because these children can
only maintain proximity to their parents by behaving as if they are not
needed, they may learn not to express their needs for closeness or
attention. Recent research indicates that 3-year-old children with
insecure attachment have more severe physiological reactions to
stress than similar age children with secure attachment; they also
have poorer language and cognitive skills (de Mendonça Filho et al.,
2022).

Anxious-ambivalently attached infants are distraught when their

parent figures leave. Upon their parent’s return, these infants
continue to be distressed even as they want to be comforted and
held. These children employ “hyperactivation” strategies—clinging or
controlling behaviors to elicit attempts to involve their caregiver to
engage with them. Though not overtly rejecting, their parents are
often unpredictable and inconsistent in their responses. Fearing
potential caregiver abandonment, the children maximize their efforts
to maintain close parental attachments and become hypervigilant for
threat cues and any signs of rejection.

Avoidantly attached infants seem relatively undisturbed when their

parent figures leave and return. Of course, these children want to
maintain proximity to their parent figures. Still, this attachment style
enables the children to maintain a sense of closeness to parents who
otherwise may reject them. Avoidant children thus suppress
expressions of overt distress and, rather than risk further rejection in
the face of attachment figure unavailability, may give up on their
proximity-seeking efforts.

Chaotic and conflicted behaviors characterize the disorganized

attachment style. These children exhibit simultaneous approach and
avoidance behaviors. Disorganized infants seem incapable of using
consistent strategies to bond with their parents. Their conflicted and
disorganized behaviors reflect their best attempts at gaining some
sense of security from parents perceived as frightening. When afraid
and needing reassurance, these children have no options but to seek
support from a caregiver who does not demonstrate a nurturing
response. The parents may be either hostile or fearful and unable to
hide their apprehension from their children. In either case, the child’s
anxiety and distress are not lessened, and one source of stress is
merely traded for another.

Although children with disorganized attachments typically do not feel

cared for, avoidant and anxious-ambivalent children do experience
some success in fulfilling their care needs.

If you are concerned that your early relationships might have been
problematic, don’t worry. Relational theorists do not assert that
caregivers need to be perfect (whatever that might be), only that they
communicate a sense of caring and permit the child to develop an
understanding of self (Elkins, 2016). According to Saunders et al.
(2011), earned security is possible for individuals whose early
attachments are problematic. In other words, a person who
experienced an early insecure attachment in childhood could have
the ability to transform their attachment style and develop trusting and
loving relationships through alternative support figures in adulthood.

Cultural psychologists argue that most Western psychological

theories assume an independent, autonomous self as the ideal self-
in-relationship (de Carvalho et al., 2014). In contrast, they suggest
that in many cultures of the world, including Asian, African, Latin
American, and southern European cultures, the ideal self is an
interdependent self that recognizes one’s behavior as influenced,
even determined, by the perceived thoughts, expectations, and
feelings of others in the relationship. For example, Markus and
Kitayama (2003) note that in U.S. coverage of the Olympics, athletes
are typically asked how they feel about their efforts and success. In
contrast, athletes in Japan are typically asked, “Who helped you
achieve?” This idea of an interdependent self is consistent with
relational theory and feminist perspectives on relationships.

You may have experienced romantic relationships with varying

degrees of closeness and wonder how those processes fit with
attachment theory themes. Romantic love has many definitions, but it
is generally agreed to include passion and sexual attraction (for initial
bonding), attachment with intimacy (to generate interdependence),
and commitment (to keep partners together and suppress the search
for other mates) (Fletcher et al., 2015). It is thus shaped partly by
attachment styles but also features additional characteristics.

Romantic love is considered one of the deepest and most meaningful

human responses. It is a cultural and perhaps an evolutionary
development in the human species and provides a motivating force
for bonding and survival. Some romantic partners decide to have
children and raise a family. Romantic love features distinct emotional,
behavioral, social, hormonal (testosterone and estrogen), and
neurological (oxytocin) processes that support pair bonding, a
positive predictor of health and survival in adults and children. Certain
social phenomena such as arranged marriages, polygamy,
polyamory, divorce, and infidelity may represent cultural differences in
romance. Gay and lesbian couples were once considered deviant
and pathological in our society, but for some time they have been
able to legally marry, conceive, and raise children if they choose in
the United States and other countries.

Because it is tied to reproductive functions, romantic love is not

permanent in all its manifestations. Shared feelings of passion
between committed couples tend to diminish over time, although at
different rates. In addition, infatuation is not necessarily associated
closely with attachment style, so when people have come together as
committed couples in this pair-bonding way, the compatibility of their
underlying attachment styles eventually becomes more significant in
determining the strength and duration of their relationship (Heffernan
et al., 2012).

The most prominent theory of romantic love is Sternberg’s

(Sternberg, 1988; Sternberg & Sternberg, 2019) triangular theory of
love, which proposes three components of love: intimacy, passion,
and commitment/decision. Intimacy, the “warm” love component,
involves connectedness, closeness, communication, and emotional
investment. Passion, the “hot” love component, involves romance,
excitement, physical attraction, sexual arousal, and a need for
physical proximity. Commitment/decision, the “cold” love component,
involves deliberately choosing to love someone and working to
maintain the relationship. Both intimacy and commitment decisions
may apply to other love relationships besides romantic partner
relationships; the passion love component usually applies only to
romantic partner relationships. Although the triangular love scale has
been used almost exclusively with Western samples, it was recently
validated in a large cross-cultural study with a sample from 25 non-
Western countries (Sorokowski et al., 2021). Sorokowski et al. (2021)
suggest that the universality of love components across cultures
indicates that love might have a biological basis (see Hutchison,
2024).

Impact of Early Nurturing on Development

We have been looking at theories that propose that relationships are
an important part of who we are throughout our lives. Turning to
human and animal research, we can find physiological evidence that,
as relational and attachment theories suggest, the quality of our early
relationships is crucial to our lifelong capacity to engage in healthy
relationships and enjoy basic physical health.

A large body of research studies the links between early life

experiences and physical and mental health risks as we age. Back in
1998, results of a large-scale adverse childhood experiences (ACEs)
study indicated that five categories of such experiences (physical,
sexual, or emotional abuse; physical or emotional neglect; violence
against the mother; living with household members who were
substance abusers, mentally ill or suicidal, or ever imprisoned; and
parental separation or divorce) were associated with negative adult
health behaviors and diseases such as alcoholism, drug abuse,
depression, suicide attempts, smoking, poor self-rated health,
sexually transmitted diseases, physical inactivity, obesity, and a
variety of other adult diseases (Felitti et al., 1998). Those with more
than four childhood risk factors were especially susceptible to those
adverse outcomes. The implications of that significant study still guide
the research of professionals who work with children (e.g., Amaya-
Jackson, 2016; Reiss et al., 2019). It is clear that relational elements
of our early environments permanently alter the development of
central nervous system structures that govern autonomic, cognitive,
behavioral, and emotional responses to stress (Cacioppo et al.,
2015). These findings support the lifelong significance of specific
relationship interactions.

Animal studies make up the bulk of research on the impact of early

life adversity on future stress and coping, but longitudinal studies with
humans produce similar findings (Boufleur et al., 2013; Novak et al.,
2013; Reiss et al., 2019). It has been found that highly groomed
young rats (pups) develop more receptors in their brains for the
substances that inhibit the production of corticotrophin-releasing
hormone (CRH), the master regulator of the stress response. As a
result of the tactile stimulation they receive from mothers, the pups’
brains develop in a way that lowers their stress response—not only
while being groomed but throughout life. When the rats are switched
at birth to different mothers, the pups’ brain development matches the
behavior of the mothers who reared them, not their biological
mothers. Furthermore, high-licking and high-grooming (nurturing)
mother rats change their behavior significantly when given a
substance that stimulates the hormonal effects of chronic stress,
raising their CRH and lowering oxytocin, a hormone related to the
equanimity (mental calmness in difficult situations) many human
mothers feel after giving birth. Under the influence of these stress
hormones, the high-nurturing mothers behaved like the low-nurturing
mothers, and their offspring grew up to have the same stress
responses. Carozza and Leong (2021) report that existing human and
rodent research indicates an important role of affectionate caregiver
touch for healthy development of the nervous and immune systems,
cognitive skills, and the capacity for mutually supportive relationships.

You may be familiar with the tradition of research on the nurturing

practices of rhesus monkeys conducted by Harry Harlow. Research
continues in this area (Asher et al., 2013; Madrid et al., 2018). In
some of these experiments, monkeys are separated from their
mothers at age intervals of 1 week, 1 month, 3 months, and 6 months
and raised in a group of other monkeys that includes a different
mother. The infants who are separated later (3 or 6 months) exhibit
normal behavior in the new setting. Those separated earlier, however,
show a variety of abnormalities. The monkeys separated at one
month initially display a profound depression and refuse to eat. Once
they recover, they offer a deep need for attachment with other
monkeys and show great anxiety during social separation whenever
they feel threatened. The monkeys separated at 1 week showed no
interest in social contact with other monkeys, and this behavior did
not change as they grew older. Autopsies of these monkeys showed
changes in brain development. The timing of separation from the
primary caregiver is significant to their later development. These
findings may have a sad counterpart in human children who are
separated at an early age from their mothers.

Although much of this research is conducted with rats, monkeys, and

other animals, it has clear implications for human development. The
concept of neuroplasticity, introduced in Chapter 3 of this book, is
significant here (Cohen et al., 2017; Mandolesi et al., 2017). Humans
may have a window of opportunity or a critical period for altering
neurological development, but this window varies, depending on the
area of the nervous system. Even through the second decade of life,
for example, neurotransmitter and synapse changes are influenced
by internal biology, but perhaps by external signals as well. In other
words, the brain is not a static organ.

Much research explores the relationship between the processes of

attachment and specific neurological development in young persons
(Feldman, 2017). Persistent stress in an infant or toddler results in
overdevelopment of areas of the brain that process anxiety and fear
and the underdevelopment of other areas of the brain, particularly the
frontal cortex. Of particular concern to one leading researcher
(Schore, 2002, 2017) is the impact of the absence of nurturance on
the orbitofrontal cortex (OFC) of the brain. Chronic stress levels
contribute to fewer neural connections between the prefrontal cortex
and the amygdala, a process significant to psychosocial functioning.
The OFC is particularly active in such processes as concentration,
judgment, and ability to observe and control internal subjective states.

Further, the frontal cortex is central to emotional regulation capacity

and experience of empathy. The amygdala, part of the limbic system
(discussed in Chapter 2) interprets incoming stimuli and information
and stores this information in implicit (automatic) memory. The
amygdala assesses a threat and triggers immediate responses to it
(fight, flight, or freeze behaviors). A reduction in neural connections
between these two areas suggests that the frontal cortex is not
optimally able to regulate the processing of fear, resulting in
exaggerated fear responses.

Stress can affect brain development, but there is evidence that the
first few years of life are not all-important, given the role of resilience
influences (Richards et al., 2016). According to these authors, five
strengths exhibited by resilient youth include social competence,
problem-solving skills, critical consciousness, autonomy, and a sense
of purpose. In addition, environmental factors associated with
resilience include involvement in prosocial organizations, mentors,
successful school experiences, competent peer friends, supportive
family members, and a close bond with a primary caregiver. Recently,
researchers are exploring the reversibility of earlier-established risk
factors, and the U.S. National Institute on Aging (NIA) and the U.K.
Economic and Social Research Council (ESRC) and Biotechnology
and Biological Sciences Research Council (BBSRC) have formed the
Interdisciplinary Network on Early Adversity and Later Life
Reversibility (NEADLLR) (Reiss et al., 2019).

In summary, research indicates that secure attachments play a critical

role in shaping the systems that underlie our reactivity to stressful
situations. When infants begin to form specific attachments to adults,
the presence of warm and responsive caregivers begins to buffer or
prevent elevations in stress hormones, even in situations that distress
the infant. In contrast, insecure relationships are associated with
higher CRH levels in potentially threatening situations. Secure
emotional relationships with adults appear to be at least as critical as
individual differences in temperament in determining stress reactivity
and regulation.

Still, there is much to be learned in this area. Many people subjected

to severe early life traumas become influential, high-functioning
adolescents and adults. Infants and children may be resilient and
have many strengths to help them overcome these early life stresses.
A systematic review by Slopen et al. (2014) found that psychosocial
interventions with children can, in fact, restore their stress-reducing
cortisol levels. Researchers are challenged to determine whether
interventions such as foster care can remedy the physical, emotional,
and social problems seen in children who have experienced poor
nurturing and early difficulties with separation. We will now consider
several social influences on one’s sense of attachment to persons
outside the family.

Critical Thinking Questions 5.1

1. Imagine that you are the social worker working with Dan Lee
(Case Study 5.1). How would you respond to Dan’s statement: “I
 don’t know how much I’ve gotten out of this, but I know you tried
to help, and I appreciate that”? What thoughts and emotions
would you have on hearing this evaluation? What would you say
to Dan in response to his comments? What guidance can you
draw from relational and attachment theories?
2. In what ways can a social worker incorporate the research on
ACEs and the important impact that early nurturing has on self
and relationships into their practice on micro, mezzo, and macro
levels?

Feminist Theories of Relationships

Feminism is challenging to define because it is multidimensional and

consists of various social, political, and ideological movements for
change across diverse groups (Eren, 2022; White et al., 2019).
Feminist theories are comprised of divergent ideas, concepts, and
principles, making them flexible, frustrating, and alienating to some,
but also liberating and inspiring to others (Finn & Brown, 2021).
Feminism does not refer to any single body of thought. The feminist
movement is often described in waves. According to Finn and Brown
(2021), the first wave focused on the suffrage movement, the second
wave was driven by education and occupational inequality issues tied
with the experience of being a woman and fighting for equality, and
the third wave concentrated on expanding and building the feminist
agenda to be more representative of more diverse women (Black,
Indigenous, Latina, and Asian). The fourth wave now focuses on the
need for an intersectional approach to be incorporated into feminist
theory, honoring the roots of intersectionality in Black feminist theory.
According to White et al. (2019), there are three themes within
feminist theories: centering women’s experiences, recognition, and
value for diversity across women. Feminist theories are not
monolithic, but they all have an emancipatory focus. We will briefly
consider how feminist theories have deepened our capacity for
understanding the impact of power, oppression, and privilege on
human behavior, social interaction, and social relationships within a
sociocultural context by focusing on psychoanalytic feminism (Layton,
2016), gender feminism (Hare-Mustin, 2017), and feminist relational
theory (Koggel et al., 2022). However, you will also find further
discussion of gender as it relates to culture in Chapter 8.

Psychoanalytic feminists assert that women’s ways of acting are

rooted deeply in women’s unique ways of thinking and socialization.
Some of these gender differences may be biological, but they are
certainly influenced by cultural and psychosocial conditions. Feminine
attitudes and behavior feature gentleness, modesty, humility,
supportiveness, empathy, compassion, tenderness, nurturance,
intuitiveness, sensitivity, and unselfishness. Masculine attitude and
behavior are characterized by the strength of will, ambition, courage,
independence, assertiveness, hardiness, rationality, and emotional
control. Psychoanalytic feminists assert that these differences are
largely rooted in early childhood relationships based on stereotypical
gender roles grounded in patriarchy and traditionalism (Layton,
2016). In the traditionalist view, women are seen and treated as the
primary caretakers in our society, and young girls are socialized to
develop and enjoy ongoing relationships with their mothers that
promote their valuing of relatedness and other feminine behaviors.
Young boys are socialized to eventually perceive their mother as
fundamentally different, particularly as they face social pressures to
begin fulfilling male roles and hold traditional masculine points of view
about themselves and others (Layton, 2016). The need to separate
from the mother figure has long-range implications for boys as they
tend to lose what could otherwise become an intellectual capacity for
intimacy and relatedness in future relationships (Layton, 2016).

According to Few and Allen (2020), sociologists define gender as a

social structure that exists across the micro, mezzo, and macro levels
of society, shaping and constraining individuals’ ability to engage,
perform, and live out various social roles and opportunities, which go
beyond the idea of gender as property and identity of individuals. For
our purposes, we will look at an aspect of gender feminism that is
concerned with values of separateness (for men) and connectedness
(for women) and how these lead to a different morality for men and
women (Hare-Mustin, 2017). Carol Gilligan (1982; see also the
section on theories of moral reasoning in Chapter 4 of this book) is a
leading thinker in this area. Gilligan elucidated a process by which
women develop an ethic of care rather than an ethic of justice based
on the value they place on relationships. Gender feminists believe
these female ethics are equal to male ethics, although they have
tended to be considered inferior in patriarchal societies. Gilligan
asserts that humanity would be best served if both sets of ethics
could be valued equally. Other gender feminists go further, however,
arguing for the superiority of women’s ethics. For example, Noddings
(2002, 2005) asserts that war will never be discarded in favor of the
sustained pursuit of peace until the female ethic of caring, aimed at
unification, replaces the male ethic of strenuous striving, aimed at
dividing people.

Feminist relational theory (FRT) is an interdisciplinary lens that is

grounded in anti-oppression and emancipatory goals that consist of
eight features (Koggel et al., 2022). These FRT features align well
with social work’s mission and commitment to advance human rights
and social, racial, economic, and environmental justice, engaging
anti-racist practice; and promoting diversity, equity, and inclusion
(Council on Social Work Education, 2022, p. 9). FRT can be utilized
as a framework to guide social workers’ decisions and actions with
and on behalf of the individuals, families, and communities we serve
(NASW, 2021). According to Koggel et al. (2022), the eight features
of FRT are as follows:

1. Oppression: FRT’s origins and commitment are grounded in a

clear understanding of oppression and privilege as having
structural features across all social relationships, institutions, and
identities. This theory uses a relational lens to analyze and
describe structures, institutions, norms, and practices that shape
individuals’ and groups’ specific interactions and experiences of
oppression.
2. Interpersonal relationship and care ethics: FRT sees individuals
and interpersonal relationships as situated in social, economic,
and political networks that shape personhood and possibilities for
action. Care is a practice, and critical political theory is utilized in
FRT to critique dominant norms, government structures, and
public policy.
 3. Individualism and capability themes and approaches:
Capabilities theories and approaches aim to answer questions
focused on what people can do and what lives they can lead.
FRT strives to uncover the role of norms, structures, and powers
that shape public policy and impact what individuals can do and
be.
4. Empirical investigations: FRT is committed to empirical
investigations that analyze how power is utilized in structures,
norms, and public policy to sustain and perpetuate oppressive
relationships.
5. Non-ideal theory: FRT is grounded in an emancipatory and anti-
oppression position; it focuses on paying close attention to
current conditions, analyzing what is wrong with the world, and
identifying existing injustices to offer guidance and engage in
action to dismantle oppressive powers and structures.
6. Emancipatory goals: FRT centers emancipatory goals by seeking
to transform harmful norms and structures that sustain societal
networks of oppression and power.
7. Implications for epistemology: FRT calls attention to relationships
of power on the micro, mezzo, and macro levels, calling out how
knowledge is created, who gets to know, how they come to, and
what they know. FRT calls in and acknowledges individuals and
groups that have been historically marginalized and excluded
from participating in knowledge creation because of race, class,
gender, sexual orientation, religion, ability, and so on. Yet, these
individuals and groups have knowledge that consists of diverse
experiences and perspectives that can expose oppression,
inequities, injustices, and privileges embedded in structures,
norms, institutions, and public policy.
8. Multiple frameworks and approaches: FRT was built across
different disciplines and provides a multidisciplinary framework to
challenge oppressive conditions that contribute to such
interpersonal situations as racism, sexism, ableism,
heteronormativity, poverty, mass incarceration, and other forms
of marginalization and social exclusion.

Using the feminist relational theory can guide social workers to be

aware of, identify, and take action to combat and transform
oppressive structures, norms, and public policies that negatively
affect individuals and groups who are marginalized.

Please keep in mind feminist theories promote the value of

relationships, look closely at power dynamics within our society, and
recognize the importance of reciprocal interpersonal supports. Dan
was raised to be an achievement- and task-oriented person. These
are admirable characteristics, but they represent traditional male
perspectives. Dan’s inclinations for interpersonal experience and
embracing all parts of himself may have been discouraged if they did
not align with the conventional male view, which was harmful to his
overall development.

Social Identity Theory

Social identity theory (SIT) assumes that people’s identities are highly
influenced by the groups to which they belong (Scheifele et al., 2021).
Whitaker (2020) identifies three principles of SIT: (1) humans draw a
part of their self-concept from the groups with which they associate
and identify; (2) social identity is a collective self, a self that is defined
in group rather than individual terms; and (3) social identities
influence behaviors toward both ingroup and outgroup members.
Social identity development can be an affirming process that provides
us with a lifelong sense of belonging and support. For example,
Tawanda, the second author of this chapter, might feel good to have
membership in the Black community as an African American woman.
Because social identity can be exclusionary, however, it can also give
rise to prejudice and oppression. Tawanda may believe her race is
the best and value her community and cultural background. Tawanda
also recognizes that others may not see her or view her community
the same way; instead, they may project false ideas of inferiority onto
African American women.

Hardiman and Jackson (1997) present a five-stage model of social

identity development. However, these stages are not genuinely
distinct or sequential, and people often experience several stages
simultaneously (Cross, 2021). Social identity may fluctuate over time
and across social settings (Jardina et al., 2021; Syed et al., 2018).
1. Naïveté. During early childhood, we have no social
consciousness. We are unaware of particular codes of behavior
for our group or any other social group members. Our parents or
other primary caregivers are our most significant influences, and
we accept that socialization without question. As young children,
we do, however, begin to distinguish between ourselves and
other groups of people. We may not feel completely comfortable
with the racial, ethnic, or religious differences we observe, but
neither do we feel fearful, superior, or inferior. Children at this
stage are mainly curious about differences.
2. Acceptance. Older children and young adolescents learn the
distinct ideologies and belief systems of their own and other
social groups. During this stage, we learn that the world’s
institutions and authority figures have rules that encourage
certain behaviors and prohibit others, and we internalize these
dominant cultural beliefs and make them a part of our everyday
lives. Those questions that emerged during the stage of naïveté
are submerged. We come to believe that the way our group does
things is normal, makes more sense, and is better. We regard the
cultures of people who are different from us as strange, marginal,
inferior, or superior. We may passively accept these differences
or actively do so by joining organizations that highlight our own
identity and (perhaps) devalue or esteem others as superior to
others.
3. Resistance. In adolescence, or even later, we become aware of
the harmful effects of acting on social differences. We have new
experiences with members of other social groups that challenge
our prior assumptions. We begin to reevaluate those
assumptions and investigate our own role in perpetuating
harmful attitudes toward differences. We may feel anger at
others within our own social group who foster these irrational
attitudes. We begin to move toward a new definition of social
identity that is broader than our previous definition. We may work
to end our newly perceived patterns of collusion and oppression.
4. Redefinition. Redefinition is a process of creating a new social
identity that preserves our pride in our origins while perceiving
differences with others as positive representations of diversity.
 We may isolate from some members of our social group and shift
toward interactions with others who share our level of
awareness. We see all groups as being rich in strengths and
values. We may reclaim our own group heritage but broaden our
definition of that heritage as one of many varieties of constructive
living.
5. Internalization. In the final stage of social identity development,
we become comfortable with our revised identity and can
incorporate it into all aspects of our life. We act unconsciously
without external controls. Life continues as an ongoing process
of discovering vestiges of our old biases, but now we test our
integrated new identities in broader contexts than our limited
reference group. Our appreciation of the plight of all oppressed
people, and our enhanced empathy for others, are a part of this
process. For many people, the internalization stage is an
ongoing challenge rather than an end state.

SIT has most often been used to study ethnic-racial social identities,
but it has also been used to consider social identities based on
gender (Scheifele et al., 2021), political (Jardina et al., 2021), and
religious (Penning, 2009) groups. It can be used to understand any
social grouping with which people form collective identities. Ethnic-
racial identity (ERI) is the part of one’s identity that is based on
membership in one or more ethnic-racial groups; it involves a sense
of belonging, attitudes about, and commitment to the ethnic-racial
group(s) to which one belongs (Toro et al., 2021; Verkuyten, 2016,
2021). Researchers have studied both the content of ethnic-racial
identity and the processes by which it develops, but almost all the
research in the United States and other Western cultures has focused
on social identity development in racialized groups (Asian, Black,
Indigenous, and Latinx). This research has sought to understand how
ethnic-racial identity develops in the context of ethnic-racial
discrimination (see Toro et al., 2021). Recently, social identity
scholars have argued for more research on white racial identity
development in the context of white dominance of major social
institutions. A question that is important to social work’s emphasis on
racial justice is what socialization processes can help white
individuals to develop anti-racist collective identities rather than social
dominance collective identities (Holt & Sweitzer, 2020; Jardina et al.,
2021; Karras et al., 2021).

For all ethnic-racial groups, positive ethnic identity is associated with

higher self-esteem, purpose in life, academic achievement, physical
health, and self-confidence (Kuang & Nishikawa, 2021; Rogers-Sirin
& Gupta, 2012; Toto et al., 2021). Further, positive ethnic-racial
identity is associated with higher levels of psychological well-being
and lower levels of depression among white, African American, and
Asian youth (Rogers-Sirin & Gupta, 2012; Toto et al., 2021). Social
identity theory is sometimes used to explain a process by which those
who most strongly identify with their groups may come to hold less
favorable attitudes about different groups (Verkuyten, 2016, 2021).
Multicultural theory, another approach to social identity, proposes
more positively that affirmations toward one’s group, particularly
about ethnicity and race, should correspond with higher levels of
acceptance toward dissimilar groups (Eun-Ju & Kyung-Hwa, 2021;
Sue et al., 2016).

Critical Thinking Questions 5.2

Give some thought to social identity theory. With what social groups
do you identify? How did you come to identify with these groups?
How might your social identities affect your social work practice?

The Concept of Stress

One of the main benefits of good nurturing is strengthening our ability

to cope with stress. Stress can be defined as any event in which
environmental or internal demands tax our adaptive resources. Stress
may be biological (a disturbance in bodily systems), psychological
(cognitive and emotional factors involved in the evaluation of a
threat), and even social (the disruption of a social unit). Stress is a
necessary part of human life and has a major influence on human
physiology and behavior (Buzinschi, 2021). Dan Lee (Case Study
5.1) experienced psychological stress, as evidenced by his negative
feelings resulting from marginalization and perceived rejection, but he
also experienced other types of stress. He experienced biological
stress because he did not give his body adequate rest to attend all
his classes and study every day. As a result, he was susceptible to
colds, which kept him in bed for several days each month and
compounded his worries about managing coursework. Dan also
experienced social stress because he was functioning in a social
system that he perceived to be threatening and had few positive
relationships there.

Categories of Stress

Child development scholars identify three types of stress responses

that have very different impacts on physical and emotional
development in young children: positive stress, tolerable stress, and
toxic stress (Buzinschi, 2021; Murray, 2018; Shonkoff et al., 2009).

1. Positive stress is characterized by moderate and temporary

increases in one’s heart rate, blood pressure, and stress
hormone levels. These changes occur in response to the
challenges involved in dealing with the many types of frustration
that are common and expected in childhood, such as minor
physical injuries, conflicts with parents and friends, or struggles
with schoolwork. Experiencing and managing positive stress is
essential to healthy development when experienced in the
context of stable adult relationships. The stress response system
soon returns to its normal levels with adaptive responses.
2. Tolerable stress , also known as moderate stress, refers to a
physical state that might possibly disrupt neural circuits in the
brain but is offset by supportive relationships that facilitate
adaptive coping. The precipitants of this kind of stress are more
serious than those with positive stress and may include the
experience of possibly traumatic events such as the death of a
loved one or a move away from home. Still, the stressor occurs
during a limited period, enabling protective relationships to help
bring the child’s stress-response system back to baseline. Höltge
et al. (2019) found that moderate levels of childhood stress were
 associated with the highest levels of quality of life and mental
health in 60-year-olds.
3. Toxic stress has the most deleterious effects on a child’s nervous
system and refers to the strong, frequent, and perhaps prolonged
activation of the stress response system without adequate adult
protection. Toxic stress disrupts nervous system function for
extended periods and may lead to stress-management systems
that are persistently fragile throughout life. It also results in
biological alterations in the endocrine and immune systems.
Researchers have often found that child abuse and neglect result
in toxic stress responses, and recent research has also found
toxic stress responses in child refugees and children exposed to
interpersonal and structural racism (Murray, 2018; Shonkoff et
al., 2021).

This woman is experiencing psychological stress; she is challenged

by the task at hand and may or may not feel equal to the task.

© Jupiterimages/Pixland/Thinkstock
In animal studies with rodents, Du Preez and colleagues (2021)
studied the differential impacts of two different types of stressors:
physical stressors and psychosocial stressors. They found that
physical stressors, such as pain, were associated with depressive-
like symptoms and impaired social interactions. Psychosocial
stressors, such as crowding or social isolation, were associated with
anxiety- and depressive-like behavior; impaired social interaction,
learning, and memory; and inflammation. Worse outcomes resulted
from exposure to both physical and psychosocial stressors.

Here is another way to think about stress. In an analysis of the

relationship between stress and emotion, Lazarus (2007) makes a
distinction among three types of psychological stress appraisals:
harm, threat, and challenge:

1. Harm. An event appraised as damaging has already occurred.

Dan Lee (Case Study 5.1) minimized interactions with his
classmates during much of the semester, which may have led
them to decide that he was aloof and that they should not try to
approach him socially. Dan has to accept that this rejection
happened and that some harm has been done to him, although
he can learn from the experience and try to change in the future.
2. Threat. A situation is appraised as having potential for harm. This
is probably the most common form of psychological stress. We
feel stressed because we are apprehensive about the possibility
of a negative event. Dan may have felt threatened when he
walked into a classroom during the first semester because he
had failed once before and, further, anticipated rejection from his
classmates. We can be proactive in managing threats to ensure
that they do not occur and result in harm to us. Palmwood and
McBride (2019) found that threat appraisals result in both
cognitive depletion and emotional exhaustion.
3. Challenge. A situation is appraised as an opportunity rather than
an occasion for alarm. We are mobilized to struggle against the
obstacle, as with a threat, but our attitude is quite different.
Faced with a threat, we are likely to act defensively to protect
ourselves. Our defensiveness sends a negative message to the
environment: We don’t want to change; we want to be left alone.
 In a state of challenge, however, we are excited, expansive, and
confident about the task. The challenge may be an exciting and
productive experience for us. Palmwood and McBride (2019)
found that challenge appraisals can result in cognitive depletion
but not in emotional exhaustion. Because Dan has overcome
several setbacks in his drive to become a physician, he may feel
more excited and motivated to attain his goals. He might be more
aware of his resilience and feel more confident.

Stress has been measured in several ways (Aldwin & Wenner, 2009;
Lazarus, 2007). One of the earliest attempts to measure stress
consisted of a list of life events, uncommon events that bring about
some change in our lives—experiencing the death of a loved one,
getting married, becoming a parent, and so forth. The use of life
events to measure stress assumes that significant changes, even
positive ones, disrupt our behavioral patterns.

Stress has also been measured as daily hassles , common taxing

occurrences—standing in line waiting, misplacing or losing things,
dealing with troublesome coworkers, worrying about money,
microaggressions, and many more. It has been established that in
many cases, an accumulation of daily hassles takes a greater toll on
one’s coping capacities than do more severe but relatively rare life
events, for example, among professional first responders (Larsson et
al., 2016).

Sociologists and community psychologists also study stress by

measuring role strain —problems experienced in performing specific
roles, such as a romantic partner, caregiver, or employee. Research
on caregiver burden is one example of measuring stress as role
strain (Riffin et al., 2019). Biomedical researchers measure physical
stressors such as pain, noise stress, light stress, and cold and heat
stress (Du Preez et al., 2021).

Researchers have also developed measures of minority stress for

groups that have been discriminated against, marginalized, and
excluded. Williams et al. (1997) developed an Everyday
Discrimination Scale (EDS) to measure the accumulation of
discriminatory life events, asking respondents to report how often
they experienced nine different discriminatory actions: almost every
day, at least once a week, a few times a month, a few times a year,
less than once a year, and never. The scale was created to capture
the experience of racialized groups and continues to be widely used
to study discrimination against diverse social groups. Testa et al.
(2015) developed the Gender Minority Stress and Resilience
Measure for understanding the stress experienced by transgender
and other gender diverse individuals. Sue (2010) coined the phrase
microaggressions to refer to these everyday, subtle, intentional, or
unintentional interactions or behaviors that communicate some sort of
bias toward historically marginalized groups.

Social workers should be aware that as increasing emphasis is

placed on the deleterious effects of chronic or toxic stress on the
immune system, our attention and energies are diverted from the
possibility of changing societal conditions that create stress and
toward managing ourselves as persons who respond to stress. We
are often offered individual or biomedical solutions to situations that
are created by unjust structural arrangements. Social workers should
stay alert to the social nature of stress.

Stress and Crisis

A crisis is a major upset in our psychological equilibrium due to some

harm, threat, or challenge we cannot cope with (James & Gilliland,
2013). Writing about family crises, Boss (2006) proposes three
aspects of crisis: (1) the disturbance is overwhelming, (2) the
pressure is severe, and (3) the family system cannot function
adequately. The crisis poses an obstacle to achieving a personal or
group goal and cannot be overcome through usual methods of
problem solving. We temporarily lack the necessary knowledge for
coping or the ability to focus on the problem because we feel
overwhelmed. A crisis episode often results when we face a serious
stressor with which we have had no prior experience. It may be
biological (major illness), interpersonal (the sudden loss of a loved
one), or environmental (unemployment or a natural disaster such as a
flood or fire). Some researchers write about the “COVID-19 crisis era”
when families, communities, organizations, and social institutions had
to make many adaptations in a very rapid fashion (Bogin & Varea,
2020; Chen, 2022).

Crisis episodes occur in three stages:

1. Our level of tension increases sharply.

2. We try and fail to cope with the stress, which further increases
our tension and contributes to our sense of being overwhelmed.
We are particularly receptive to receiving help from others at this
stage.
3. The crisis episode ends either negatively (unhealthy coping) or
positively (successful management of the crisis).

Crises can be classified into three types (Kanel, 2018; Lantz & Walsh,
2007). Developmental crises occur when events in the normal flow of
life create dramatic changes that produce extreme responses.
Examples of such events include going off to college, graduating, the
birth of one’s child, a midlife career change, and retirement from
work. People may experience these crises if they have difficulty
negotiating typical developmental challenges. Situational crises refer
to uncommon and extraordinary events that a person has no way of
forecasting or controlling. Examples include physical injuries, sexual
assault, loss of a job, major illness, and the death of a loved one.
Existential crises are characterized by escalating inner conflicts
related to issues of purpose in life, responsibility, independence,
freedom, and commitment. Examples include remorse over past life
choices, feeling that one’s life has no meaning, and questioning one’s
fundamental values or spiritual beliefs.

Dan’s poor midterm grades during his first semester of taking courses
that would help him qualify for medical school illustrate some of these
points. First, he was overwhelmed by the negative emotions of anger
and sadness. Then, he occasionally retreated to church and his
hometown, where he received much-needed support from his friends,
mother, and sister. Finally, as the situation stabilized, Dan concluded
that he could try to change some of his behaviors to relieve his
academic-related stress.

Traumatic Stress

Although a single event may pose a crisis for one person but not
another, some stressors are so severe that they are almost
universally experienced as crises. The stress is so overwhelming that
almost anyone would be affected. Traumatic stress refers to events
involving actual or threatened death, severe injury, or sexual violation
of oneself or significant others (Basham, 2022). Aldwin and Wenner
(2009) identified three types of traumatic stress: natural (such as
flood, tornado, and earthquake) and technological (such as nuclear)
disasters; war and related problems (such as concentration camps);
and individual trauma (such as being raped, assaulted, or tortured).
Others have proposed a category of cultural trauma, which consists
of day-to-day verbal and physical assaults inflicted on members of
racialized and other marginalized groups (Basham, 2022). Basham
(2022) makes a distinction between impersonal and interpersonal
trauma.

The experience of trauma can be defined as an emotional state of

discomfort resulting from memories of a catastrophic experience that
shatters the person’s sense of protection from harm, rendering them
acutely vulnerable to stressors (Mahoney & Markel, 2016). The
trauma may be experienced as a single event (a traffic accident or
sexual assault), known as type 1 trauma. Others experience chronic
and repetitive traumatic events (as with ongoing child abuse, the
continual crises associated with refugee status, or cultural trauma),
known as type2 trauma or complex trauma. Still others experience
trauma as a secondary event, from knowing about the event
happening to a significant other person, known as secondary trauma.

It is important to make a distinction between traumatic events and the

responses to traumatic events. A traumatic stress response involves
a set of neurobiological reactions accompanied by strong emotional
reactions (Cozolino, 2014). In positive or tolerable stress situations,
the same physical reactions occur, but only temporarily and to a
lesser degree. They do not typically result in completely dismantling a
person’s inner world. It is essential to understand that the experience
of a traumatic event does not necessarily imply that the person will be
traumatized afterward. The precipitating event is always severe, but
the individual may have success coping with it based on available
supports and resources, such as friends and family, crisis counselors,
or constitutional hardiness (Lemma, 2010). Not all people respond to
traumatic stressors in the same way. Some experience a temporary
traumatic stress response, and others have long-term negative
reactions (Basham, 2022).

Social work’s interest in the effects of trauma on social functioning,

while always considerable, has increased over the past 20 years
because so much more has become known about its physical and
psychological effects and their association with potential long-term
adverse outcomes for those who experience it (Henshaw, 2022;
Mersky et al., 2019). Families, significant others, and in some cases
communities may be negatively affected (Goelitz, 2022; Sangalang &
Vang, 2016). The COVID-19 pandemic intensified growing attention
to the experience of shared trauma (Goelitz, 2022; Tosone, 2021). It
is important for social workers to have a general awareness of the
prevalence and symptoms of trauma reactions, routinely assess for
trauma exposure and symptoms, practice with sensitivity to trauma
triggers, and encourage client empowerment (Mersky et al., 2019).

This is not a chapter on the biological person, but it is helpful to briefly

review how trauma affects the body and the brain (Evans &
Coccoma, 2014; Rosenthal, 2020). Physiologically, intense stress
raises the levels of certain chemicals in the body that put the nervous
system in a state of high alert. Although helpful for managing stress,
high cortisol levels moving through the body make it hard for the
person to attend to important activities of daily living, such as
processing information, eating, or sleeping. Ideally, once the threat
has passed, the cortisol activity shuts down, enabling the body to
resume its prior state of effective functioning. In extreme conditions,
however, the cortisol fails to adequately shut down the body’s
responses to the trauma, leading to ongoing activation and negative
effects on the person’s emotional and physical states.
The heightened negative feelings and somatic processes induced by
stress are due to chaotic biochemical reactions in parts of the brain
responsible for processing social and emotional information, bodily
states, and attachment. The thalamus, in the midbrain, registers
messages as dangerous. The amygdala, in the higher brain, hijacks
ordinary processes of information processing and broadcasts
distress. The hippocampus, the center of emotional processing, is
flooded with emotionally laden stimuli laid down negatively as body
memories. Every cell in the body records memories, and every
trauma-embedded neuropathway can be repeatedly reactivated. The
sympathetic nervous system is responsible for the fight-or-flight
response. When this is activated, the body is primed for quick action
and may run or demonstrate considerable strength in response to a
threat. The parasympathetic system releases opioids that contribute
to decreased blood pressure and a state of numbness or emotional
paralysis. The simultaneous activation of all these systems produces
a state of frozen watchfulness and creates problems with self-
soothing and disorganized attachment. Some trauma survivors may
develop post-traumatic stress disorder (PTSD), which is discussed
later in this chapter.

Some occupations—particularly those of emergency workers such as

police officers, firefighters, disaster relief workers, and military
personnel in war settings—involve regular exposure to traumatic
events that most people do not experience in a lifetime. The literature
about the stress emergency workers face refers to these traumatic
events as critical incidents and their reactions as critical incident
stress (Kamena & Galvez, 2020; Pack, 2013). Emergency workers,
particularly police officers and firefighters, may experience threats to
their own lives and the lives of their colleagues, as well as encounter
mass casualties. Emergency workers may also experience
compassion stress, a feeling of deep sympathy and sorrow for
another stricken by misfortune, accompanied by a strong desire to
alleviate the pain (Kapoulitsas & Corcoran, 2015). Compassion
fatigue is a state of emotional exhaustion and a diminished ability to
feel compassion for others. Compassion satisfaction, pleasure and
satisfying feelings that come from helping others, is an antidote to
compassion fatigue. Any professionals who regularly work with
trauma survivors are susceptible to compassion stress. Many social
workers fall into this category. Health care providers were found to
have both compassion fatigue and compassion satisfaction during the
early days of the COVID-19 pandemic (Ruiz-Fernández et al., 2020).

Critical Thinking Questions 5.3

Why do you think we easily get diverted from thinking about societal
conditions that create stress and come, instead, to focus on helping
individuals cope with stress? How does such an approach fit with
social work’s commitment to social justice?

Coping Processes

Coping refers to the many ways humans respond to the various forms
of stress they encounter. At times, our response to stress can feel
automatic, instantaneous, and beyond our control. A better
understanding of the ways we cope with stress can help to demystify
these processes and may aid us to cope more effectively. One
method of coping is adaptation , which may involve adjustments in
our biological responses, perceptions, or lifestyle. As you consider
the variety of ways that we might cope with stress, you might envision
a physical response or behavior (e.g., you might be physically sick or
go for a run), you might have thoughts or ideas that pop into your
mind as a form of response (e.g., “I don’t like the looks of this” or “I
don’t know what I’m going to do”), you might feel your response first
(e.g., you feel a “wave of relief” or you might start to feel your “anger
rising”), or you might experience a spiritual response (e.g., you pray,
dance, or read a spiritual text). These four categories—
behaviors/actions, cognitions/thoughts, feelings/affect, and spirituality
—represent the ways in which we respond to stress. Of course, we
rarely have only one response to a stressor, so knowing these
categories can aid in unpacking the range of reactions we experience
in any stressful situation. These categories can be further broken
down to understand the processes associated with them.

Biological Coping Processes

The traditional biological view of stress and coping, developed in the
1950s, emphasizes the body’s attempts to maintain physical
equilibrium, or homeostasis , which is a steady state of functioning
(Baffy & Loscalzo, 2014; Selye, 1991). Stress is considered the result
of any demand on the body (specifically, the nervous and endocrine
systems) during perceived emergencies to prepare for fight
(confrontation), flight (escape), or freeze (non-response). A stressor
may be any biological process, emotion, or thought. In this view, the
body’s response to a stressor is called the general adaptation
syndrome . It occurs in three stages:

1. Alarm. The body first becomes aware of a threat.

2. Resistance. The body attempts to restore homeostasis.
3. Exhaustion. The body terminates coping efforts because of its
inability to physically sustain the state of disequilibrium.

The general adaptation syndrome is explained in Figure 5.1. In this

context, resistance has a different meaning than is generally used in
social work: an active, positive response of the body in which
endorphins and specialized cells of the immune system fight off
stress and infection. Our immune systems are constructed for
adaptation to stress, but the cumulative wear and tear of multiple
stress episodes can gradually deplete our body’s resources.
Common outcomes of chronic stress include stomach and intestinal
disorders, high blood pressure, heart problems, and emotional
problems. If only to preserve healthy physical functioning, we must
manage and prevent stress.
Description

Figure 5.1 The General Adaptation Syndrome

This traditional view of biological coping with stress came from

research that focused on males, either male rodents or human males.
Since 1995, the federal government has required federally funded
researchers to include a broad representation of both men and
women in their study samples. Consequently, recent research on
stress has included female as well as male participants, and gender
differences in responses to stress have been found.

Research suggests that females of many species, including humans,

respond to stress with “tend-and-befriend” rather than the “fight-or-
flight” behavior described in the general adaptation syndrome
(Cardoso et al., 2013; Steinbeis et al., 2015; Sunahara et al., 2022).
That is, under stressful conditions, females have been found to
protect and nurture their offspring and to seek social contact. The
researchers suggest a possible biological basis for this gender
difference in the coping response. More specifically, they note a large
role for the hormone oxytocin, which plays a role in childbirth but also
is secreted in both males and females in response to stress. High
levels of oxytocin in animals are associated with calmness and
increased sociability. Sunahara et al. (2022) also found support for
the connection between high oxytocin levels and the tend-and-
befriend response to stress in humans. Although males as well as
females secrete oxytocin in response to stress, there is evidence that
male hormones reduce the effects of oxytocin. This is thought to, in
part, explain the gender differences in response to stress. Basham
(2022) reports a similar response to stress in some Latino families, a
“pause-collect” response that involves seeking out loved ones to
protect. Both Basham (2022) and Sunahara et al. (2022) suggest a
likely cultural role in response to stress.

Research has also begun to examine processes of intergenerational

transmission as it relates to the biological process of stress and
coping. That is to say there is some evidence that parental exposure
to stress and biological coping processes may have implications for
physical, behavioral, and cognitive outcomes for offspring (Bowers &
Yehuda, 2020). Of course, biological processes are not the only
means of intergenerational transmission of stress and coping
responses. Children can also “learn” coping responses through
parenting style and other sources of social modeling that they
experience during development, passing coping characteristics on to
future generations as they integrate these models into their own
parenting style. Furthermore, parents and children may experience
the same or similar stressors in their environments (e.g., war,
financial insecurity, political instability). Regardless of the mechanism,
identifying the potential ripple effects of stress produced by
intergenerational transmission offers important insights for social
workers as they engage with families and support their coping efforts.

Psychological Coping Processes

From a psychological perspective, our response to stress may be
categorized in a few different ways. Some psychological theorists
consider coping ability to be a stable personality characteristic, or trait
; others see it instead as a transient state —a process that changes
over time, depending on the context (Cetinkaya et al., 2022; Fatima &
Tahir, 2013).

Those who consider coping to be a trait see it as an acquired

defensive style. Defense mechanisms are unconscious, automatic
responses that enable us to minimize perceived threats or keep them
out of our awareness entirely. Table 5.1 lists the common defense
mechanisms identified by ego psychology (discussed in Chapter 2).
Some defense mechanisms are considered healthier, or more
adaptive, than others. Dan Lee’s (Case Study 5.1) denial of his need
for intimacy, for example, did not help him meet his goal of
developing relationships with peers. But through the defense of
sublimation (channeling his need for intimacy into alternative and
socially acceptable outlets), he has been an effective and nurturing
tutor for numerous high school science students.

Table 5.1
Sources: Adapted from Goldstein, E. G. (1995). Ego psychology and
social work practice (2nd ed.). Free Press; Schamess, G., & Shilkret,
R. (2022). Ego psychology. In J. Berzoff, L. Flanagan, & P. Hertz
(Eds.), Inside out and outside in (5th ed., pp. 47–74). Rowman &
Littlefield.

Those who see coping as a state, or process, observe that our coping
strategies change in different situations. After all, our perceptions of
threats, and what we focus on in a situation, change. The context
also has an impact on our perceived and actual abilities to apply
effective coping mechanisms. From this perspective, Dan’s use of
denial of responsibility for relationship problems would be adaptive at
some times and maladaptive at others. Perhaps his denial of needing
support from classmates during the first academic semester helped
him focus on his studies, which would help him achieve his goal of
receiving an education. During the summer, however, when classes
are out of session, he might become aware that his avoidance of
relationships has prevented him from attaining interpersonal goals.
His efforts to cope with loneliness might also change when he can
afford more energy to confront the issue.

The trait and state approaches can usefully be combined. We can

think of coping as a general pattern of managing stress that allows
flexibility across diverse contexts. This perspective is consistent with
the idea that cognitive schemata develop through the dual processes
of assimilation and accommodation, described in Chapter 4.

As an alternative to trait and state, another psychological approach to

understanding coping involves categorizing responses in relation to
what they primarily aim to accomplish. Lazarus and Folkman (1984)
proposed that our coping responses can generally be divided into two
broad categories of problem-focused and emotion-focused coping,
depending on whether our response is geared more toward altering
the source of distress (problem-focused coping ) or regulating the
emotional response that has been triggered (emotion-focused coping
). Building on this work, and recognizing that many of our reactions
reflect a mixture of both problem- and emotion-focused responses,
Stanisławski (2019) suggests a multiaxial model, the coping
circumplex model, which situates problem-focused and emotion-
focused coping each on their own axis perpendicularly dissecting
each other. The problem-focused axis spans between a problem-
solving pole and a problem-avoiding pole, while the emotion-focused
axis spans between positive emotional coping and negative
emotional coping. Table 5.2 outlines the coping styles produced by
these two intersecting axes, with a brief description of each and a
corresponding cognitive message associated with this style. The
dissecting axes then suggest general coping styles based on a
response’s orientation to each axis. Some of these coping styles may
be more effective in resolving sources of distress, while others are
better adapted for supporting our emotional well-being. Depending on
circumstances, one or both of these areas may be vital for our self-
preservation.

Table 5.2
Source: Adapted from Stanisławski, K. (2019). The coping circumplex
model: An integrative model of the structure of coping with stress.
Frontiers in Psychology, 10, 694.

Social Coping Processes

We will spend a bit of time here with social coping processes; this is
especially important given the attention that social workers pay to the
power of relationships. Thus far our discussion of biological and
psychological processes has centered on understanding individual
responses to stressors. However, coping with stress doesn’t end with
the individual; we also utilize social or interpersonal processes in
coping. While U.S. culture tends to prioritize individualism and self-
reliance, relational coping takes into account actions that maximize
the survival of others—such as our families, children, and friends—as
well as ourselves (Bekteshi & Kayser, 2013). Feminist theorists
propose that women are more likely than men to employ the
relational coping strategies of negotiation and forbearance, and some
research gives credence to the idea that women are more likely than
men to use relational coping (e.g., Kim et al., 2014). As a subset of
relational coping, dyadic coping specifically examines the ways in
which couples either support each other in their coping or engage in
joint coping efforts (Bodenmann et al., 2019). Communal coping
situates coping in the broader social context in which a shared stress
is experienced and responded to. Communal coping requires that a
group of individuals collectively: (1) appraise a stressor and the
responsibility to respond to it, (2) communicate about the stressor
and how to respond, and (3) take joint action to address the stressor
(Afifi et al., 2020).

It is important to recognize that all of us use any or several of these

mechanisms at different times. None of them is any person’s sole
means of managing stress. As social workers, we must be careful not
to assume that one type of coping is superior to another. Power
imbalances and social forces such as ableism, cis-heteronormativity,
racism, and sexism affect the coping strategies of individuals. We
need to give clients credit for the extraordinary coping efforts they
may make in hostile environments. We might note that Dan used
many problem-focused coping strategies to manage stressors at the
university, even though he was mostly ineffective because of the
specific strategies he used. For example, he directly confronted his
peers, teachers, family members, and social worker, and he also tried
with limited success to control his moods through force of will.

Given the conceptualizations of self presented in Chapters 2 and 4 in

this book, it is helpful to review a stress/coping model that focuses on
the tripartite self (Gaertner et al., 2012; Hardie, 2005). This model
proposes that the self includes three domains—the relational
(experiencing the self most fully in relationships), individual (a strong
sense of independence, autonomy, and separateness), and collective
(a preference for social group memberships)—and that the relative
strength of a person’s self-domains will guide their preferences for
coping styles. Those with a well-developed self in all three domains
will possess a full range of coping options, and those with a more
limited self-experience will have fewer. A person with a sense of self
that encompasses three domains will also experience more sources
of stress, but this model suggests that when a source of stress
matches one’s developed self-domain, coping will be most effective.
That is, if a highly relational person experiences relational stress
(such as a conflict with a friend), they will be inclined to address the
issue in a manner that is likely to be effective. Dan Lee, on the other
hand, has a stronger sense of an “independent” self than others, so
when he experiences interpersonal conflict, his range of available
coping strategies is limited due to the mismatch. Although Dan is
attached to persons from his cultural group, he has a limited sense of
a broader collective self and thus tends to have limited judgment or
skill in how to deal with conflict with representatives of other social
groups (including his school peers).

The Nature of Social Support

In coping with the demands of daily life, our social supports—the

people we rely on to enrich our lives—can be invaluable. Social
support has many definitions, but it can be understood as the
interpersonal interactions and relationships that provide us with
assistance or feelings of attachment to persons we perceive as caring
(Razurel et al., 2013). The following are three types of social support
resources worthy of a social work provider’s attention (Walsh, 2000):

1. Material support: food, clothing, shelter, and other concrete items

2. Emotional support: interpersonal support
3. Instrumental support: services provided by casual contacts such
as grocers, hairstylists, and landlords

Some authors add “social integration” support to the mix, which refers
to a person’s sense of belonging. That is, simply belonging to a
group, and having a role and contribution to offer, may be an
important dimension of support (Lu & Hampton, 2017). This is
consistent with the “main effect” hypothesis of support, discussed
shortly.

Our social network includes not just our social support but all the
people with whom we regularly interact and the patterns of interaction
that result from exchanging resources with them (Gillieatt et al.,
2015). Members of your own social network might include some
student peers, your coworkers, the school librarians, and the
Starbucks barista. Network relationships often occur in clusters
(distinct categories such as nuclear family, extended family, friends,
neighbors, community relations, school, work, church, recreational
groups, and professional associations). Network relationships are not
synonymous with support; they may be negative or positive. But the
scope of the network does tend to indicate our potential for obtaining
social support. Having supportive others in a variety of clusters
indicates that we are supported in many areas of our lives, rather
than being limited to relatively few sources. Our personal network
includes those from the social network who, in our view, provide us
with our most essential supports (Bakker et al., 2022; Ellwardt et al.,
2015).

Table 5.3 displays Dan Lee’s social network. He is supported

emotionally as well as materially by his family members, with whom
he keeps in regular contact, although the relationship with his father
is strained. Dan particularly looks to his sister for understanding and
emotional support, while at the same time being critical of her failure
to be adequately supportive of him. Dan does not see his
grandmother except for the trips he takes to China every 3 or 4 years,
but he feels a special closeness to her and writes to her regularly.
Dan has had an on-again, off-again relationship with his girlfriend
Christine, who lives 1 hour away in his hometown and keeps in touch
with him primarily by e-mail and text messaging. Their
communications are civil, and Dan seems to enjoy giving her advice
when she needs to make certain decisions about her jobs and daily
living activities. Dan has instrumental relationships with his landlord
and several other tenants in his apartment building, and one neighbor
is a friend with whom he has lunch or dinner every few weeks. Dan is
further instrumentally connected with several other students because
they represent consistency in his life and are casually friendly and
supportive. This is also true of two peers with whom he performs
volunteer work. It is apparent from Dan’s social network that he
receives most of his emotional support from peers at the church
where he attends services and social activities every Sunday.

Table 5.3
* = Identified as close personal support.

In total, Dan has 19 people in his social support system, representing

seven clusters. He identifies 9 of these people as personal, or
primary, supports. It is noteworthy that 7 of his network members
provide only instrumental support, which is important but the most
limited type. We cannot determine based on numbers whether Dan’s
support system is adequate to meet his needs, because people are
very different in the desired nature of their supports. Still, the social
worker might explore with Dan his school, neighborhood, and work
clusters for the possibility of developing more active or meaningful
supports.

If Dan has an inadequate support network, he is not alone. A

longitudinal study of 38,300 adults from 13 European countries found
that over 70% of the sample reported a social network size of four or
fewer close social ties. It is well established that persons across the
life span who experience a lack of adequate social support are at risk
for many adverse health consequences, including an earlier death
(Holt-Lunstad et al., 2015). Interestingly, feelings of loneliness and
social isolation take a greater emotional toll on younger adults
compared to those over 65. Social network size is associated with
overall mental health as well as suicidal thoughts and behaviors, with
better mental health outcomes associated with larger social network
size (Arenson et al., 2021; Santini et al., 2021; Taylor et al., 2022).
These research findings have implications for social work
assessment and intervention.

Virtual Support

We don’t need to tell you, of course, that much social support is now
provided through connective technologies that allow people to be in
contact without being physically present with one another. Facebook,
Skype, Zoom, e-mail, blogging, Instagram stories and reels, tweets,
and texts put people in touch with one another instantaneously,
regardless of where they are or what they are doing. There is much to
be admired about these developments, and they clearly allow us to
be in touch with significant others we might never otherwise see.
They were a lifeline for maintaining social connection during the
COVID-19 time of “social distancing.” Connective technologies also
create the potential for us to reduce the frequency of, and even our
desire for, face-to-face contacts and thus redefine the nature of
relationships, support, and intimacy. Indeed, the number of people
with whom people physically interact has fallen in recent years, and
research has produced mixed findings regarding the effects of social
media use on perceived social support. For example, in two large-
scale national studies conducted before the COVID-19 pandemic, it
was found that social media contacts produced an increased
perception of social support for many, but not all, people and that the
heaviest users of social media may in fact perceive less support than
those with less frequent use (Lu & Hampton, 2017; Shensa et al.,
2016). It is not yet clear how effective virtual support was during the
COVID-19 pandemic or what the long-term outcome of public health
practices will be in terms of the mix of face-to-face and virtual support
in people’s lives. We do know that social workers and other
professionals found new uses of communication technology as they
supported individuals, families, and communities during the
pandemic. We also know that we will continue to wrestle with the
implications that these technologies hold for issues like quality of
care, professional ethics, accessibility, and equity far into the future.

Dan Lee, like many of his peers, spent several hours per day on the
Internet communicating with others; in his case it was primarily
through e-mail. Spencer believed this was a mixed blessing for his
client, because although it did help Dan feel connected to his support
system, it prevented any efforts he might otherwise expend for
intimate interaction with people whose lives physically intersected
with his own. Turkle (2011, 2015), among others, is concerned about
the unpredictable ways social technology may alter the nature of our
relationships. As one disconcerting yet very real example of this
process, she writes at length about the coming use of robots to
provide people with major interpersonal support, existing as their full-
time companions. She is also concerned about the use of electronic
communication as a substitute for face-to-face interaction, arguing
that face-to-face interaction is “where we develop the capacity for
empathy” (Turkle, 2015, p. 3).

How Social Support Aids in Coping

As noted earlier, the experience of stress creates a physiological
state of emotional arousal, which reduces the efficiency of our
cognitive functions. When we experience stress, we become less
effective at focusing our attention and scanning the environment for
relevant information. We cannot access the memories that normally
bring meaning to our perceptions, judgment, planning, and integration
of feedback from others. These memory impairments reduce our
ability to maintain a consistent sense of identity.

Social support helps in these situations by acting as an “auxiliary

ego.” Our social support—particularly our personal network—
compensates for our perceptual deficits, reminds us of our sense of
self, and monitors the adequacy of our functioning. Here are 10
characteristics of effective support (Caplan & Caplan, 2000):

1. Nurtures and promotes an ordered worldview

2. Promotes hope
3. Promotes timely withdrawal and initiative
4. Provides guidance
5. Provides a communication channel with the social world
6. Affirms one’s personal identity
7. Provides material help
8. Contains distress through reassurance and affirmation
9. Ensures adequate rest
10. Mobilizes other personal supports

Some support systems are formal (service organizations), and some

are informal (such as friends and neighbors). Religion, which attends
to the spiritual realm, also plays a distinctive support role. This topic
is explored in Chapter 6.

Two schools of thought have emerged around the question of how we

internalize social support (Gottlieb & Bergen, 2010; Venkatesh et al.,
2022).

1. Main effect model. Support is seen as related to our overall

sense of well-being. Social networks provide us with regular
positive experiences, and within the network a set of stable roles
 (expectations for our behavior) enables us to enjoy stability of
mood, predictability in life situations, and recognition of self-
worth. We simply don’t experience many potential stressors as
such, because with our built-in sense of support, we do not
perceive situations as threats.
2. Buffering model. Support is seen as a factor that intervenes
between a stressful event and our reaction. Recognizing our
supports helps us to diminish or prevent a stress response. We
recognize a potential stressor, but our perception that we have
resources available redefines the potential for harm or reduces
the stress reaction by influencing our cognitive, emotional, and
physiological processes.

Most research on social support focuses on its buffering effects, in

part because these effects are more accessible to measurement.
Social support as a main effect is difficult to isolate because it is
influenced by, and may be an outcome of, our psychological
development and ability to form attachments. The main effect model
has its roots in sociology, particularly symbolic interaction theory, in
which our sense of self is said to be shaped by behavioral
expectations acquired through our interactions with others. The
buffering model, more a product of ego psychology, conceptualizes
social support as an external source of emotional, informational, and
instrumental aid.

Perceived support is consistently linked to positive mental health,

which is typically explained as resulting from objectively supportive
actions that buffer stress. Yet this explanation does not fully account
for the often-observed main effects between support and mental
health. Relational regulation theory hypothesizes that main effects
occur when people regulate their affect, thoughts, and actions
through ordinary, yet affectively consequential, conversations and
shared activities, rather than through conversations about how to
cope with stress (Lakey et al., 2016, 2022). This form of regulation is
primarily relational in that the types of people and social interactions
that help recipients are mostly a matter of personal taste. Dan Lee
reports that he receives emotional support from nine people, but he is
not necessarily drawn to these people to the same degree, which is
partly why he does not experience adequate social support.

How Social Workers Evaluate Social Support

There is no consensus about how social workers can evaluate a

client’s level of social support. The simplest procedure is to ask for
the client’s subjective perceptions of support from family and friends
(Tinajero et al., 2015). An example of a more complex procedure
involves measuring eight indicators of social support: available
listening, task appreciation, task challenge, emotional support,
emotional challenge, reality confirmation, tangible assistance, and
personal assistance (Rosenfeld & Richman, 2003). One practical
model for social work practice includes three social support indicators
(Uchino, 2009):

1. Listing of social network resources. The client lists all the people
with whom they regularly interact.
2. Accounts of supportive behavior. The client identifies specific
episodes of receiving support from others in the recent past.
3. Perceptions of support. The client subjectively assesses the
adequacy of the support received from various sources.

In assessing a client’s social supports from this perspective, the

social worker first asks the client to list all persons with whom they
have interacted in the past 1 or 2 weeks. Next, the social worker asks
the client to draw from that list the persons they perceive to be
supportive in significant ways (significance is intended to be open to
the client’s interpretation). The client is asked to describe specific
recent acts of support provided by those significant others. Finally,
the social worker asks the client to evaluate the adequacy of the
support received from specific sources and in general. On the basis
of this assessment, the social worker can identify both subjective and
objective support indicators with the client and target underused
clusters for the development of additional social support. Social
workers also might consider combining these assessment measures
with other tools such as ecomaps, introduced in Chapter 10 of this
book, that aid in visualizing the social network within which families
are situated.

Spiritual or Religious Coping Processes

Spiritual or religious coping is another means of responding to stress

that involves making meaning, finding purpose, and seeking
connection with values, beliefs, and a sense of faith and/or faith
community. This form of coping may be especially important or
relevant based on cultural or familial beliefs, perceived nature of the
stress (e.g., is the stress attributed to divine or spiritual forces),
understanding of how the stress may be resolved (e.g., is there some
form of action that we can take or is it beyond our control and
requiring omnipotent intervention), and understanding of what the
resolution might look like (e.g., mindful acceptance, some form of
healing).

Religious coping is often broadly categorized into positive religious

coping and negative religious coping (Abu-Raiya & Pargament, 2015;
Xu, 2016). Positive religious coping reflects a sense of confidence,
connectedness, and coherence in beliefs and religious relationships,
including relationship to the divine. Negative religious coping includes
intrapersonal, interpersonal, and divine struggles, questions, and
conflicts regarding religious ideas, practices, and relationships.
However, critics of this dichotomization caution that a holistic model
of spiritual coping recognizes that elements from both of these
categories may interact with each other in dynamic and complex
ways. Social workers seeking to assess spiritual coping should
engage with clients to arrive at an in-depth and subjective
understanding of the role of spiritual or religious coping in clients’
lives (Xu, 2016).

In their study of religious coping of African refugees, Adedoyin and

colleagues (2016) developed a typology of coping strategies that
included organized religious activities (ORAs; e.g., services,
celebration of religious holiday and sacraments), private religious
activities (PRAs; e.g., prayer, observance of rituals), and sense of
religiosity (the psychological and emotional connection to religious
feelings or beliefs). As social workers, these categories may be
particularly helpful as we explore the role that religious coping plays
in the lives of our clients. In reviewing Dan Lee’s case, ORAs appear
to be quite an important source of coping for Dan and a valued social
outlet. Dan may reveal that PRAs are also very important to him, but
this is not yet clear based solely on the case description provided.

Critical Thinking Questions 5.4

1. Are there forms of religious or spiritual coping that you have

employed? If so, would you categorize these as positive or
negative religious coping, or do they not fit neatly into either
category? How might your experience or lack of experience with
religious or spiritual coping impact how you explore this with
clients in the helping relationship? How might you approach
religious or spiritual coping in your work with Dan?
2. How important is virtual support to you? Which types of virtual
support are the most meaningful to you? What have you
observed about how technology is affecting the way people give
and receive social support?

Coping and Traumatic Stress

People exhibit some similarities between the way they cope with
traumatic stress (described earlier) and the way they cope with
everyday stress, but there are some significant differences (Kramer &
Landolt, 2010; Szabo et al., 2017). Because people tend to have
much less control in traumatic situations, their primary emotion-
focused coping strategy is emotional numbing, or the constriction of
emotional expression. They also make greater use of the defense
mechanism of denial. Confiding in others and the search for meaning
take on greater importance, and transformation in personal identity is
common. Further, the process of coping tends to take a much longer
time, months or even years.

Although there is evidence of long-term negative consequences of

traumatic stress, trauma survivors sometimes report positive
outcomes as well. Studies have found that 34% of Holocaust
survivors and 50% of rape survivors report positive personal changes
following their experiences with traumatic stress (Koss & Figueredo,
2004). A majority of children who experience such atrocities as war,
natural disasters, community violence, physical abuse, catastrophic
illness, and traumatic injury also recover, demonstrating their
resilience (Husain, 2012; Le Brocque et al., 2010).

Recent research indicates that almost one-third of people with severe

traumatic experiences develop a set of symptoms known as post-
traumatic stress disorder (PTSD) (Peraica et al., 2022). These
symptoms include the following (American Psychiatric Association,
2022; World Health Organization, 2019):

Recurrent, involuntary, and intrusive distressing memories of the

traumatic event(s); recurrent distressing dreams associated with
the traumatic event(s); dissociative reactions (e.g., flashbacks)
where the person feels as if they are reliving aspects of the
traumatic event(s); psychological or physiological reactions to
internal or external cues associated with the traumatic event(s)
Persistent avoidance of things associated with the traumatic
event(s); this can be psychological or physical avoidance
Negative alterations in cognition or mood after the event, such as
memory problems, negative emotions, distorted beliefs about the
event (such as self-blame), diminished interest in significant
activities, feeling detached/estranged from others, and inability to
experience positive emotions
Changes in arousal and reactivity associated with the traumatic
event(s): difficulty sleeping, irritability, difficulty concentrating,
hypervigilance, reckless or self-destructive behavior,
exaggerated startle response

Four categories of risk and protective factors for PTSD have been
identified in the research literature: sociodemographic factors, pre-
trauma factors, peri-trauma factors, and post-trauma factors. There is
some overlap of the sociodemographic factors and pre-trauma
factors. Identified sociodemographic and pre-trauma risk factors
include female gender, previous traumatic experiences, cognitive
inflexibility, problems with emotion regulation, and economic instability
(Di Crosta et al., 2020; Peraica et al., 2022; Schultebraucks et al.,
2021). In civilian groups, younger age has been found to be a risk
factor for PTSD, and older age has been found to be a risk factor in
military samples (Dalenberg, 2014; Peraica et al., 2022). Several
peri-trauma factors related to the traumatic event put a person at risk
for PTSD, including a higher degree and intensity of exposure to the
event, a higher degree of physical violation, longer duration of the
event, greater frequency of the experience, a greater sense of
unpredictability and vulnerability, a closer relationship with the
offender (if there is one), and an unsupportive social environment
(Dalenberg, 2014). Adequate social support and economic stability
are major post-trauma protective factors (Di Crosta et al., 2020;
Peraica et al., 2022).

The majority of people who develop PTSD develop the symptoms

during the first week or month following the traumatic exposure, but a
significant minority of people have a delayed trajectory in meeting
diagnostic criteria for PTSD (Bonde et al., 2022; Smid et al., 2022;
Yang et al., 2021). Studies have found that about 25% of cases of
PTSD among combat veterans involve a delayed trajectory, while the
prevalence of delayed-onset PTSD is about 10% among survivors of
natural disasters (Peraica et al., 2022; Yang et al., 2021). Delayed-
onset PTSD is about twice as common among combat veterans,
firefighters, rescue workers, and police compared to other
populations (Peraica et al., 2022). Delayed-onset PTSD can involve a
delay in the appearance of first symptoms or a delay in fulfilling all of
the criteria for a PTSD diagnosis (Bonde et al., 2022). Exposure to
stressful events in the period following the primary traumatic
experience puts one at risk for delayed PTSD (Bonde et al., 2022;
Smid et al., 2022). Exposure to traumatic stressors increases
reactivity to subsequent stressors, a process that involves several
neurobiological structures and processes, including the hippocampus,
amygdala, prefrontal cortex, autonomic nervous system, and the
hypothalamic-pituitary-adrenocortical axis, and neuroendocrine
(hormone) mechanisms (Smid et al., 2022).
A person who experiences significant trauma may benefit from social
work interventions that attend to both the cognitive and emotional
aspects of mental life discussed in Chapter 4 (McCrea et al., 2016).
The goal of intervention should be to help the person move from a
state of relative fear and powerlessness to one of positive agency
and heightened assertiveness. It is essential for the social worker to
first develop a relationship of trust with the person and provide a safe
and secure base from which they can begin to face the trauma.
Through the recognition of appropriate social supports and gradual
encouragement of affective expression, the client may begin to regain
a sense of emotional control. The client can learn to manage the
negative physical sensations associated with feelings of stress
through relaxation and other mindfulness exercises. Eventually the
person will feel secure enough to become able to reflect on the
trauma and its meaning more directly. The social worker can help the
client become aware of the differences between safe and unsafe
situations, develop new self-care skills, practice safety skills, learn
and practice appropriate problem-solving and emotional coping skills,
and become better able to face feared situations through exposure.
Cognitive behavioral therapy (CBT), eye movement desensitization
reprocessing (EMDR), cognitive processing therapy, and prolonged
exposure therapy have all been found to be effective interventions
with people with PTSD (American Psychological Association, 2020;
de Jongh et al., 2019).

Perspectives on Coping

A variety of disciplines can help us to understand the act of coping

from many different lenses. Below, we will consider how a number of
different perspectives frame coping, including medicine, psychology,
sociology, anthropology, public health, and of course, social work.
None of these perspectives offer us a complete understanding of
coping, but all offer valuable information.

Before considering these various perspectives, it is worth thinking

about how these disciplines help us, as social workers, to assess
coping in our work with clients. A central concept for this assessment
is normality. Normality is characterized by conformity with one’s
community and culture. We can be deviant from some social norms,
so long as our deviance does not impair our reasoning, judgment,
intellectual capacity, and ability to make personal and social
adaptations (Rashed & Bingham, 2014). Most people readily assess
the coping behaviors they observe in others as “normal” or
“abnormal.” But what does normal mean? We all apply different
criteria. The standards we use to classify coping thoughts and
feelings as normal or abnormal are important, however, because they
have implications for how we view ourselves and how we behave
toward those different from us (Francis, 2013). For example, Dan Lee
was concerned that other students at the university perceived him as
abnormal because of his ethnicity and social isolation. Most likely,
other students did not notice him much at all. It is interesting that, in
Dan’s view, his physical appearance and demeanor revealed him as
abnormal. However, he was one of many Asian American students at
the university, and his feelings were not as evident to others as he
thought.

Social workers struggle just as much to define normal and abnormal

as anybody else, but our definitions may have greater consequences.
Misidentifying someone as normal who has a mental illness may
forestall needed interventions or access to certain resources;
misidentifying someone as abnormal may create a stigma or become
a self-fulfilling prophecy. The perspectives that follow can offer us
guidance in assessing coping, especially given that many of the
systems in which social workers practice (e.g., health care, schools,
child welfare) require labels attached to this idea or designation of
normal and abnormal. However, it is also worth noting that many
liberatory perspectives still reject labels of normal and abnormal, and
connect them with power, control, and oppression. Alternatives to the
designation of normal and abnormal coping such as effective and
ineffective coping, where effective and ineffective are subjectively
defined by clients in ways that are meaningful to them, may offer
another option, but may not meet specific institutional requirements.

Medical (Psychiatric) Perspective

One definition from psychiatry, a branch of medicine, states that we
are normal when we are in harmony with ourselves and our
environment. Significant abnormality in perceived thinking, behavior,
and mood may even classify as a mental disorder. In fact, the current
definition of mental disorder used by the American Psychiatric
Association (2022), which is intended to help psychiatrists and many
other professionals distinguish between normality and abnormality, is
a “syndrome characterized by clinically significant disturbance in an
individual’s cognition, emotion regulation, or behavior that reflects a
dysfunction in the psychological, biological, or developmental
processes underlying mental functioning” (p. 14). Such a disorder
usually represents significant distress in social or occupational
functioning. According to this definition, we clearly get the sense that
a person’s coping response becomes data for assessing if there is a
problem or pathology to be addressed or not. This represents a
medical perspective, only one of many possible perspectives on
human behavior, although it is a powerful, socially sanctioned one.
The medical definition focuses on underlying disturbances within the
person and is sometimes referred to as the disease model of
abnormality. This model implies that the abnormal person must
experience changes within the self (rather than create environmental
change) in order to be considered “normal” again.

In summary, the medical model of abnormality focuses on underlying

disturbances within the person. An assessment of the disturbance
results in a diagnosis based on a cluster of observable symptoms.
Interventions, or treatments, focus on changing the individual. The
abnormal person must experience internal, personal changes (rather
than induce environmental change) in order to be considered normal
again. Table 5.4 summarizes the format for diagnosing mental
disorders as developed by psychiatry in the United States and
published in the Diagnostic and Statistical Manual of Mental
Disorders (American Psychiatric Association, 2022). Many people in
the helping professions are required to follow this format in mental
health treatment facilities, including social workers. However, there is
growing resistance to the historical and contemporary use of the DSM
in “the disproportionate labeling of Black, Indigenous and People of
Color as violent or severely mentally ill” (Riquino et al., 2021, p. 750),
perpetuating structural racism through medical institutions and
practices. Riquino and colleagues (2021) advocate for the use of a
transdiagnostic perspective in assessment as an alternative to the
traditional categorical classification driven by a diagnostic label. A
transdiagnostic perspective seeks to “identify symptoms or traits that
underlie human suffering that occur across diagnostic categories and
are informed by macro systems of privilege and oppression” (p. 750).
This perspective better situates the person (and their symptoms) in
the environment(s) in which they occur and acknowledges the
socially constructed barriers to well-being that many people
experience.

Table 5.4

Psychological Perspective

One major difference between psychiatry and psychology is that

psychiatry tends to emphasize biological and somatic interventions to
return the person to a state of normalcy or baseline/premorbid
functioning. Psychology emphasizes various cognitive, behavioral, or
reflective interventions. That is, through their own decisions and
determination, and sometimes with the help of a professional, the
person can change certain problematic (abnormal) characteristics
into more adaptable, functional (normal) ones.

Psychological theory is quite broad in scope, but some theories are

distinctive in that they postulate that people normally progress
through a sequence of life stages. The time context thus becomes
important. Each new stage of personality development builds on
previous stages, and any unsuccessful transitions can result in
abnormal behavior—that is, a deviant pattern of coping with threats
and challenges. An unsuccessful struggle through one stage implies
that the person will experience difficulties in mastering subsequent
stages.

One life stage view of normality well known in social work is that of
Erik Erikson (1968), who proposed eight stages of normal
psychosocial development (see Table 5.5). Dan Lee, at age 24, is
struggling with the developmental stage of young adulthood, in which
the major issue is intimacy versus isolation. Challenges in young
adulthood include developing a capacity for interpersonal intimacy as
opposed to feeling socially empty or isolated within the family unit.
According to Erikson’s theory, Dan’s current difficulties would be
related to his lack of success in negotiating one or more of the five
preceding developmental phases or challenges, and reviewing this
would be an important part of his intervention.

Table 5.5
From this perspective, Dan’s experience of stress would not be seen
as abnormal, but his inability to make coping choices that promote
positive personal adaptation would signal psychological abnormality
that impacts his current functioning. For example, at the university, he
was having difficulty with relationship development and support
seeking. He avoided social situations such as study groups,
recreational activities, and university organizations in which he might
learn more about what kinds of people he likes, what interests he
might share with them, and what insecurities they might share as
well. From a stage theory perspective, Dan’s means of coping with
the challenges of intimacy versus isolation might be seen as
maladaptive, or abnormal.

Sociological Perspective

The field of sociology situates people in the broader context of society

to understand both individual and interpersonal interactions. Social
capital is an important concept in understanding a sociological
perspective toward coping. Social capital can be understood as the
(access to) resources that people possess as a result of institutional
and other levels of social relationships (Bourdieu, 1986). This access
to resources can also mean the power to make or influence
decisions. As you might imagine, having a lack of social capital could
limit options for coping, while having greater social capital can open
up opportunities for accessing coping resources. We often obtain
social capital by virtue of the systems of social connections that we
are raised in, although we certainly can gain social capital by
association with new groups and new roles that we may take on in
our life. As you think about Dan Lee’s case, how might you assess
his social capital? How do you imagine that his social capital might
influence his access to resources as he copes with his current
circumstances?

Sociology also offers a variety of approaches to the study of

abnormality, or deviance, one of which is derived from symbolic
interactionism. It states that those who cannot constrain their
behaviors within role limitations that are acceptable to others become
labeled as deviant. Thus, deviance is a negative label assigned when
one is considered by a majority of significant others to be in violation
of the prescribed social order (Mustaine, 2015). Put more simply, we
are unable to grasp the perspective from which the deviant person
thinks and acts; the person’s behavior does not make sense to us.
We conclude that our inability to understand the other person’s
perspective is due to that person’s shortcomings rather than to our
own rigidity, and we label the behavior as deviant. The deviance label
may be mitigated if the individual accepts that they should think or
behave otherwise and tries to conform to the social order. It should be
emphasized, however, that sociologists are increasingly using the
term positive deviance to describe those persons whose outstanding
skills and characteristics make them “outliers” in a constructive sense
(LeMahieu et al., 2017).

From this viewpoint, Dan Lee would be perceived as abnormal, or

deviant, only by those who had sufficient knowledge of his thoughts
and feelings to form an opinion about his allegiance to their ideas of
appropriate social behavior. He might also be considered abnormal
by peers who had little understanding of his Asian American cultural
background. Those who knew Dan well might understand the basis
for his negative thoughts and emotions and, in that context, continue
to view him as normal in his coping efforts. However, it is significant
that Dan was trying to avoid intimacy with his university classmates
and work peers so that he would not become well known to them.
Because he still views himself as somewhat deviant, he wants to
avoid being seen as deviant (or abnormal) by others, which in his
view would lead to their rejection of him. This circular reasoning
poorly serves Dan’s efforts to cope with stress in ways that promote
his personal goals.

Another important sociological concept for understanding coping is

socialization. Socialization is the process(es) through which we
become aware of and internalize the norms, values, and ideals of
society, including acceptable ways of coping with stress. However,
these processes are not experienced the same way by everyone. For
instance, Anderson and Stevenson (2019) have explored the process
of racial socialization (RS) through which racialized parents and
communities prepare youth for future discriminatory racial encounters
(DREs) in efforts to help protect against the harmful impact of these
experiences. It is important to consider how these socialization
processes might look different from our own if we don’t belong to
racialized or other marginalized communities.

Anthropological Perspective

In the United States, we have widely adopted an individualist

orientation in society, that is to say that we emphasize and prioritize
the rights of each individual and the importance of personal
achievement. However, in many parts of the world and even for
groups of people within the United States, worldview is shaped by a
collectivist orientation that emphasizes and prioritizes belonging to
community and collective responsibility to each other over the
individual experience. As you might imagine, these two orientations
or worldviews have very different perspectives on coping. An
anthropological perspective can help us to compare and contrast how
individualist and collectivist societies deal with different forms of
stress.

Long (2020) contrasts these worldviews in relation to our response to

the COVID-19 pandemic. Social distancing has been a key public
health strategy to slow the transmission and spread of the pandemic,
and for our purposes we can think of this as a behavioral coping
response to the stress presented by COVID-19. While being
positively associated with a slowed COVID-19 transmission, social
distancing also led to increased feelings of isolation, depression, and
anxiety for many and a decreased sense of overall mental health and
well-being (Marroquín et al., 2020; Viner et al., 2022). Long (2020)
argues that rather than emphasizing social distancing, public health
policy could just as easily endorse social containment. While both
emphasize the need to conscientiously attend to our interpersonal
interactions, social distancing emphasizes pervasive limiting of our
contact with others; social containment suggests that we thoughtfully
and intentionally plan our social relationships so they are a tool to
help protect against disease spread and preserve valuable social
connections. Distancing accentuates separation (individualistic) while
containment underscores keeping important social relationships intact
(collectivist). This anthropological framing of societal behavioral
responses can be very important for guiding more inclusive and
potentially more effective public health policy and campaigns for
shaping coping behaviors.

Since anthropology is concerned with the study of humanity and its

evolution over time, the context of normal and abnormal is largely
framed in an adaptive context. Does a coping strategy help the
person or group adapt and thrive in their current circumstances or is it
maladaptive? Applying this adaptive lens, coping may be impacted
when different cultures come in contact, such as with migration. As
families move from one country to another, they will likely encounter
different ways of coping and different societal expectations about
“acceptable coping” in their receiving country, compared to their
country of origin. Fox and colleagues (2017) suggest that
understanding these families’ acculturation experience and a host of
sociocultural factors associated with acculturation (e.g., ethnocultural
composition of the receiving country and country of origin,
experiences with discrimination, attitudes toward assimilation) can
impact how immigrant families both experience and respond to
stress.

Public Health Perspective

The American Public Health Association (APHA) defines the scope of

public health as “promoting and protecting the health of people and
the communities where they live, learn, work and play” (APHA, 2022).
A public health focus encourages us to broaden our attention from a
sole focus on treatment to an emphasis on prevention and promotion
of wellness. Furthermore, it emphasizes interventions that are public
serving—seeking to reach and influence large groups of people,
rather than individually delivered. Applying a public health framework
to the focus of stress and coping encourages us to consider how
large groups of people are impacted by common stressors (e.g.,
violence, pandemics, natural disasters, poverty), and how to design
broad-scale interventions to reduce the impact of these stressors and
promote effective coping. Since public health has a broad focus on
the well-being of people as a whole, terms of normal or abnormal
coping are largely connected to discerning whether coping attempts
impact the health and wellness of the broader community. For
example, if a person copes with stressful circumstances by smoking
or vaping, this has the potential for poor health outcomes both for the
individual and those around them and thus this behavior may be a
target for intervention.

While public health draws on numerous theories, one particularly

relevant to our discussion is public health’s use of social ecological
models. Drawing on the work of Urie Bronfenbrenner (1977) and
McLeroy et al. (1988), social ecological models situate people in
concentric and expanding spheres of influence: intrapersonal (within
the individual), interpersonal (between people and within small
groups), institutional or organizational, community, and public policy
or societal factors. These various levels of influence interact in
complex ways to influence our perceptions and behaviors. A social
ecological model situates our experiences of stress within the context
of our daily lives and social interactions and attempts to account for
the variety of factors that may put us at risk for, or resilient to, the
impact of stressors.

Just as the social ecological model prompts us to consider multiple

spheres of influence that impact our thoughts and behaviors, public
health interventions may be targeted at changes beyond the
individual in hopes of broader impact. For example, Galla et al.
(2015) designed and tested a community-based intervention,
teaching basic mindfulness skills to the general public. They found
improvements in participants’ self-reported mindfulness and self-
compassion, and a reduction in their perceived stress. In another
example, Razani et al., (2016) describe an intervention where
families are “prescribed” to spend time in local parks by their
pediatrician, and a treatment group receives additional supports to
plan and engage in outdoor park activities. The aim of the
intervention is to decrease parent and child stress and increase
family resiliency and flourishing. These examples help to reflect the
range and versatility a public health framework allows in
conceptualizing and intervening to reduce stress and promote
effective coping.

Social Work Perspective

Last, but certainly not least, a social work perspective on coping

draws on a biopsychosocial-spiritual framework to situate coping in
the context of a complex interplay of factors. This framework
integrates many of the aspects from the various perspectives
discussed above. Some of the factors within this framework are
intrapersonal or occurring within ourselves, related to biological (e.g.,
genetic predisposition, activation of our physiological systems) and
psychological (e.g., learned behaviors, cognitive schemas)
characteristics and processes. Other factors reflect interpersonal
aspects, including our social networks and the social experiences we
have. Lehman and colleagues (2017) emphasize the importance of
contemporary biopsychosocial models accounting for the influence of
other extra-personal factors or factors that are beyond what is
personal or individual, including macro influences such as the
political, community, and societal contexts we all exist in.
Furthermore, Lehman et al. argue we need to account for both
current contextual factors and historical influences, such as
oppression, which add a temporal or time element to our
biopsychosocial understanding. That approach is consistent with the
life course perspective, which serves as the conceptual framework for
Dimensions of Human Behavior: The Changing Life Course, the
companion volume to this book. Finally, social workers also attend to
cultural and spiritual influences in conceptualizing the lives of the
clients with whom we work and how they see themselves. This
confluence of factors creates an awe-inspiring complexity as we
consider how individuals and families come to cope with the stressors
they face. Indeed, Berzoff and Drisko (2015) caution social workers
(and social work educators!) to avoid reducing or simplifying this
complexity, in honor of more expedient and standardized approaches
to intervention that fail to take the whole client into account.

Applying the biopsychosocial-spiritual model to coping helps us to

understand both how people respond to stress and how we as social
workers might more effectively support a client’s coping efforts. In
their work surrounding post-traumatic stress, Calhoun and colleagues
(2022) propose an integrated biopsychosocial model for stress
recovery that takes into account a variety of factors, such as
biological sensitivity to stress, perceived self-efficacy, and relational
dynamics, all having important implications for experiences of and
recovery from traumatic stress. As another example of
biopsychosocial intervention, Collen (2015) critiques traditional
biomedical models as often ineffective in their approach to chronic
pain management because they often fail to situate the person coping
with pain within the context of their daily life. To address this, Collen
advocates for a more encompassing approach that not only
prescribes medication but also socialization, work (or other
purposeful activities), and exercise for people living with chronic pain
and illness. A biopsychosocial-spiritual approach to coping
encourages us to consider how coping exists within a person’s or
family’s complex life, not as a response that is isolated from other
aspects of daily living.

The profession of social work is also characterized by the

consideration of systems and the reciprocal impact of persons and
their environments on human behavior. Social workers tend not to
classify individuals as abnormal. Instead, they consider the person-in-
environment as an ongoing process that facilitates or blocks one’s
ability to experience satisfactory social functioning. In fact, in social
work, the term normalization refers to helping clients realize that their
thoughts and feelings are shared by many other individuals in similar
circumstances (Hepworth et al., 2017).

Three types of situations are most likely to produce problems in social

functioning: stressful life transitions, relationship difficulties, and
environmental unresponsiveness (Gitterman, 2009). Note that all
three are related to transitory interactions of the person with other
persons or the environment and do not rely on evaluating the client
as normal or abnormal.

Critical Thinking Questions 5.5

1. In formulating an interdisciplinary understanding of coping, what

do you see as the benefits of incorporating aspects of the
medical, psychological, sociological, anthropological, public
health, and social work perspectives into your work supporting
clients?
2. Through the process of socialization in your family and
community, what biases might you have developed about how
people should cope with discrimination based on race, ethnicity,
gender, sexual orientation, and so on? How might the coping
strategy need to change in different situations, such as receiving
service in a restaurant, being interviewed for a job, or dealing
with an unthinking comment from a classmate?

Implications for Social Work Practice

Always assess the nature, range, and intensity of a client’s
interpersonal relationships.
Help clients identify their sources of stress and patterns of
coping. Recognize the possibility of particular vulnerabilities to
stress and the social, environmental, and economic conditions
that give rise to stress, with special attention to forces of
oppression, such as racism, that contribute to both acute and
chronic stressors.
Help clients assess and evaluate the effectiveness of particular
coping strategies for specific situations, particularly as they are
related to their short- and long-term goals.
Use the risk and resilience framework to understand the nature
of a client’s resources, assets, and limitations.
Where appropriate, help clients develop a stronger sense of
competence in both problem-focused coping and emotion-
focused coping. Identify specific problems and related skill-
building needs, teach and rehearse skills, and implement
graduated applications to real-life situations.
Where appropriate, use case management activities focused on
developing a client’s social supports through linkages with
potentially supportive others in a variety of social network
clusters.
Recognize families as possible sources of stress as well as
support.
Recognize the benefits that psychoeducational groups, therapy
groups, mutual-aid groups, and community organizations may
have for helping clients cope with stress.
Where appropriate, take the roles of mediator, advocate, and ally
to attempt to influence organizations to be more responsive to
the needs of staff and clients. Where appropriate, take the roles
of planner and administrator to introduce flexibility into
organizational policies and procedures so that agency–
environment transactions become mutually responsive and
aligned with principles of social justice and equity.
For clients who experience stress related to inadequate
community ties, link them to an array of formal and informal
 organizations that provide them with a greater sense of
belonging in their communities.
When working with persons in crisis, attempt to alleviate distress
and facilitate a return to the previous level of functioning.
Assess with clients the meaning of hazardous events,
precipitating and perpetuating factors of hazardous events, and
potential and actual support systems.
When working with persons in crisis, use a here-and-now
orientation and use tasks to enhance support systems. Help
clients to connect current stress with patterns of past functioning
and to initiate improved coping methods. As the crisis phase
terminates, review with the client the tasks accomplished,
including new coping skills and social supports developed.

Chapter Review

Key Terms

Adaptation
Communal coping
Coping
Crisis
Daily hassles
Defense mechanisms
Dyadic coping
Emotion-focused coping
General adaptation syndrome
Homeostasis
Intergenerational transmission
Personal network
Post-traumatic stress disorder (PTSD)
Problem-focused coping
Relational coping
Relational theory
Role strain
Social identity theory
Socialization
 Social network
Social support
State
Stress
Trait
Traumatic stress

Active Learning

1. You have been introduced to a variety of perspectives on coping.

Which of these perspectives resonate with your own values?
What perspectives are in tension with your own values? Which of
these ways of thinking about normality and abnormality are the
most helpful to you in thinking about Dan Lee’s situation? For
what reasons?
2. Think of your own social support network. List all persons you
have interacted with in the past month. Next, circle those
persons on the list whom you perceive to be supportive in
significant ways. Describe recent acts of support provided by
these significant others. Finally, evaluate the adequacy of the
support you receive from specific sources and in general. What
can you do to increase the support you receive from your social
network?
3. Consider several recent situations in which you have used
problem-focused or emotion-focused coping strategies. What
was different about the situations in which you used one rather
than the other? Were the coping strategies successful? Why or
why not? How does the tripartite conceptual framework help you
to understand your choice of strategy?

Descriptions of Images and Figures

Back to Figure

The chart reads as follows.

Stage 1. Alarm: Transmission of signals about some threat via
nervous and vascular (blood) systems.

Stage 2. Resistance:

First mediator affects:

1. Hormonal discharge
2. Stimulation of lymphatic organs.
3. Enlargement of adrenal glands.
4. Feelings of fatigue.

Leading to:

1. Activation of hypothalamus (link between brain and endocrine

system.)
2. Production of corticotrophin-releasing factor (CRF.)
3. Activation of pituitary gland by CPF.
4. Release of adrenocorticotropic hormonal (ACTH) by pituitary
gland.
5. ACTH impact on adrenal cortex.

6. Secretion of cortisol and adrenaline for:

1. Energy and adaptation.

2. Enzymatic activation of connective tissue inflammatory
potential (which protects all organ systems.)
7. Hormonal secretions.

8. Adrenalin (for energy):

1. Increases pulse rate.

2. Increases blood pressure.
3. Increases blood circulation.
4. Stimulates central nervous system activity.

Stage 3. Exhaustion:

1. Gradual reversal of all processes.

2. Cumulative wear and tear on the body's resources.
6 The Spiritual Person

Michael J. Sheridan

Learning Objectives

6.1 Identify one’s own emotional and cognitive reactions to eight

case studies.
6.2 Compare the definitions of spirituality and religion.
6.3 Describe the major aspects of Fowler’s theory of spiritual
development.
6.4 Give examples of the impact of spirituality and religion in the
lives of people from diverse groups and describe methods for
gathering information about a client’s religious or spiritual history.
6.5 Apply knowledge of human spirituality to recommended
guidelines for social work engagement, assessment,
intervention, and evaluation.

Eight Case Studies of Spirituality and Religion

There is much diversity in the global spiritual and religious landscape.

In this chapter we introduce eight case studies to represent some of
the diverse ways in which spirituality and religion influence human
behavior.

Case Study 6.1: Caroline’s Challenging Questions

Caroline, who grew up in a large, close-knit family in North Carolina,

is in her first year of college at a university in another state where she
is encountering all kinds of new experiences. A devout Christian,
Caroline is a member of a Baptist church back home, which her
family has attended for generations. She was very involved in her
home church, singing in the choir and actively engaged in several
youth programs. Most of her high school friends attended her church,
so she was more than a little uncomfortable when she learned that
her roommate, Ruth, was Jewish. Caroline has met several other
students who are from different faiths or who say that they don’t
belong to a church at all. This has been a new and challenging
experience for her.

At first, she tried to stay away from anyone who wasn’t Christian, but
she struggled with this because so many of her non-Christian
classmates seemed like nice people and she really wanted to have
friends. All sorts of questions began to emerge in her mind, like How
can they not believe in Jesus Christ? and I wonder what they do
believe? and What will happen to them in the afterlife if they are not
saved? These questions only grew as she took a comparative
religions class where she learned about faiths that she had never
heard of before. In one class exercise, she was paired with another
student from Turkey who said she was Muslim. At first, Caroline was
anxious about talking with her, but as they moved through the
exercise, she began to feel that they were more alike than different.
They both were from very religious families, their faith was important
to them personally, and they both were struggling with all the different
perspectives that they were encountering in college. Later that day,
Caroline realized that if she had been born in Turkey, she would
probably be a Muslim too. This thought both intrigued and unsettled
her. More and more, she is asking herself: What do I really believe
and why?

Case Study 6.2: Naomi’s Health Crisis

Naomi is a 42-year-old mother of three children who are 10, 7, and 3

years old. Naomi discovered a lump in her breast a couple of weeks
ago, and she and her husband, David, have been anxiously awaiting
news regarding test results. When the diagnosis of cancer finally
comes, they are both stunned and frightened but pull themselves
together for the sake of the children. Naomi begins the long journey
of doctors, surgery, chemotherapy, and radiation treatments while
simultaneously trying to maintain family life and a part-time job as
best she can. David takes on new duties as a more active parent and
homemaker while still going to his full-time job. He struggles with his
own fears and anger about what is happening, initially not sharing
these with Naomi because he is determined to be her “rock.”

Naomi and David are members of Temple Shalom, a local Reform

Jewish congregation, which they joined after their first child was born.
When they were growing up, Naomi’s family were members of a
Reform congregation, whereas David’s family expressed their Jewish
heritage in more secular and cultural terms, gathering annually for a
Passover Seder but not attending services except occasionally.
Naomi had not regularly attended services after her bat mitzvah, but
both she and David decided that they wanted to be part of a spiritual
community for their children. They had heard good things about the
temple in their neighborhood and decided to explore it. They like its
open, welcoming atmosphere; its liberal viewpoints on social issues;
and its active engagement in social action in the community. They
both enjoy the weekly connection with other adults and are happy
with the religious classes that their children attend. Recently, Naomi
and David have been engaged in weekly Shabbat Torah study
sessions to deepen their understanding of Jewish sacred texts.

Now that Naomi is facing this health crisis, both she and David are
feeling a bit lost and are searching for answers. Although friends
have been supportive, both of their families live far away, and their
short visits and phone calls only provide minimal comfort. One night,
when they both can’t sleep, Naomi and David begin to share their
doubts and fears with one another, even admitting that they feel
angry with God and are wondering if there is such a thing as God at
all. Naomi finally suggests, “I think it would help to talk with Rabbi
Shapiro and some of the people we’ve met at Temple Shalom.” David
agreed and added that they should also explore the Jewish Healing
Network that was described in the bulletin last week.

Case Study 6.3: Matthew’s Faith Journey

Matthew will be 70 next month—a fact that is hard for him to believe.
He’s been a widower for 5 years now since he lost his wife, Betty,
who died of a sudden heart attack. The first few years following her
death were rough, but Matthew made it through with the help of his
sons and their families, and members of his Catholic parish, which he
has been attending for 40 years. His faith has always been very
important to him, even though he has struggled with periods of doubt
and confusion—the latest following Betty’s death. At one point when
he was younger, he considered leaving the church, when
disagreements about doctrine and rumblings about the new priest
were causing uproar in the congregation. He even visited several
other denominations to see if they were a better fit for him. But after
much reflection and conversation with Betty, Matthew decided to stick
with his commitment to the Catholic faith and his parish saying, “No
church is perfect, and this is where I truly belong.”

For the past couple of years, he has been actively involved with the
outreach activities of the church, working on the Food Bank and
Affordable Housing committees. Recently, he has been a member of
the Interfaith Dialogue Program, which promotes respect and mutual
understanding across religious and cultural perspectives. Matthew
finds the panel discussions, conferences, and interfaith community
projects both challenging and invigorating. He’s particularly looking
forward to an upcoming conference on the role of interfaith dialogue
in advancing world peace. He’s also been involved with the National
Religious Partnership for the Environment (NRPE), a Judeo-Christian
association composed of many faiths that focuses on environmental
stewardship. As a result of these activities, Matthew has also been
reading several books on different religions and is struck with the
similar themes that are reflected in the teachings of very diverse
traditions. He is beginning to feel a new sense of purpose for his life,
which both surprises and delights him as he heads into his seventies.
Some of his friends have asked him if his involvement with the
Interfaith Dialogue Program is making him question his own religion,
but Matthew says, “No, quite the opposite. I feel more deeply
connected to my faith as I understand more about other religions. It’s
not that I think mine is right and theirs is wrong, but I appreciate and
respect other religions, while still knowing that mine is right for me.”

Case Study 6.4: Trudy’s Search for the Sacred

Trudy is a 35-year-old single woman living in Berkeley, California—
which is a long way from the little town in Arkansas where she lived
until she left home at 18. She’s lived in several places since then,
searching for a new home that feels right to her. She thinks she may
have finally found it. A new job in a health food store, a small but
comfortable and affordable apartment, a great yoga class, and a
welcoming Buddhist Sangha (community) of like-minded people all
make her feel like she’s finally found what she’s been looking for.

Trudy’s early years were not easy ones. Her father was an alcoholic
who flew into rages when drunk, which happened more often as the
years went by. It was not unusual for someone in her family to be
physically hurt during these episodes. Trudy, her mother, and her two
sisters were afraid of her father and “walked around on eggshells”
most of the time to avoid triggering his angry spells. Trudy found
refuge in the woods behind her house and in books, which she
devoured because they took her to places beyond her current reality.
She could stay curled up in a nook of her favorite tree for hours,
transporting herself somewhere else—anywhere else. She promised
herself she would leave as soon as she finished high school.

Life since then has not been easy either. Trudy was briefly married in
her twenties to a man who also had a hard time controlling his anger
and began to drink more and more as problems in the marriage
began to emerge. Trudy even found herself turning to alcohol as a
way of numbing her pain, which really scared her. With the support of
some friends, she finally left the marriage and was off again,
searching for a new home. After a couple of other relationships that
didn’t work out, Trudy decided to avoid men and increasingly became
isolated from all social ties. But in her new home in Berkeley, she
finds that she likes the people who attend her Sangha and likes even
more the fact that they don’t share a lot of personal information,
focusing more on spiritual practices. She loves the group meditation
and the dharma talks, and she has made a commitment to increased
periods of solitary meditation when she is at home. Trudy is now
rising at 4:00 a.m. to meditate for 3 hours before she must get ready
for work, and she meditates an additional 2 hours most evenings. Her
reading is now totally focused on books about spirituality, which
support her quest to rise above personal concerns and her ego to
become an enlightened being. Although Trudy was not exposed to a
particular religious tradition during childhood, the search for spiritual
development is now her highest priority.

Case Study 6.5: Leon’s Two Worlds

Leon is a 23-year-old man who is feeling torn in two. He is the oldest

son in a family with five kids and the mainstay of his mother’s life.
Regina became a widow 8 years ago when her husband, Rodney,
was killed in an accident at the mill yard where he worked. Since
then, she’s leaned heavily on Leon for help with his brothers and
sisters and as a major contributor to the family’s finances. He is also
the one she confides in the most, sharing things with him that she
once shared with her husband. The whole family also relies heavily
on their African Methodist Episcopal (AME) church for both social
support and spiritual nurturance.

Leon has grown up in the church and loves the fellowship and the
joyous feeling that comes over him as he sings and worships on
Sundays. But it is also a place that increasingly troubles him, as he
has finally admitted to himself that he is gay. He has denied this for
years, trying hard to follow church teachings about homosexuality
being a sin and something that can be overcome with the help of
God. He has prayed and prayed to God to change him, but this has
not worked. Leon is now battling despair, as he fears that he will
always be caught between his love for his faith and his church and a
longing to be who he truly is. The idea of telling his mother about his
sexual orientation seems unthinkable, but he’s not sure how long he
can go on living a lie. He thinks he will have to leave the church if it
ever becomes known that he is gay. That possibility also seems
unthinkable. He has been feeling more and more depressed, to the
point where his mother keeps asking him what’s wrong. He’s even
had thoughts of suicide, which frighten him. In his nightly prayers to
God he asks, “Why must I lose you to be who I am?”

Case Study 6.6: Jean-Joseph’s Serving the Spirits

Jean-Joseph is a 50-year-old man, originally from Haiti, who came
with his family to the United States 10 years ago. He and his family
were adherents of the Roman Catholic faith in Haiti and now attend a
Catholic church near their new home. Jean-Joseph’s family members
are also believers in Vodoun (known by most Westerners as Voodoo),
which is widely practiced in Haiti and often integrated with belief in
Catholicism. Most Roman Catholics who are active in this spiritual
tradition refer to it as “serving the spirits.” Although this belief system
holds that there is only one God, Bondje, who created the universe,
he is seen as too far away for a personal relationship with humans.
Instead, believers in Vodoun center on Loa, or spirits of ancestors,
animals, natural forces, and good and evil spirits. Family Loa are
spirits who are seen to protect their “children”—the Haitian people—
from misfortune. Jean-Joseph and his family regularly participate in
rituals to feed the Loa food and drink and offer them other gifts.

Recently, a Loa visited Jean-Joseph in a dream, telling him that his

youngest son was ill and needed healing. His son Emmanuel had
indeed been listless for days, not wanting to eat or play, and his
parents were very worried about him. Jean-Joseph decided that they
needed to take him to a Mambo, a Vodoun priestess, who could
mediate between the human and spirit worlds to diagnose and treat
Emmanuel’s illness. The Mambo agreed to perform a healing
ceremony, which was held at a hounfour, or Vodoun temple, around a
poteau-mitan, a center pole where the spirits can communicate with
people. A veve, or pattern of cornmeal unique to the Loa who was the
focus of the ceremony, was created on the floor, and an altar was
decorated with candles, pictures of Christian saints, and other
symbolic items. A goat was also sacrificed for the ceremony. The
Mambo and her assistants began to chant and dance, accompanied
by the shaking of rattles and beating of drums. Finally, the Mambo
was possessed by the Loa and fell down. The Loa then spoke
through the Mambo and told the family how to treat the distressed
spirit that was causing Emmanuel’s illness. After the ceremony, the
Mambo gave Jean-Joseph an herbal remedy to give to his son and
instructions on how to continue feeding the spirit of the Loa until
Emmanuel was healed. The family also prayed to the Christian God
and Catholic saints to bring healing to Emmanuel.
Case Study 6.7: Amira’s Quest for Self

Amira is the middle child of a Pakistani American family that

emigrated to the United States over 30 years ago and settled in a
Pakistani Muslim neighborhood in New Jersey. Her father, Kamil,
owns an appliance store; her mother, Farida, and her older sister,
Nadia, frequently help run the store along with three other
employees. Her younger brother, Nasif, is a sophomore in high
school and works at the store on the weekends. During college,
Amira also worked at the store when she was living at home, but now
that she has completed her undergraduate degree, she has her own
apartment in Washington, DC. This was a monumental change for
both Amira and her family, for it is considered unusual in her
community for a young woman to be living on her own before
marriage. But Amira has consistently been the “odd one” in her family,
chafing at what was expected of her by her family and community.
She has many memories of arguments with her parents about what
she should wear and how she should behave. From an early age,
Amira had big dreams of becoming a doctor and living an
independent life where she could make her own choices.

Although Amira’s parents have been generally supportive of her goals

for higher education, they also expected her to be married by her
early twenties. Now that she is 22, earlier conflicts about proper dress
and respect for traditions have been replaced with threats of an
arranged marriage. Amira reports that her parents have no real
understanding of what is required to get into and complete medical
school. However, they have allowed her to attend a 1-year
premedical program to enhance her chances of getting into medical
school if she returns home for frequent visits and keeps in touch with
her mother daily. Although not happy with these requirements, Amira
is adhering to them so she can pursue her goals.

Another area of potential conflict is religion. Amira is struggling with

the realization that she does not believe much of what she was taught
as a child and does not feel a strong connection to the Muslim faith of
her family. She says, “I know I believe in God, but not the God that
my family does. And I do not believe what they say is the role of
women. But I can’t let them know any of this, as I would be married
off to someone who would make me a ‘proper Muslim woman.’ I’m
not sure I want to be married at all, but if I do, I want to be in love with
my husband and have him treat me as an equal—and respect my
work.” She further states that she is confused about what place she
wants faith to have in her life, for she enjoys certain aspects of it. She
sighs and says, “I guess I’ll figure all that out later—after I have my
medical degree.”

Case Study 6.8: Beth’s Framework for Living

Beth grew up as the only child of parents who were very clear about
not wanting their child to be “brainwashed by religion.” Beth’s mother,
Sarah, had been the daughter of a Presbyterian minister but had not
spoken to her father for several years after many conflicts about her
leaving the church. Beth’s father, Sam, was raised by two union
organizer parents who had not been involved with any religious faith
throughout their lives. Both Sarah and Sam felt strongly that everyone
needed a strong code of personal ethics, and they felt confident they
could give Beth a solid “framework for living” that didn’t involve
religion. Instead, they taught Beth to be honest and fair and to
“always walk a mile in someone else’s shoes” before she judged
anyone.

Beth didn’t think much about religion during her growing-up years
except when it came up in school or when she became aware that
some of her friends’ families were very religious. She tended to feel
more comfortable with kids from more secular families like hers, but
she didn’t let this stop her from making friends with kids from more
religious families as well. As Beth grew older, she relied more and
more on her parents’ framework for living to help her navigate
challenges, like when some of her friends wanted her to go shoplifting
with them or when other friends cheated on an exam. In both cases,
she didn’t go along with her friends, but she didn’t tell on them either
—telling herself that she didn’t really know what it was like to walk in
their shoes, and she shouldn’t judge them. She had many long talks
with her father about the importance of having personal integrity and
caring about social injustices that others faced. She also loved to
hear him tell stories of his parents’ union organizing days when they
“fought the system” and sometimes won. So, when it came time to
choose her major in college she chose political science, and when
she graduated, she became a union organizer for the SEIU (Services
Employees International Union). Her first job was as a field organizer
in West Virginia, focused on organizing nursing home, home care,
and hospital employees. The hours were long, and the work was
tough, but she felt she was living from a place of integrity and making
the world a better place.

She recently became close friends with Karen, another field

organizer, who shared with Beth that her commitment to workers’
rights was grounded in her deep Catholic faith—something Beth
found surprising because she hadn’t thought of religious people as
being very concerned about the struggles ordinary people face. She
began to wonder if she needed to rethink her views about “all those
religious people.” Was it time to walk a bit in their shoes?

The Spiritual Dimension

The stories presented in the eight case studies could be viewed

through many different lenses. Social work’s biopsychosocial
framework is helpful in understanding many facets of these cases.
Knowledge of the biological components of health certainly would be
useful in understanding the circumstances of Naomi’s health crisis
and Jean-Joseph’s attempts at healing his son’s illness.
Psychological perspectives would shed light on Caroline’s discomfort
with encountering different beliefs, Matthew’s deepening faith
perspective, Trudy’s search for a home and a different sense of self,
Leon’s despair at being torn between his faith and his sexual identity,
Amira’s struggle with finding her own way, and Beth’s views about
religious people. Social theories of family dynamics, ethnicity and
culture, social movements, socioeconomic class, and social
institutions would yield invaluable information about all the people in
these cases, providing a wider frame for understanding their
individual lives.
However, the biopsychosocial framework omits an important
dimension of human existence: spirituality. This omission seems
antithetical to social work’s commitment to holistic practice. What
would be gained if we added a spiritual lens in our attempt to
understand Caroline’s challenging questions, Naomi’s health crisis,
Matthew’s faith journey, Trudy’s search for the sacred, Leon’s two
worlds, Jean-Joseph’s serving of the spirits, Amira’s path, and Beth’s
framework for living? And how would this perspective help you as a
social worker provide holistic and effective service in working with
them? Keep these questions and all of the stories in mind as you
read the rest of the chapter.

The Meaning of Spirituality

The concept of spirituality is often confused with religion, and writers

in social work and related fields point to numerous attempts to
delineate these terms and distinguish them from one another. Canda
et al. (2020) provide a detailed discussion of how the two terms are
understood in social work and related fields, including medicine,
nursing, pastoral counseling, psychiatry and psychology, as well as
religious studies. They also report findings from a series of national
studies they conducted in the United States, the United Kingdom,
Norway, and Aotearoa (New Zealand), which show relative
consistency across countries. Specifically, the top six descriptions
across geographic locales were “meaning, personal, purpose, values,
belief, and ethics.” Similar congruence was found for the term
religion, where the top six descriptors selected in all countries were
“belief, ritual, community, values, prayer, and scripture” (p. 86).
Drawing from these studies and additional research in the helping
professions, Canda et al. (2020) propose the following definitions for
these two concepts.

Spirituality is “a process of human life and development

focusing on the search for a sense of meaning, purpose,

morality, and well-being; in relationship with oneself, other
people, other beings, the universe, and ultimate reality however
 understood (e.g., in animistic, atheistic, nontheistic, polytheistic,
theistic, or other ways);
orienting around centrally significant priorities; and
engaging a sense of transcendence (experienced as deeply
profound, sacred, or transpersonal)” (p. 96).

Religion is “a systematic and organized pattern of values, beliefs,

symbols, behaviors, and experiences that involves

spirituality;
a community of adherents;
transmission of traditions over time; and
community support functions (e.g., organizational structure,
material assistance, emotional support, or political advocacy)
that are directly or indirectly related to spirituality” (pp. 97–98).

Thus, the term spirituality is generally used in the social work

literature to mean a broader concept than religion in that spiritual
expression may or may not involve a particular religious faith or
religious institution. But some writers have pointed out that for
persons affiliated with certain faith perspectives, the two terms either
cannot be separated from one another; or religion is seen as the
broader construct, subsuming spirituality; or spirituality is something
viewed as unfamiliar or unorthodox (Canda et al., 2020; Nelson-
Becker, 2018). Others propose that the separation of the two terms in
social work has resulted in discrimination against particular religious
worldviews, especially those of evangelical or conservative faiths
(Hodge, 2002; Ressler & Hodge, 2003). Clearly, there is a need for
continued exploration and dialogue about definitional issues.
Regardless of how the scholarly definition of these terms evolves, it is
important as social workers to always inquire about and honor the
client’s definition of spirituality and religion and use the term that is
most acceptable and relevant for that person, family, or community.

For the sake of clarity, it should be noted that when the term
spirituality is used in the current chapter, it is meant to convey
spirituality as the broader concept, inclusive of both religious and
nonreligious expressions. Occasionally, the two terms are used
together in the same sentence (e.g., “gathering religious or spiritual
information”). In this case, the reader should recognize that both are
included to be applicable regardless of whether persons identify
themselves as primarily religious, primarily spiritual, both religious
and spiritual, or neither.

Regardless of the precise words used to capture the meaning of

spirituality, the term suggests many related themes. Table 6.1 lists 12
commonly noted attributes of the concept of spirituality (Canda et al.,
2020, pp. 94–95). Which attributes do you think are most applicable
to the eight case studies presented at the beginning of this chapter?

Table 6.1
Source: Based on Spiritual Diversity in Social Work Practice (3rd ed.,
p. 170), by E. R. Canda, L. D. Furman, and H. W. Canda, 2020,
Oxford University Press.

Spirituality in the United States and Globally

The current spiritual landscape in the United States reveals both
common threads and a colorful array of unique patterns. According to
an average of all 2021 Gallup polls, about 75% of Americans identify
with a specific religious faith (Jones, 2021). The largest proportion
identify with the Christian faith (69%), including 35% who are
Protestant, 22% Catholic, and 12% who identify with another
Christian religion or as simply “Christian.” Seven percent identify with
a non-Christian faith, including 2% who are Jewish, 1% Muslim, and
1% Buddhist, among others. Twenty-one percent of Americans
reported no religious preference and 3% did not respond. Given this
overview, the claim that the United States is still primarily a “Christian
nation” may appear to have some rationale. However, it’s important to
recognize that this picture has changed significantly over the last 50
years, when 90% of the U.S. population identified as Christian and
only 4% did not have a religious preference. Additionally, expressions
of both religious and nonreligious spirituality in the United States have
become increasingly diverse in recent years, with more than 1,500
different religious groups (Parrillo, 2013).

This diversity is due, in part, to ongoing schisms and divisions among

many of the organized religions historically present within the United
States. For example, the number of Christian denominations alone
grew from 20 to more than 900 from 1800 to 1988 (Melton, 2016). In
addition, there has been a significant rise in other spiritual traditions
with each new influx of immigrants from other parts of the world. They
have brought not only faiths recognized as major religions (e.g.,
Islam, Buddhism, Confucianism, Hinduism) but also various forms of
spiritualism, folk healing, and shamanism (e.g., Santeria, espiritismo,
Vodoun, curanderismo, santiguando, krou khmer, and mudang). This
trend is further augmented by a growing interest in Eastern and
Middle Eastern religions (e.g., Islam, Buddhism, and Hinduism) and
earth-based spiritualities (e.g., neopaganism, Wiccan, goddess
worship, and deep ecology). There has also been a revived or more
visible involvement in traditional spiritual paths within Indigenous
communities, as increasing numbers of Native Americans/Indigenous
peoples explore their tribal traditions or combine these traditions with
faith in Christianity. Many of these “new” religions are among the
fastest growing in the United States, although their overall numbers
are still relatively small. Figure 6.1 shows the breakdown in religious
affiliation according to the 2020 American Values Atlas (Jones et al.,
2020).

Description

Figure 6.1 U.S. Religious Landscape

Source: The 2020 Census of American Religion, by R. P. Jones, N.

Jackson, D. Orcés, D., and I. Huff, 2020, Public Religion Research
Institute.

One area of investigation has focused on the phenomena of religious

“retention” versus religious “switching,” with the data revealing a
general increase in the latter. In terms of retention rates—the degree
to which an individual’s current affiliation matches their childhood
identity—within specific religions, research shows both similarities
and differences with earlier research (Cox, 2022). Among those
raised as Christian, evangelical Protestants have the highest rates of
retention (77%), followed by members of the Church of Latter-day
Saints (65%), mainline Protestants (62%), and Catholics (59%).
Among non-Christian faiths, both Hindus and Muslims have high
retention rates (80% and 77%, respectively), while Jewish retention
rates have dropped from 75% in 2014 to 60% in 2020. Conversely,
65% of those who report having no childhood religious affiliation
report remaining unaffiliated as adults, which is an increase from
2014 when this figure was 53%.

A recent Pew Research Center (2022) study examines religious

“switching” in the United States over the past few decades.
Significant among these changes has been the numbers of adults no
longer affiliating as Christian. Since 1972, the percentage identifying
as Christian has dropped from about 90% to 64% in 2020.
Conversely, the percentage of non-affiliated has grown from 5% to
30% over the same time period. Several demographic trends are
apparent within these changes. First, U.S. adults who have moved
away from Christianity tend to be younger compared to older adults
(27% vs. 14%, respectively). There are also gender differences, with
men more likely to leave their Christian identity compared to women
(54% vs. 43%, respectively). Education levels also show differences,
with people who became unaffiliated after being raised Christian
being more likely to have graduated college than those who remain
Christian (35% to 31%, respectively).

It is important to understand the two general directions in religious

switching (moving from “something” to “none” and “none” to
“something/something else”), have not been equivalent. The majority
of adults leaving their religious affiliation are now religiously
unaffiliated, while a declining percentage of people raised without a
religion have converted or taken on a religion later in life. Overall, if
current trends continue, the profile of religious affiliation in the United
States may look quite different in the coming decades:

Depending on whether religious switching continues at recent

rates, speeds up or stops entirely, the projections show
Christians of all ages shrinking from 64% in 2020 to between a
little more than half (54%) and just above one-third (35%) of all
 Americans by 2070. Over that same period, “nones” would rise
from the 30% in 2020 to somewhere between 34% and 52% of
the U.S. population. (Pew Research Center, 2022, para. 4)

It is also important to note that “none” or unaffiliated may not mean

that spirituality is not important to this group of adults. In an earlier
study, 68% of unaffiliated Americans say they believe in God, 58%
say they feel a deep connection with nature and the earth, 37%
identify as “spiritual” but not “religious,” and 21% report praying every
day (Pew Research Center, 2012a, para. 4).

Spirituality is understood and expressed differently by individuals but

is generally associated with a person’s search for meaning.

© iStockPhoto.com/petekarici

Several additional patterns and trends in religious affiliation were

noted using data from the 2020 American Values Atlas data (Jones et
al., 2020), which explored the intersection of religious identity with
race, ethnicity, age, and other demographic variables. While all racial
groups reported the highest proportion of affiliation as Christian, this
ranged from a high of 76% among Hispanic Americans to smaller
percentages for other groups (72% of Black Americans, 71% of white
Americans, 60% of Native Americans, 50% of multiracial Americans,
and 34% of Asian Americans). Black Americans show the highest
percentages of both evangelical Protestants (35%) and non-
evangelical Protestants (28%), while Hispanic Americans report the
highest percentage of Catholics (50%), and Asian or Pacific Islander
Americans report the highest percentage of other world religions
(29%). Asian or Pacific Islander Americans, along with multiracial
Americans, also report the highest percentages of unaffiliated (34%
each). Figure 6.2 provides an overall breakdown in religious affiliation
by race.

Description
Figure 6.2 U.S. Religious Affiliation by Race

Source: The 2020 Census of American Religion, by R. P. Jones, N.

Jackson, D. Orcés, D., and I. Huff, 2020, Public Religion Research
Institute.

The data also show both continuation and shifts in overall trends
(Jones et al., 2020). First, the decline of white Christians, which had
been dropping roughly 11% per decade, is apparently slowing.
Although over 80% of Americans identified as white Christians in
1976, this hit a low point of 42% in 2018, with the 2020 data showing
an increase in this group to 44%. This slight increase is due to an
uptick in the percentage of white mainline (non-evangelical)
Protestants and a stabilization in the proportion of white Catholics. At
the same time, the rise in unaffiliated Americans also appears to be
slowing. The proportion of unaffiliated Americans hit a high point of
26% in 2018 but has declined slightly, to 23%, in 2020. Finally,
Christians of color and non-Christian religious groups are relatively
stable. In 2020, 26% of Americans were Christians of color, close to
the percentage in 2016 (25%). Overall, Black Protestants, Hispanic
Protestants, Black Catholics, Hispanic Catholics, Asian American and
Pacific Islander Christians, Native American Christians, and
multiracial Christians have shifted by single percentage points
between 2006 and 2020. The proportion of non-Christian groups has
also remained steady between 2006 (5%) and 2020 (4%), with no
non-Christian religious group growing or declining significantly since
2006.

When examining religious affiliation based on age, it is clear that

younger Americans, ages 18–29, are the most diverse age cohort
(Jones et al., 2020). Although the majority (54%) are Christian, only
28% are white Christians while 26% are Christians of color. More
than one-third (36%) are unaffiliated, with the remainder being Jewish
(2%) Muslim (2%), Buddhist (1%), Hindu (1%), or another religion
(1%). These figures contrast with data on older Americans, with white
Christians increasing proportionally as age increases, and the
proportion of unaffiliated declining as age increases. The proportions
of Christians of color and non-Christian religious affiliations relative to
age show more modest shifts. African American Protestants make up
5% of Americans under 30 and 8% of Americans 65 or older. By
contrast, the proportion of Hispanic Protestants, Hispanic Catholics,
and those affiliated with other world religions are significantly higher
among younger Americans than among people 65 or older. Figure 6.3
shows religious affiliation by age groups.

Description

Figure 6.3 U.S. Religious Affiliation by Age

Source: The 2020 Census of American Religion, by R. P. Jones, N.

Jackson, D. Orcés, D., and I. Huff, 2020, Public Religion Research
Institute.

Beyond affiliation, there are several other indicators of the role of

religion and spirituality in the lives of Americans, including belief in
God or a higher power; attendance at religious services; or
engagement in private practices, such as prayer. Data show changes
in these areas as well. For example, recent 2020 Gallup polls report
that 81% of people in the United States said they believe in God or a
higher power/universal spirit (Jones, 2022), down from 98% that
reported such belief between 1953 and 1967. About half (49%) of
Americans say religion is “very important” to them in 2021, down from
around 60% between 1990 and 2005. And although most Americans
have a religious preference, much smaller numbers regularly attend
religious services. In 2021, only 29% had attended a church,
synagogue, mosque, or temple in the past seven days, either in
person or virtually, compared to 44% in 2000. U.S. church
membership has also declined significantly, reported as 47% in 2020
compared to 70% in 1999 (Jones, 2021). Finally, 45% of U.S. adults
say they pray daily in 2020 compared to 55% in 2014 (Pew Research
Center, 2021). Conversely, a National Health Interview Survey
showed the use of meditation has risen, increasing three-fold, from
9.5% in 2012 to 14.3% in 2017 (Clarke et al., 2018).

Furthermore, although traditional measures of religiosity are down,

some measures of spirituality are up. From 2012–2017, there was an
8% increase in Americans who said they are spiritual, while the
number who identified as religious dropped 11%. Furthermore, 67%
said they wanted a more spiritual dimension in their lives (Lipka &
Gecewicz, 2017). Additionally, almost 6 in 10 Americans (59%)
reported that they feel a deep sense of spiritual peace and well-being
at least once a week, up from 52% in 2007 (Masci & Lipka, 2016).
And nearly half (46%) said they often feel a deep sense of wonder
about the universe, also a 7-point jump over 7 years. Even religious
“nones” have become more likely to report these experiences in
recent years, increasing from 38% to 45%, with a 17-point jump
among self-described atheists. Qualitative studies (Bender, 2010;
Mercadante, 2014; Roof, 1999) have shown that although the diverse
pathways to spiritual growth reported by many Americans may
emphasize individual exploration and personal experience, they also
involve communal sharing—albeit often outside of traditional religious
institutions (e.g., yoga centers, meditation groups, mind–body
classes). These approaches may more closely reflect Ulrich Beck’s
(1992) understanding of spirituality as attending to the development
of positive human qualities—such as generosity, gratitude, a capacity
for awe and wonder, an appreciation of the interconnectedness
among all beings, and deeper awareness and insight—as much as or
even more than a search for any divine form of transcendence.

It is important to consider all these data within the context of global

statistics (see Figure 6.4 ). Although adherents of Christianity remain
the highest proportion of the population in the United States,
worldwide they composed only 31.2% of the global population in
2015, with the remainder self-identifying with other traditions: Muslims
(24.1%), unaffiliated (16%), Hindus (15.1%), Buddhists (6.9%), folk
religions (5.7%), Jews (0.2%), and other religions (less than 0.8%).
Projections of religious growth globally predict a different scenario,
with Muslims having the greatest increase, to 31.1% by 2060, placing
them close to the projected percentage of Christians (31.8%).
Percentages for all other adherents are expected to remain the same
or drop. It is interesting to note that although the percentage of
unaffiliated in the United States is projected to be 25.6% by 2060,
globally the percentage is predicted to shrink to 12.5% (Pew
Research Center, 2017).
Description

Figure 6.4 Projections in Global Religions

Source: The Changing Global Religious Landscape, 2017, Pew

Research Center
(https://www.pewresearch.org/religion/2017/04/05/the-changing-
global-religious-landscape/).

Considering this complex and ever-changing picture, social workers

gain very little real understanding of a person by simply knowing their
primary religious affiliation. First, religious affiliation may or may not
hold great significance for the person, and identification with a religion
alone does not indicate depth of involvement. Second, belief,
practice, and involvement can be quite varied, even among adherents
of the same spiritual tradition or among members of the same family,
kinship group, or faith community—even if they all self-identify as
Methodist or Muslim or Wiccan. Third, some people feel connected to
multiple spiritual perspectives simultaneously, such as a combination
of Judaism and Buddhism or traditional Indigenous spiritual beliefs
and Christianity. Fourth, the meaning of religious or spiritual affiliation
may change across the life course; a person may feel more or less
connected to a particular tradition at different points in their life. And
finally, the meaning of a person’s religious or spiritual affiliation must
be understood within the broader historical, sociopolitical, and cultural
context for its full significance to be realized. It is important to
understand the range of spiritual influences (both religious and
nonreligious) that may contribute to anyone’s life story and the larger
collective realities that impact that story at any particular point in time.
Religion involves the patterning of values, beliefs, symbols,
behaviors, and experiences.

© iStockphoto.com/halbergman

Critical Thinking Questions 6.1

At the beginning of the chapter, you read about the spiritual and
religious beliefs of eight people. With which of the stories were you
most comfortable? For what reasons? With which of the stories were
you least comfortable? For what reasons? How comfortable are you
with the idea of including the spiritual dimension in social work’s
understanding of human behavior? What do you like about the idea?
What don’t you like about the idea?

Theories of Spiritual Development

The view that spirituality is an important dimension of human
behavior is not a new one in social work or in other helping
professions. Although Sigmund Freud (1928) asserted that all
religious and spiritual beliefs were either illusions or projections of
unconscious wishes, many other early behavioral science theorists
viewed the role of spirituality differently.

Notably, Carl Jung, a student of Freud’s, differed with his former

teacher and mentor regarding the topic of spirituality. Jung’s (1933)
theory of personality includes physical, mental, and spiritual selves,
which all strive for unity and wholeness within each person. In Jung’s
(1969) view, an important archetype (a universal unconscious idea) is
“the Spirit” (p. 214). Jung further proposed that the evolution of
consciousness and the struggle to find a spiritual outlook on life were
the primary developmental tasks in midlife. If this task is successfully
accomplished, the result is individuation, which Jung defined as “the
moment when the finite mind realizes it is rooted in the infinite” (as
quoted in Keutzer, 1982, p. 76).

Robert Assagioli (1965, 1973) also emphasized the spiritual

dimension in his approach known as psychosynthesis. His
understanding of the human psyche included the constructs of
“higher unconscious” or “superconscious” as the source of creativity
and spirituality. In Assagioli’s view, some psychological disturbances
are best understood as crises of spiritual awakening rather than
symptoms of psychopathology. In such cases, the responsibility of the
therapist is to facilitate the client’s exploration of spiritual possibilities
while dealing with the difficulties such awakenings can engender. As
Assagioli (1989) defined it, “‘spiritual’ refers not only to experiences
traditionally considered religious but to all the states of awareness, all
the human functions and activities which have as their common
denominator the possession of values higher than average” (p. 30,
italics in original).

A third major contributor to early formulations on spirituality and

human behavior was Abraham Maslow, founder of humanistic
psychology. Maslow (1971) described spirituality as an innate and
key element in human nature. In his study of optimally functioning
people, he characterized people at the top of his hierarchy as
“transcendent self-actualizers” and described them as having (among
other traits) a more holistic view of life; a natural tendency toward
cooperative action; a tendency to be motivated by truth, goodness,
and unity; a greater appreciation for peak experiences; an ability to
go beyond their ego self to higher levels of identity; and more
awareness of the sacredness of every person and every living thing.
Maslow later came to believe that even this definition was not
adequate to explain the highest levels of human potential. Near the
end of his life, he predicted the emergence of a more expansive,
transpersonal understanding of human behavior, which will be
discussed in the section on transpersonal theories, but let’s turn now
to one of the most utilized theories of spiritual development.

Fowler’s Stages of Faith Development

James Fowler’s (1981, 1995) theory of faith development grew out of

359 in-depth interviews conducted from 1972 to 1981 in Boston,
Chicago, and Toronto. The sample was overwhelmingly white
(97.8%), largely Christian (over 85%), evenly divided by gender, and
widely distributed in terms of age (3.5 years to 84 years). Each
semistructured interview consisted of more than 30 questions about
life-shaping experiences and relationships, present values and
commitments, and religion. After the responses were analyzed,
interviewees were placed in one of six faith stages . Fowler found a
generally positive relationship between age and stage development;
as age increased, so did the tendency for persons to be in higher
stages. However, only a minority of persons revealed characteristics
of Stages 5 or 6, regardless of age.

To Fowler (1996), faith is broader than religious faith, creed, or belief.

It can, in fact, be expressed even by people who do not believe in
God or a higher power. Instead, faith is viewed as a way of meeting
life and thus, a universal aspect of human existence,

an integral, centering process, underlying the formation of

beliefs, values, and meanings that (1) gives coherence and
direction to people’s lives, (2) links them in shared trusts and
 loyalties with others, (3) grounds their personal stances and
communal loyalties in a sense of relatedness to a larger frame of
reference, and (4) enables them to face and deal with the limited
conditions of life, relying upon that which has the quality of
ultimacy in their lives. (p. 56)

Thus, Fowler’s definition of faith is more aligned with the definition of

spirituality given at the beginning of this chapter and is clearly
distinguished from more specific notions of religious beliefs and
traditions.

Another important concept in Fowler’s theory is the ultimate

environment —the highest level of reality. Faith is not only your
internal image of the ultimate environment but also your relationship
with that image. Your view of the ultimate environment—as personal
or impersonal, trustworthy or not dependable, capable of dialogue or
silent, purposeful or based on chance—and your relationship with it,
is an evolving, dynamic process strongly influenced by your
experiences throughout the life course. Thus, Fowler’s faith is best
understood as a verb, or a way of being, versus a noun, or a thing
that is unchangeable.

Fowler’s stages of faith development should not be viewed as goals

to be achieved or as steps necessary for “salvation.” Rather, they
help us understand a person’s values, beliefs, and sense of meaning
and help us better appreciate the tasks, tensions, and challenges at
various points in life. They also reveal increasing capacity in terms of
cognitive functioning; moral reasoning; perspective taking; critical
reflection and dialectical thought; understanding of symbols, myths,
and rituals; deeper faith commitments; and openness to and
acceptance of difference. Here is a brief description of Fowler’s faith
stages.

Pre-stage: Primal Faith (infancy)

If consistent nurturance is experienced, the infant develops a sense

of trust and safety about the universe and the divine. Negative
experiences produce images of the ultimate as untrustworthy,
punitive, or arbitrary.

Stage 1: Intuitive-Projective Faith (early childhood, beginning

about age 2)

The young child’s new tools of speech and symbols give rise to fluid
and magical thoughts, based on intuition and imagination. Faith is
fantasy-filled and imitative and can be powerfully influenced by
examples, actions, stories of significant others, and familial and
cultural taboos.

Stage 2: Mythic-Literal Faith (middle childhood, beginning about

age 6, and beyond)

The child begins to take on stories, beliefs, and practices that

symbolize belonging to their community. There is a high degree of
conformity to community beliefs and practices. The ability to
participate in concrete operational thinking allows a distinction
between fantasy and reality. There is increased capacity to take the
perspective of others, and ideas about reciprocity and fairness
become central.

Stage 3: Synthetic-Conventional Faith (adolescence and beyond)

For many adolescents, the capacity for abstract thinking and

manipulation of concepts affects the process of developing faith as
well as overall identity. Authority is perceived as external and is found
in traditional authority figures, but there is an increased influence of
peers, school and work associates, the media, and popular culture.
Beliefs and values are often deeply felt but not critically examined or
systematically reflected on. Symbols are not perceived as literally as
in Stage 2.

Stage 4: Individuative-Reflective Faith (young adulthood and

beyond)

Beginning in young adulthood, many people experience an increased

responsibility for their own commitments, lifestyles, beliefs, and
attitudes. Previously held creeds, symbols, and stories are
demythologized through critical analysis. The ultimate becomes more
explicit and personally meaningful, and symbols are reshaped into
more powerful conceptualizations.

Stage 5: Conjunctive Faith (midlife and beyond)

A minority of adults begins in midlife to rework the past and become

open to voices of the “deeper self.” They develop the capacity for
“both/and” versus “either/or” thinking and come to tolerate ambiguity
and paradox, both considering and looking for balance in such
polarities as independence and connection and determinism and free
will. They recognize that there are many truths and engage in critical
examination of their own beliefs, myths, and prejudices. They expand
their definition of community and their sense of connection and
responsibility to others.

Stage 6: Universalizing Faith (midlife and beyond)

A very small minority of adults develops the capacity to truly embrace

paradox. They develop an enlarged awareness of justice and
injustice. The vision of truth is expanded to recognize partial truths.
Symbols, myths, and rituals are appreciated and cherished at a
deeper level. Divisions within the human family are felt with vivid pain
because of the recognition of the possibility of the inclusive union of
all beings. They lead selfless lives of service and action for justice
aimed at the transformation of humankind.

Critiques of Fowler’s model investigate four core theoretical

assumptions: (1) faith develops in stages, (2) faith has a maturational
direction toward “higher” levels of faith development, (3) aspects of
faith development move in sync as a structural whole, and (4) the
claim of cultural universality (Mallery & Mallery, 2022). In terms of the
first assumption of developmental stages, critics have called for a
more contemporary life span development approach that would
recognize development as multidimensional, adaptive, and involving
both gains and losses (Baltes et al., 2007; Coyle, 2011). The second
assumption of maturational direction has been challenged by
research that reveals that while some individuals move toward higher
stages over time, others show movement toward lower stages
(Streib, 2001), as well as evidence that multiple stages may be
apparent within the same person at any given time (Streib et al.,
2020). Research findings have both supported and refuted the third
assumption of structural wholeness. For example, studies have found
evidence of aspects of faith developing simultaneously and
consistently, while other research shows aspects unfolding differently
across various stages (Snarey, 1991; Streib & Klein, 2018). Finally,
the claim of the model’s universality has probably produced the most
criticism, as it was based on interviews with primarily white, middle-
class, Christian participants within a Western context (Coyle, 2011;
Furushima, 1985; Green & Hoffman, 1989). While there is research
that supports the wide applicability of the theory, others note
problems with cross-cultural use (Parker, 2010). It has also been
criticized for having a gender bias (Coyle; 2011; Slee, 2004). Another
major critique beyond these four assumptions is that there is an over-
emphasis on cognitive development and not enough attention to
socio-emotional development (Parker, 2010; Streib, 2001).

Keeping in mind these criticisms of the theory, let us now consider the
stories revealed in the eight case studies through the lens of Fowler’s
faith stages, based on both his early research and later theoretical
refinements. In Fowler’s model, our early experiences set the stage
for later faith development. Given what we know about the eight
people described in the case studies, it is probably safe to assume
that most of them were able to develop at least a “good enough” fund
of basic trust and mutuality during the Pre-stage: Primal Faith for later
development of a relationship with the ultimate. A possible exception
to this is Trudy, whose early years were marked by parental
substance abuse and violence. It would be important to know when
these problems first appeared within her family and how much they
interfered with her initial bonding with her parents, for these factors
would be influential in both her ability to trust and her internal sense
of the ultimate as she moves through her life.

None of the eight case studies tells us much about the development
of early images of the ultimate environment during Stage 1: Intuitive-
Projective Faith. However, we can speculate that these images were
probably drawn from each person’s particular faith affiliation. For
Caroline, Matthew, and Leon, these initial conceptions of the divine
would have been grounded within their specific Christian
denominations; Naomi would have developed her sense of the
ultimate as it was reflected in her Jewish faith; and Amira’s sense of
the divine would have been based on examples, modes, actions, and
stories that she experienced in her family’s belief in Islam. Jean-
Joseph’s sense of the ultimate would have been influenced by a
combination of Catholic symbols, narratives, and rituals and the
spiritual beliefs and practices of Vodoun. Trudy and Beth were not
raised in a religious tradition but found meaning and purpose in other
ways. Trudy found solace in nature, and Beth found significance
through social justice activities. It would be important to talk with them
about how their early experiences affected their sense of what they
held to be most important in their lives and to not assume their lack of
exposure to organized religion meant they had no early images or
experiences with the ultimate, for spirituality is experienced and
expressed through both religious and nonreligious means. In working
with all eight people, we would want to understand how this process
of image making was handled by their families and others in their
lives and how much support they were given for their own intuition
and imagination during this time.

If Fowler had interviewed any of the eight during middle childhood, he

more than likely would have seen many of the aspects of Stage 2:
Mythic-Literal Faith reflected in this group. It would be important to
understand the role of their childhood spiritual communities in
shaping each person’s sense of the world and their place in it. It
would be particularly useful to explore the stories and narratives they
remember from that time, especially as they transmitted values,
attitudes, and norms for behavior. For example, discussing with Leon
what he understood as his church’s core principles relative to sin and
redemption would be invaluable in comprehending his current
struggle. It would also be important to understand the messages
Caroline received regarding her own religion as the only true faith.
For Naomi, Jean-Joseph, and Amira, it would be key to talk about
how their communities handled being believers of a nondominant (or
“other”) religion in a culture where Christianity is the dominant faith
and is generally seen as “the norm.” For Beth, it might mean
understanding the meaning of the stories she heard about her
grandparents’ experiences as union organizers. For all eight people,
it would be vital to explore what helped create a sense of order and
meaning at this stage of life and what provided a sense of guidance
and belonging.

The events that occur during adolescence generally have a

significant effect on faith development during Stage 3: Synthetic-
Conventional Faith, for this is the point where people are heavily
engaged in the process of identity development, including spiritual
identity. It is also a time when the person’s world is greatly expanded,
bringing diverse and complex ideas and experiences regarding all of
life. Adolescents must make coherent meaning from all the different
messages they receive from family, school, work, media, and the
larger sociocultural realm. A person’s faith understanding can help
synthesize various values and viewpoints and provide a basis for
forming a stable identity and worldview. There is a tendency to
construct one’s faith through conforming to a set of values and beliefs
that are most familiar and to defer to whatever authority is most
meaningful. As two people most recently in this life stage, both
Caroline and Leon illustrate the strong impetus to form a faith identity
that provides a solid sense of self and a feeling of belonging to a
particular group. For both of them, the faith of their families and their
home churches were highly instrumental in this process. Beth and
Amira are also in the midst of developing an identity. For Beth this
identity is composed of attributes of personal integrity and
commitment to actions grounded in the socially conscious, ethical
framework of her family. Amira is focused on forging an identity based
on her career goals, while attempting to set aside issues of religious
identity. For all of them, entry into the next stage of life brought
questions regarding the beliefs and values of these key social
institutions and an urge to explore beyond what they had previously
known.

Let’s now consider Jean-Joseph’s spiritual path, which includes a

syncretism (combination) of Catholicism and Vodoun, or “serving the
spirits.” If a social worker embedded in dominant Western culture
assessed his faith development solely from the standpoint of this
context, they might determine that Jean-Joseph falls within an earlier
stage, either Mythic-Literal or perhaps even Intuitive-Projective. This
determination would no doubt lead to a conclusion that this 50-year-
old man is an example of underdeveloped faith and may lead to
interventions aimed at helping him give up his “primitive and
immature” beliefs and practices for a worldview seen as more
appropriate for mature adults. If this were the stance taken by a
practitioner, they would be showing ethnocentric and religiocentric
bias, as well as cultural insensitivity. Viewed within his sociocultural
context, Jean-Joseph is exhibiting a faith stage that could be more
accurately determined to be at least Synthetic-Conventional, given its
congruence with the spiritual beliefs and practices of his Haitian
culture. Upon further exploration with him—with an open mind,
respect, and humility for the limits of one’s knowledge about his
religion—a social worker may discover that Jean-Joseph displays
characteristics of higher stages of faith development. This highlights
the need for social workers to constantly be aware of their own lack of
knowledge and their internalized biases when working with religious
and spiritual traditions unfamiliar to them, in order to engage in
culturally sensitive service respectful of those traditions (Weaver,
2011).

If we look at Caroline’s, Leon’s, Beth’s, and Amira’s lives as they

move into Stage 4: Individuative-Reflective Faith, we see young
people grappling with key questions about themselves and their belief
systems. Caroline’s experiences at college have opened the door to
considering different worldviews, which she handles with an
approach-avoidance strategy. On the one hand, she is troubled by
her experience with others who believe and practice differently from
the way she does, but on the other hand, she is increasingly curious
about these differences. For Leon, the struggle is more difficult, as he
is attempting to live with values, attitudes, and beliefs that tell him a
core aspect of his identity is unacceptable. Beth is being challenged
to reconsider whether she has misperceptions or even biases about
people who are religious, and the possible positive role religion might
play in societal change. Amira is struggling to find her own way,
including how to define herself as a Muslim, a woman, and a young
professional. For all these young adults, the task ahead is to
construct a unique, individual self (identity) and outlook (ideology )
from previously held conventional beliefs and develop an approach to
faith that is both personal and workable. It is important to recognize
that this task does not exclude Beth as a nonreligious person,
because “faith” in Fowler’s (1996) terms involves developing “an
integral, centering process, underlying the formation of beliefs,
values, and meanings” for living one’s life—whether or not this is
found through a particular religious orientation (p. 56). Thus, the
process at this point for all three young people requires a level of
critical reflection and a capacity to struggle with conflicts and tensions
that were not yet fully developed in the previous stage. As a social
worker, you would want to facilitate this process while being mindful
of the social work principles of self-determination and empowerment.

Naomi and David provide another example of Individuative-Reflective

Faith, even though they are considerably older than Caroline, Leon,
and Beth. When they were in their late teens and early 20s, their
identity formation led them to a more secular worldview, as Naomi
lessened her involvement with her faith and David continued to base
his identity and outlook on more humanistic understandings of self
and the world. But the creation of a family caused them both to
reconsider the role of Judaism in their lives as they realized their
desire for a spiritual community. As their children grew, their
involvement with their temple has provided the personal and
workable framework characteristic of this phase. That framework is
now being challenged by Naomi’s illness and is leading both her and
David to a deeper reflection of their faith. Social work with this couple
would involve supporting this reflection, as well as exploring with
them possible supports they could receive from their rabbi and larger
faith community in dealing with Naomi’s health crisis.

According to Lownsdale (1997), only 1 in 6 adults reflect

characteristics of Stage 5: Conjunctive Faith. Of our eight life stories,
only Matthew’s provides glimpses of this faith stage. Although there is
not much information about Matthew’s internal reflection on the
paradoxes of life (a key criterion of Conjunctive Faith), we do know
that he was able to work through the loss of his wife, and other losses
that inevitably come with aging, to embrace a new chapter in his life.
As a social worker, you might find it useful to explore with Matthew
his understanding of life’s paradoxes (such as God being both
personal and abstract, and life being both rational and mysterious)
and talk with him about any previously unrealized parts of himself that
are now emerging. What is apparent in Matthew’s story is his
enthusiastic willingness to acknowledge and honor multiple faith
perspectives, while being open to new depths within his own
spirituality. We also see him engaging in service for others and
concern for the natural world. All these activities suggest a
perspective that goes beyond egocentric and ethnocentric views to a
more worldcentric (identification with the entire global human family)
and ecocentric (identification with the whole ecosphere, of which
humans are only one part) way of being in the world. As a result of
these commitments, he is experiencing a renewed sense of purpose,
meaning, and connection in his life. All of these are characteristic of
persons of Conjunctive Faith, which brings a broader social
consciousness, a passion for social justice, and a wider and deeper
understanding of the sacred.

It is clear that none of the eight people reflects the self-sacrificial life
of Fowler’s Stage 6: Universalizing Faith. Persons at this stage are
exceedingly rare, perhaps two or three individuals per thousand
(Lownsdale, 1997). Given the exceptional nature of such persons, it
is not surprising that the eight case studies do not reveal examples of
this faith stage. Some might point to Trudy’s total immersion in
spiritual practices as evidence of this stage, but let’s turn now to
transpersonal theory as a useful lens for understanding Trudy’s
development.

Transpersonal Theories

As noted in the discussion of Maslow, he predicted the development

of a fourth force in theoretical understanding of human behavior: “a
still ‘higher’ Fourth Psychology; transpersonal, trans-human, centered
in the cosmos, rather than in human needs and interests, going
beyond humanness, identity, self-actualization, and the like” (as
quoted in Wittine, 1987, p. 53). Au-Deane Cowley (1996) describes
the emergence of this fourth level in her discussion of the four major
therapeutic approaches that have emerged over the past century,
each developed in response to our understanding of human behavior
and human needs at the time.

1. First force therapies are based on psychodynamic theories of

human behavior. The prime concern of these therapies is dealing
with repression and resolving instinctual conflicts by developing
insight.
2. Second force therapies evolved from behavioral theories. These
therapies focus on learned habits and seek to remove symptoms
through various processes of direct learning.
3. Third force therapies are rooted in
existential/humanistic/experiential theories. They help the person
deal with existential despair and seek the actualization of the
person’s potential through techniques grounded in immediate
experiencing.
4. Fourth force therapies , based on transpersonal theories,
specifically target the spiritual dimension. They focus on helping
the person let go of ego attachments and identifications with the
mind, body, and social roles—and transcend the self through
various spiritually based practices.

The fourth force builds on the previous three forces and thus
incorporates existing knowledge concerning human behavior within
its framework. What differentiates the fourth force—the transpersonal
approach —from other theoretical orientations is the premise that
some states of human consciousness and potential go beyond our
traditional views of health and normality. These states explicitly
address the spiritual dimension of human existence (Cowley &
Derezotes, 1994).

The term transpersonal literally means “beyond” or “through” the

“persona” or “mask” (Wittine, 1987). When applied to theories of
human behavior, transpersonal means going beyond identity tied to
the individual body, ego, or social roles to include spiritual experience
or higher levels of consciousness. The self is experienced as in unity
with all others. A major focus of transpersonal theory is on
“humanity’s highest potential” (Lajoie & Shapiro, 1992, p. 91).
Increasingly recognized is the relevance of a transpersonal
orientation to the realm of everyday life as well, including the “lower
end” of human functioning. Thus, transpersonal practice approaches
must “include the whole—not just the high end of human experience
but the very personal realm of ordinary consciousness as well”
(Cortright, 1997, p. 13). Several branches of transpersonal thought
are currently recognized, including Jungian psychology; depth or
archetypal psychology; spiritual psychology; positive psychology;
psychosynthesis; and approaches based on the writings of Abraham
Maslow, Stanislav Grof, Ken Wilber, Michael Washburn, Frances
Vaughan, Roger Walsh, Jorge Ferrer, and Charles Tart, among
others.

One of the most well-known approaches to transpersonal theory is

the work of Ken Wilber (2006), who identified three levels of
consciousness (prepersonal, personal, and transpersonal). In his
integral model, Wilber proposed that the personal phase of
development, with its achievement of strong ego development and
self-actualization, is not the highest potential of human existence,
although a necessary point along the way. Rather, the ultimate goal of
human development is the transpersonal (or transegoic) phase—
beyond ego or self to self-transcendence and unity with ultimate
reality. Although the levels Wilber outlined at the prepersonal and
personal levels are similar to those proposed by Fowler, he
delineated additional levels within the transpersonal stage, which
extend beyond Fowler’s sixth stage (Universalizing Faith). These
stages involve a continual evolution of consciousness until the person
perceives the self and all of life as nondual (not two), where there is
no separation between the self and the ultimate reality. The capacity
for attaining these higher levels of consciousness is seen as innate
within each human being, although Wilber acknowledges that very
few people reach the highest levels.

Wilber (2000a, 2006) stresses that practitioners need to be able to

correctly identify the correct phase of development (prepersonal,
personal, or transpersonal) to provide the most appropriate
intervention and support to clients. If not accurately identified, there is
the probability of what Wilber (2000b) calls the “pre/trans fallacy,”
which occurs when a problem at a transpersonal level (such as a
spiritual awakening) may be treated as if it were a prepersonal or
personal disorder (a psychotic episode or existential crisis) or vice
versa. This distinction is important in understanding Trudy’s spiritual
development.

Trudy is currently focusing most of her time and energy toward

developing her spiritual self to achieve enlightenment. She is
meditating 5 hours a day, is engaged with a daily yoga practice, and
limits her reading and interpersonal contacts to those she identifies
as spiritual. Given that most transpersonal theorists and spiritual
leaders would agree that engagement in some type of spiritual
practice is helpful for spiritual growth, one might characterize Trudy’s
behavior as that of a disciplined, spiritual seeker and perhaps
assume that she is moving into the transpersonal phase of
development. But there is evidence in her story that Trudy is caught
up in spiritual bypassing , a term first coined by John Welwood
(2000), which he describes as “the tendency to use spiritual practice
to bypass or avoid dealing with certain personal or emotional
‘unfinished business’” (p. 11). Welwood states that persons struggling
with life’s developmental challenges are particularly susceptible to
spiritual bypassing, as they attempt to find themselves by giving
themselves up—or prematurely trying to move beyond their ego to
self-transcendence, ignoring their personal and emotional needs.
This attempt to create a new “spiritual” identity to avoid the pain of
working through unresolved psychosocial issues does not work and
frequently causes additional problems.

Trudy’s story reflects the possibility of three of the eight

manifestations of spiritual bypassing discussed by Sheridan (2017):
avoidance/repression of undesirable or painful emotions; fear of
intimacy, closeness, and vulnerability; and spiritual
obsession/addiction. As Trudy’s social worker, you would want to do a
thorough assessment, considering the substantial unresolved trauma
and losses in her life. To ignore these issues and focus only on
supporting her quest for enlightenment would be to commit Wilber’s
pre/trans fallacy and miss the possibility of spiritual bypassing. As a
responsible and ethical social worker, you would help her address
these unresolved issues at the personal, and perhaps even
prepersonal, level while maintaining respect for her spiritual
perspective. You would also help her discern the appropriate role of
her spiritual practices in support of her overall growth and
development. Consulting with a spiritual teacher or a transpersonal
practitioner, with Trudy’s permission, also might be helpful in this
case.

Likewise, if a practitioner identifies a client’s spiritual practices as

signs of a serious problem simply because they are unfamiliar or
seem “strange,” they would be moving to the other side of Wilber’s
pre/trans fallacy—treating potentially spiritual or transpersonal
experiences as if they were psychological disorders at the
prepersonal or personal level. The potential for this type of error is
evident in the case of Jean-Joseph and his family. If this family
sought help from conventional health care services, while also
following traditional spiritually based healing processes, as a social
worker your task would be to help the family and the medical
professionals find a way to work together. This is not always an easy
task, as is poignantly illustrated in Anne Fadiman’s (1998) book, The
Spirit Catches You and You Fall Down, which tells the tragic story of a
Hmong child with epilepsy who becomes brain-dead because of the
failure of professionals to understand unfamiliar spiritual worldviews
and negotiate cultural differences. This true account highlights the
critical need for social workers to develop the knowledge, values, and
skills of spiritually sensitive practice in order to serve clients from
diverse spiritual traditions.

Critical Thinking Questions 6.2

Fowler’s faith development model assumes that spiritual development

goes through various stages over a lifetime, regardless of particular
faith affiliation. Do you think this is a helpful way to think about
spirituality? Explain. Is it a helpful way to think about your own
spiritual life? Explain. What do you think about the possibility that
there are stages beyond full ego development—or levels of
consciousness that are transpersonal?

The Role of Spirituality in Social Work

The social work profession has evolved over time in its attention to
the spiritual dimension in understanding human behavior and the
human condition. The following sections trace this evolution, highlight
the intersection of spirituality and diversity, and discuss current
developments in spiritually sensitive social work practice.

Developments in the Profession

Canda et al. (2020) outlined six broad historical phases that trace the
development of linkages between spirituality and social work in the
United States. An overview of these phases is presented next.

1. Indigenous precolonial period: This period includes the

thousands of years when Indigenous cultures in North America
employed a variety of spiritually based approaches to healing
and mutual support. These practices, discussed in greater detail
later in the chapter, focused beyond human welfare to include
the well-being of other living beings and the earth itself. Many of
these traditional ways continue into the present, both outside of
and within social work (Baskin, 2016; Brave Heart, 2001; Bucko
& Iron Cloud, 2008).
2. Sectarian origins: This phase began with the colonial period and
lasted through the first 20 years of the 20th century. Early human
services, institutions, and social welfare policies were
significantly influenced by Judeo-Christian worldviews on charity,
communal responsibility, and social justice (Lowenberg, 1988;
Popple et al., 2020). There were also competing explanations of
human behavior: on the one hand, an emphasis on
distinguishing individual moral blame or merit (e.g., the worthy
versus unworthy poor) and on the other hand, a focus on social
reform and social justice (e.g., Jewish communal service and
 Christian social gospel). Human service providers typically had a
strong spiritual foundation for their work but offered service
through nonsectarian means (e.g., Jane Addams and the
settlement house movement). Indigenous, African American, and
Spanish and French Catholic spiritual perspectives also
contributed to the evolution of social work during this time frame
(Brade, 2008; E. P. Martin & Martin, 2002; Van Hook et al.,
2001).
3. Professionalization and secularization: Beginning in the 1920s
and continuing through the 1970s, social work began to distance
itself from its early sectarian roots. This movement mirrored a
shift within the larger society, which began to replace moral
explanations of human problems with a scientific, rational
understanding of human behavior. The social work profession
increasingly relied on scientific empiricism and secular
humanism as the major foundations for its values, ethics, and
practice approaches (Siporin, 1986). This period also witnessed
social work’s reliance on a variety of emerging psychological and
sociological theories (such as psychoanalytic, behavioral, and
social functionalism), which did not recognize the spiritual
dimension as significant either for understanding human
behavior or as a focus for practice. However, several religiously
affiliated agencies continued to provide social services (e.g.,
Catholic Social Services, Jewish Family Services, Lutheran
Social Services, the Salvation Army). Nonsectarian spiritual
influences were also felt, including principles of 12-step
programs; humanistic, existential, and Jungian thought; and
ideas about human development drawn from Eastern religions
(Robbins et al., 2019).
4. Resurgence of interest in spirituality: A renewed interest in the
spiritual dimension began in the 1980s (Canda, 1997; Russel,
1998). Indicators of this new phase within the profession
included a marked increase in the number of publications and
presentations on the topic; the development of the national
Society for Spirituality and Social Work (SSSW); and the first
national conference, held in 1994, on spirituality and social work.
As part of this substantial activity, there was infusion of new and
 diverse perspectives on spirituality that influenced the profession,
including Buddhism, Confucianism, Hinduism, Shamanism,
Taoism, and transpersonal theory. This period differed from the
earlier sectarian period in that it emphasized the need to address
spirituality in a way that recognizes the value of diverse spiritual
traditions and respects client self-determination (Canda, 1988).
This trend toward reexamination and reintegration of spirituality
within the profession corresponded with increased interest within
the larger culture (Gallup & Lindsay, 1999).
5. Transcending boundaries: From 1995 to 2009, the profession
witnessed an escalation of prior trends. This included the
reintroduction of references to religion and spirituality in the
Council on Social Work Education’s (CSWE) 1995 Curriculum
Policy Statement and 2000 Educational Policy and Accreditation
Standards after an absence of more than 20 years. The first
international conference of the SSSW was held in 2000, with
other national and international conferences increasingly
including presentations on spirituality (e.g., National Association
of Social Workers [NASW], CSWE’s Annual Program Meeting,
Canadian Society for Spirituality in Social Work [CSSSW],
International Federation of Social Workers [IFSW], International
Association of Schools of Social Work [IASSW]). New
postmodern perspectives on spirituality entered the arena,
including feminist, ecophilosophical, postcolonial, and expanded
transpersonal frameworks, which broadened the focus of
spirituality to include all peoples, all nations, all beings, and the
planet itself, with special concern for marginalized and
oppressed groups (Besthorn, 2001; Canda, 2005; Coates, 2003;
Coates et al., 2006; E. P. Martin & Martin, 2002; McKenzie &
Morrissette, 2003). There was exponential growth in empirical
work during this period, including more than 50 studies of social
work practitioners, faculty, and students (see Sheridan, 2004 and
2009, for reviews of this literature) and growing numbers of
studies relative to direct practice with social work clients (e.g.,
Beitel et al., 2007; Brown et al., 2013; Nelson-Becker, 2006).
There were also developments in integrating spirituality and
macro practice (e.g., Hugen & Venema, 2009; Rogers, 2009).
 The focus shifted from whether the topic should be included in
the profession to how to integrate spirituality within social work
practice in an ethical, effective, and spiritually sensitive manner
(Canda et al., 2020; Sheridan, 2009).
6. Inclusion: Beginning in 2010 and continuing to the present, the
profession has entered a new phase, characterized by a
continuation of the trends in phase 5 and the publication of
notable textbooks on religion and spirituality (e.g., Canda et al.,
2020; Crisp, 2010, 2017; Cunningham, 2012; Dudley, 2016;
Groen et al., 2012; Holloway & Moss, 2010; Loue, 2017; Nelson-
Becker, 2018; Sheridan, 2014). There is also work that includes
content on spirituality without necessarily using the term or
making it the primary focus. Examples include expansion of
holistic frameworks that include spirituality, such as Indigenous
helping approaches (Baskin, 2016); integrated body-mind-spirit
social work (M. J. Lee et al., 2018); holistic education and
healing justice approaches (Pyles, 2018); and use of creative
expressive arts (Land, 2015). There has also been a proliferation
of therapeutic practices grounded in religious roots, such as yoga
and mindfulness, but applied within a more secular framework
(Canda & Warren, 2013). Although the 2015 Educational Policy
and Accreditation Standards deleted any reference to spirituality
as part of its endeavor to become less prescriptive, it continued
to state sanctions against religious discrimination. Finally,
international attention growth continues, as evidenced by
references to religion and spirituality within both the International
Federation of Social Workers (IFSW) (2018) and the International
Association of Schools of Social Work (IAASW) (2018)
statements of ethical principles. There are also a growing
number of publications by international scholars (e.g., Bhagwan,
2013; Crisp, 2010, 2017; Higashida, 2019; Ji-Young, 2011;
Kvarfordt & Herba, 2018; Pandya, 2015).

At this point in the profession, spirituality is generally seen as an

important part of the human experience; hence, the use of an
expanded bio-psycho-social-spiritual framework in understanding
human behavior. It is also important to understand how religion and
spirituality intersect with other aspects of diversity.
Spirituality and Human Diversity

Commitment to issues of human diversity and to oppressed

populations is a hallmark of the social work profession. At various
times in history, some branches of organized religion have played a
negative or impeding role in the attainment of social justice for
various groups. Examples include the use of religious texts, policies,
and practices to deny the full human rights of persons of color;
women; and gay, lesbian, bisexual, transgender, and other sexuality
and gender identities. At the same time, organized religion has a rich
heritage of involvement in social justice causes and movements,
including the Black civil rights movement, the peace movement, the
women’s movement, the gay rights movement, abolition of the death
penalty, the antipoverty movement, and the environmental
movement. It is beyond the scope of this chapter to do an overall
analysis of the role of religion in the struggle for social, racial,
economic, and environmental justice. However, the following sections
provide examples of the impact of both religious and nonreligious
spirituality in the lives of oppressed groups as defined by race and
ethnicity, sex and gender, sexual orientation and gender identity,
disability, and age.

Race and Ethnicity

Spirituality expressed in both religious and nonreligious forms has

been pivotal in the lives of many persons of color and other
marginalized ethnic groups. This brief discussion of spirituality and
race/ethnicity emphasizes common experiences and themes to
provide a general overview. However, remember that a great deal of
diversity exists within these groups and that every person’s story is
unique.

American Indian/Alaskan Native (AI/AN) and Native Americans.

Persons belonging to the tribal nations of the continental United

States are referred to as American Indians (AI) and those who are
members of the tribal nations and villages of Alaska are known as
Alaska Natives (AN). Native American is a broader term that refers to
all Native people of the United States and its trust territories (e.g.,
American Indians, Alaska Natives, Native Hawaiians, Chamorros,
and American Samoans), as well as persons from Canadian First
Nations and Indigenous communities in Mexico and Central and
South America who are U.S. residents (National Congress of
American Indians, 2020). Prior to the arrival of European settlers to
the Americas, the original Indigenous peoples numbered in the
millions and were members of hundreds of distinct nations, each with
its own language, heritage, forms of government, and spiritual
traditions (Healey & Stepnick, 2020). Today, there are 574 sovereign
tribal nations that have a formal nation-to-nation relationship with the
U.S. government (National Congress of American Indians, 2020).
There are another 400 non-federally recognized tribal communities,
although some of these have state recognition (United States
Government Accountability Office, 2012). In terms of current-day
religious affiliation, 60% identify as Christian: 47% Protestant (28%
evangelical, 19% non-evangelical), 11% Catholic, 1% Latter-day
Saint, and 1% Jehovah’s Witness. Two percent identify with another
religion, 1% each are Jewish or Muslim, and less than 1% are Hindu
or Buddhist. Nearly 3 in 10 (28%) are religiously unaffiliated (Jones et
al., 2020). It is also important to recognize two other spiritual
affiliations that are not usually captured in statistics of religious
affiliation: Aboriginal or traditional spiritual traditions and the Native
American Church.

Aboriginal traditional spiritual expressions are often focused on

kinship and community ties and on a particular geographical place
(Beck et al., 1992). Spirituality is viewed as inseparable from the rest
of life, including connection to and responsibility for the earth and all
her creatures; the sacredness of all things, including animals, plants,
minerals, and natural forces; the values of balance, harmony, and
connectedness; the importance of extended family and community;
and the use of myth, ritual, and storytelling as spiritual practices
(Duran & Duran, 1995; Matheson, 1996; Yellow Bird, 1995). Despite
the diversity among Aboriginal traditions, they generally see collective
matters as intertwined, including politics, economy, agriculture,
medicine, and art, into a spiritually informed whole and, thus, may be
“better described as lifeways rather than religions” (McNally, 2000, p.
849).

The Native American Church (NAC), sometimes called the Peyote

Way, is a synthesis of traditional AI/AN spiritual traditions and
Christianity, although specific beliefs vary from tribe to tribe. These
traditions use peyote as a sacramental substance, which is viewed as
medicine, as a cleansing ritual, and as a teacher. At the heart of this
tradition is the all-night gathering in which a ceremonial leader, or
“road man,” guides practitioners to approach the sacred through
singing, drumming, praying, and ingesting peyote. Peyote is a
psychoactive plant whose use is generally proscribed by federal and
state drug laws, historically creating conflicts between NAC members
and various governmental authorities. However, in 1994, the U.S.
Congress passed an amendment to the American Indian Religious
Freedom Act, which provided for protected use of peyote as a
sacrament in traditional religious ceremonies (Public Law 103–344,
1994). There are approximately 250,000 adherents of the NAC
nationwide; membership does not preclude other religious affiliations,
and members may participate in a variety of other traditional
ceremonies as well as attend Christian churches (World Religions
and Spirituality Project, n.d.).

Regardless of the particular belief system or traditions employed,

spirituality has been a key resource for AI/AN peoples facing
oppression throughout history. Beginning with Spanish and French
colonization in the 16th century and continuing with British
colonization in the 17th century, Native peoples faced dire
consequences resulting from European attempts to increase
economic and political power in the New World. Native lands were
usurped, treaties were broken, and tribal peoples were enslaved,
displaced, and confined to reservations or killed through warfare or
disease (Dunbar-Ortiz, 2014). In a campaign to “humanize and
civilize” Native Americans, Congress appropriated funds for Christian
missionary efforts beginning in 1819 (U.S. Department of the Interior,
2022). As part of this effort, the United States ran or supported 408
boarding schools between 1819 and 1969, where children were
forbidden to wear their Native attire, eat their Native foods, speak
their Native language, or practice their traditional religion, and were
often severely punished for failure to adhere to these prohibitions
(Haig-Brown, 1988; Snipp, 1998). These schools “were designed to
separate a child from his reservation and family, strip him of his tribal
lore and mores, force the complete abandonment of his native
language, and prepare him for never again returning to his people”
(U.S. Department of the Interior, 2022, p. 51). The U.S. Department
of the Interior (2022) report notes rampant physical, sexual, and
emotional abuse and more than 500 deaths of Native children, with
that number expected to increase as the Department’s investigation
into these boarding schools continues.

A key feature of efforts to assimilate and Christianize AI/AN people

involved religious customs being discouraged or even criminalized
(Irwin, 1997; Jenkins, 2004). Even though the First Amendment
states that “Congress shall make no law respecting an establishment
of religion or prohibiting the free exercise thereof” [emphasis added],
it was not until the American Indian Religious Freedom Act (AIRFA) of
1978 that Native religious cultural rights and practices were protected
under the Constitution (Zotigh, 2018), and there are still challenges to
full protection of these rights (Echo-Hawk et al., 2004). It’s important
to note that, from first contact with Europeans, conversion of AI/AN
people was a high priority among many Christian denominations, with
varying degrees to which this faith was accepted (J. W. Martin, 2001).
While many AI/AN people resisted conversion, others found a
compatibility with traditional beliefs and became “bireligious,”
adopting a fusion of Christianity and Indigenous faith traditions
(Heidenreich, 2005).

Throughout this history of genocide, displacement, family disruption,

religious suppression, and forced acculturation, many AI/AN peoples
have suffered lasting intergenerational trauma (Brave Heart &
DeBruyn, 1998). As part of addressing this trauma, there has been a
movement to reclaim AI/AN cultural identities, including a restoration
and revitalization of spiritual traditions (Allen et al., 2014; Garroutte et
al., 2009). These efforts involve reclaiming and teaching traditional
languages and stories, adopting traditional approaches to well-being
and healing, restoring sacred sites, establishing learning centers and
museums, and engaging in traditional spiritual rituals. All these
actions play an important role in healing historical trauma and
countering oppression (Garrett et al., 2014; Gone, 2009).

A growing body of literature addresses the importance of attending to

cultural and spiritual traditions when providing services to AI/AN
peoples. For example, engagement in traditional spirituality has been
shown to be a protective factor against substance abuse in both
adults and adolescents (Kulis et al., 2012; Stone et al., 2006; Yu &
Stiffman, 2007). Spiritual beliefs and practices have also been found
to be related to better mental health, lower levels of depression and
anxiety, and less risk of suicide (Dickerson et al., 2021; Muehlenkamp
et al., 2009; Running Bear et al., 2018). A review of the literature
revealed culturally appropriate and spiritually sensitive service
provision as key for “best practices” with AI/AN persons dealing with
cardiovascular disease, cancer, and diabetes (Wright, 2009).
Additionally, traditional healing has been identified as pivotal for
physical, spiritual, and mental health and as an important
complement to Western medicine (Moghaddam et al., 2015).
Understanding traditional beliefs, values, and practices has also been
reported as vital in working with AI/AN couples and families
(Lettenberger-Klein et al., 2013; Rink et al., 2018). Overall, many
service providers call for sensitivity and awareness of the effects of
historical trauma on Native Americans and recommend the
integration of traditional practices for more effective service delivery
(Chong et al., 2009; Gone, 2022; Limb & Hodge, 2008; Skye, 2002;
Weaver, 2011; Yurkovich et al., 2011).

Black and African Americans.

The origins of people who currently identify as Black or African

American in the United States are more complex than is generally
recognized. While the first African people were forcibly brought to the
Virginia colony in 1619, not all Africans who came to America were
enslaved. Some came as free men as sailors working on ships, while
others came as indentured servants who obtained freedom after a set
period of years. Still others were born to free women of color or to
white indentured or free white women and were considered free
themselves based on partus sequiter ventrem—the doctrine that
mandated that all children inherit the legal status of their mothers
(Hannah-Jones et al., 2021). By 1860, while nearly 4 million people of
African descent were enslaved in the United States, there were
around 490,000 free African Americans living in the country (E. F.
Frazier, 2012). Later, significant numbers of Black immigrants arrived
from various locations. During the 1990s, almost 1 million Black
immigrants came from the Caribbean, 400,000 came from Africa, and
still others came from Europe and the Pacific Rim. By the beginning
of the 21st century, more people had emigrated to the United States
from Africa than were brought to the continent through the slave
trade, with nearly 1 in 10 Black Americans being an immigrant or the
child of an immigrant (Berlin, 2010).

In terms of current religious affiliation, the majority of Black and

African Americans are Christian (72%), with more than 6 in 10 (63%)
identifying as Protestant (35% evangelical and 28% non-evangelical).
The remainder of Christians are either Catholic (7%) or “other
Christian” (2%) (e.g., Jehovah’s Witnesses, Orthodox Christians,
Church of Jesus Christ of Latter-day Saints). Another 3% identify as
other religious affiliations (Muslims, Buddhists, or adherents of
traditional African or Afro-Caribbean religion). In addition to the 3%
who identify with non-Christian religions, some note that, aside from
religion, they feel a tie to these faiths ethnically, culturally, or because
of their family’s background. Finally, about 1 in 5 (21%) are not
affiliated with any religion, describing themselves as atheist, agnostic,
or “nothing in particular” (Jones et al., 2020; Mohamed et al., 2021).
Research also reveals that Black and African Americans emerge as
notably more religious than the general U.S. population based on
several indicators. They are more likely to say they believe in God or
a higher power, to agree that religion is “very important” to them, and
to believe prayers to ancestors have protective power. They are also
more likely than other Americans to view opposition to racism as
essential to being a religiously faithful or moral person. Even among
Black and African Americans who are not affiliated, 90% say they
believe in God or a higher power, 60% report praying at least a few
times a month, and 58% rely on prayer to some extent for making
major life decisions (Mohamed et al., 2021).

The history of Black people in the United States has been marked by
over 400 years of struggle against racism and oppression. This
struggle began with being forced to leave their home countries and
being held as chattel property in the colonies, eventually leading to
almost 100 years of government-sanctioned enslavement in the
newly formed country—despite the rhetoric of “all men are created
equal” enshrined in the Declaration of Independence (Hannah-Jones
et al., 2021). Following the Civil War, the Reconstruction period
brought three key constitutional amendments: the 13th Amendment in
1865 abolishing slavery; the 14th Amendment in 1868 giving
citizenship and equal protection under the law to all people born in
the United States (including people who were previously enslaved);
and the 15th Amendment in 1869 giving Black American men the
right to vote (Foner, 2019). These new freedoms were countered by
Black Codes and Jim Crow laws that made it difficult or impossible to
work, get an education, travel, own property, or vote, and segregated
and marginalized African Americans from most societal opportunities.
This backlash also included threats and acts of violence. From 1877
to 1950, 4,425 documented lynchings occurred in the United States
(Equal Justice Initiative, 2017), and it was not until March 29, 2022,
that the H.R. 55 Emmett Till Antilynching Act made lynching a federal
hate crime (Public Law No. 117–107). From the civil rights era in the
1950s and 1960s to today, Black and African Americans continue to
contend with discrimination and racial disparities in key areas of life,
including education, employment, housing, health, criminal justice,
food security, voting access, income and intergenerational wealth,
and life expectancy (Hartman et al., n.d.).

Throughout this ongoing battle for freedom, equality, and equity, the
integrated heritage of Black and African American spiritual values has
emphasized collective unity and the connection of all beings (Nobles,
1980). Afrocentric spirituality stresses the interdependence among
God, community, family, and the individual. Its central virtues include
beneficence to the community, forbearance through tragedy, wisdom
applied to action, creative improvisation, forgiveness of wrongs and
oppression, and social justice (Paris, 1995). An expression of this
integrated heritage is the celebration of Kwanzaa, which is an
important nonsectarian Afrocentric spiritual tradition developed by
Maulana Karenga in the 1960s as a mechanism for celebrating and
supporting Black and African American strengths and empowerment.
Seven principles represent the core values of Kwanzaa: umoja
(unity), kujichagulia (self-determination), ujima (collective work and
responsibility), ujamaa (collective economics), nia (purpose), kuumba
(creativity), and imani (faith) (Karenga, 1995).

The Black Church has long played a pivotal role in the struggle for
justice, dating back to at least the late 18th century. This institution
has been, and continues to be, an epicenter of Black life, providing
sanctuary, resistance, resilience, community, social support, political
activism, and opportunities for cultural expression (Gates, 2021).
More recently, the Black Lives Matter (BLM) movement is fostering a
religious experience and political ethic grounded in new conceptions
of spirituality for organizing, activism, leadership development, and
organizational structure. This includes the conscious use of healing
modalities to impart meaning, combat burnout, heal grief and trauma,
and encourage transformational justice. This new approach blends a
variety of practices, such as African spiritual beliefs and practices,
ancestor worship, and chanting, dancing, and other rituals. Examples
include white-clad Black women burning sage across a militarized
police line, chanting in front of the Los Angeles courthouse to
summon the ancestors, and using spiritually infused tools to heal
those directly impacted by state violence. The BLM network also
employs “radical inclusion” by embracing female and queer
leadership, as well as others who have been marginalized by
traditional faith groups, which historically have been primarily limited
to hetero-normative, cisgender men. This emphasis on healing and
self-care while challenging injustice has created a new community
focused on addressing state-sanctioned violence and trauma not just
politically but also spiritually (Farrag, 2018).

The social work literature highlights the importance of paying

attention to the role of spirituality in its various forms when working
with Black and African American clients, families, and communities.
For example, religious involvement and spiritual beliefs/practices
have been found to be protective factors in the areas of substance
use and involvement in the criminal justice system for Black and
African American youth (Nasim et al., 2011; Stevens-Watkins &
Graves, 2011). Among elders, involvement in religious congregations
is an important source of concrete aid, emotional support, and well-
being (Collins, 2011; Cosby, 2020; Moon, 2012). Religious
involvement and spiritual practices have also emerged as important
resources for family caregivers of Black and African American elders
(Bennett et al., 2014; Sheridan et al., 2014). More broadly, religion
and spirituality have also been identified as key coping strategies for
a range of physical and mental health conditions, such as cancer,
dementia, depression, diabetes, substance abuse, and suicidality
(Alford, 2017; Choi & Hastings, 2019; Clay et al., 2010; Montgomery
et al., 2014; Reed & Adams, 2020; Sullivan & Beard, 2014). Finally,
the Black Church and other aspects of spirituality have also been
found to be supportive for positive parenting and family functioning
(Bell-Tolliver & Wilkerson, 2011; Collins & Perry, 2015; C. K. Wilson et
al., 2014).

Latinx Americans.

This ethnic group includes people with ties to 26 countries in North,

South, and Central America; the Caribbean; and Europe (Spain). As
there is no general agreement as to how to refer to this highly diverse
group, I am using the gender-neutral term “Latinx” rather than
“Hispanic,” “Latino,” or “Latino/a,” to be inclusive of those who live
beyond binary gender roles. However, it should be noted that the
categorizing of these peoples under any generic label denies the
considerable diversity within this population. Keeping this in mind,
recent data show 3 in 4 (76%) Latinx Americans identify as Christian:
50% Catholic, 24% Protestant (14% evangelical and 10% non-
evangelical), and another 2% “other Christian.” Within this subgroup,
there are notable changing trends in religious affiliation, with a
decrease in Catholic identity and an increase in evangelical Christian
affiliation. Approximately 5% report other religious affiliations (Jones
et al., 2020), with growing numbers of Latinx Mennonites, Mormons,
Jehovah’s Witnesses, Seventh Day Adventists, and Muslims over the
past 20 years (Nabhan-Warren, 2016). Finally, about 1 in 5 (19%)
Latinx Americans are religiously unaffiliated (Jones et al., 2020).

Many Latinx people follow beliefs and practices that represent a

blending of Christian, African, and Indigenous spiritual traditions
(Canda et al., 2020; Castex, 1994). These include several African
and Indigenous spiritual healing and support traditions practiced by
the Latinx community today, including Curanderismo, Santiguando,
Espiritismo, Santeria, and Vodoun (Delgado, 1988; Paulino, 1995).
As with Black and African Americans, Latinx Americans show
relatively high indicators of religious beliefs and practices compared
to the general U.S. population. Barna (2019) tracking data show that
73% agree that “faith is very important in my life,” 70% report praying
to God in the last seven days, and 42% attended church services in
the last seven days. However, some of these indicators have shown
declines in recent years, including a 13 percent drop in praying to
God and a 12% drop in church attendance. However, the Barna
report notes a “firm belief in faith practice,” along with deep
connection to family and concern for social justice, remains one of
three key elements that characterize much of the Latinx community
(2019, para. 2).

The history of Latinx American discrimination and oppression in the

United States largely began in 1848, when the United States won the
Mexican–American War. The Treaty of Guadalupe Hidalgo at the end
of this war resulted in 55% of Mexican territory becoming part of the
United States, and the Mexican people who stayed became U.S.
citizens. Their numbers increased as Mexicans were encouraged and
recruited to come to the United States as cheap labor. As immigration
numbers grew, so did anti-Latinx sentiment. Latinx peoples faced
their own “Jim Crow” experiences, often being barred from entering
Anglo establishments, forced to live in segregated areas, and
compelled to attend under-resourced “Mexican” schools, regardless
of ethnicity. In the late 1920s and 1930s, negative views spiked
during the Great Depression, as Latinx workers were accused of
stealing American jobs—a reaction that continues into the present
day (Blakemore, 2018). As fears about jobs and the economy spread,
1 million Latinx people were forcibly removed from the United States
in the 1930s as part of a “repatriation” movement, with 60% of the
deported being legal American citizens (Balderrama & Rodrigues,
2006). Latinx communities were also subjected to mob violence and
lynching in the late 19th and early 20th centuries, with 547 confirmed
deaths and estimates into the thousands (Carrigan & Webb, 2013).
Latinx spirituality has been strongly affected by these factors of
colonialism and discrimination (Costas, 1992). This history includes
military, political, economic, cultural, and religious conquest, forcing
many originally Indigenous peoples to take on the Catholicism of their
conquerors. Many traditional places of worship, spiritual texts, beliefs,
and practices were destroyed, repressed, or blended with Catholic
traditions (Canda et al., 2020).

The legacy of colonialism and suppression of Latinx spirituality is one

contributing factor to post-colonization stress disorder resulting in
ongoing negative effects for many in the Latinx community, especially
Afro-Latinx people (Comas-Díaz, 2021). The reclamation of traditional
spiritual beliefs and practices has provided means of coping and
resilience for many. Specifically, spirituality can mediate between
racial stress and mental health symptoms by promoting post-
traumatic growth. It can also foster critical consciousness, identity
development, and engagement in sociopolitical action. Participation in
traditional events and celebrations, such as saints’ feast days, Holy
Week, Christmas Eve, feasts of the Virgin, and life passages (e.g.,
baptisms, first communions, confirmations, coming-of-age
ceremonies, weddings, and funerals) also provides individual and
community support and healing (Aguilar, 2001; Ramirez, 1985).

In the Latinx immigrant community today, loss of previous resources

and social connections; fear of deportation, even among those with
legal status; and financial, family, and work-related stressors are often
daily challenges. Religious and spiritual beliefs and practices can be
valuable supports among this population. A qualitative study (Moreno
et al., 2020) of 20 Latinx immigrants living in a southern U.S. state
revealed that religious practices and reliance on a higher power
provided strength, peace, well-being, and a sense of purpose during
the migration process. After migration, these practices also helped to
create a sense of family/community, as well as providing financial and
social support during difficult times. Still other research reveals that
religious beliefs and connections to religious communities are
associated with greater resilience and social support among Latinx
immigrants (Revens et al., 2021; Sanchez et al., 2019).

Given both history and current realities, social workers need to

understand the importance of both religious institutions and spiritual
traditions when working with Latinx populations as they are key
protective factors supporting resilience, coping strategies, social
support, and linkages to human services. For example, studies have
shown that among adolescents, various indicators of religiosity were
correlated with lower levels of premature sexual activity, lower
substance use, and more positive attitudes toward school, as well as
working as a protective buffer to exposure to community violence
(Caputo, 2009; Hardy & Rafaelli, 2003; Hodge et al., 2011; Jocson et
al., 2020; Kaplan et al., 2007). Religious beliefs and rituals have also
been identified as important factors in adjustment among elders
receiving long-term home and community-based services (Donlan,
2011), and daily spiritual experiences and private religious practices
have been associated with greater life satisfaction among community-
dwelling Latinx elders (Marquine et al., 2015). Religious involvement
and personal spiritual practices have also been reported as powerful
sources of strength, coping, and positive feelings among Latinx family
caregivers (Desai et al., 2016; Hodge & Sun, 2012; Koerner et al.,
2013). In terms of mental health, higher levels of religiosity and
spirituality are associated with decreased odds for depression,
anxiety, substance abuse, and suicidality (Becerra et al., 2014;
Morena & Cardemil, 2018; Robinson et al., 2012). Other studies
suggest an important role of spirituality in coping with various physical
health conditions, as well, such as cancer, diabetes, and stroke
(Rosario & De La Rosa, 2014; Ruiz & Praetorius, 2016; Skolarus et
al., 2012). Other findings reveal that many Latinx individuals seek
religious consultation (church-based or Indigenous healers) for
physical and mental health issues (Leung et al., 2014), suggesting it
is important to incorporate Latinx clients’ worldview and ethnocultural
variables, including religion and spirituality, in providing social work
services.
Asian Americans and Native Hawaiian/Pacific Islanders (AANHPI).

It’s important to note that there is no consensus for one term to

describe this diverse group of people whose heritages reflect a wide
range of countries, cultures, and identities. Some prefer “AAPI”
(Asian American and Pacific Islander), while others use “AANHPI”
(Asian American, Native Hawaiian and other Pacific Islanders) to
bring attention to the unique histories and challenges faced by
different groups. Still others call for the larger umbrella term of “Pan-
Asian” to emphasize unity across differences. This chapter uses
AANHPI to be as inclusive as possible while highlighting the distinct
identities and experiences of this growing segment of the American
population. There are at least 24 diverse origin groups that comprise
the AANHPI population in the United States: Bangladeshi,
Bhutanese, Burmese, Cambodian, Chamorro, Chinese, Filipino,
Guamanian, Hmong, Indian, Indonesian, Japanese, Korean, Laotian,
Malaysian, Micronesian, Mongolian, Pakistani, Okinawan, Samoan,
Sri Lankan, Taiwanese, Thai, and Vietnamese (Budiman & Ruiz,
2021). Of these, 85% identify as Chinese, Indian, Filipino,
Vietnamese, Korean or Japanese. These different peoples are
affiliated with a wide range of spiritual traditions, including Hinduism,
Buddhism, Islam, Confucianism, Sikhism, Zoroastrianism, Jainism,
Shinto, Taoism, and Christianity (Tweed, 1997). In 2020, AANHPI
people in the United States were equally likely to be Christian (34%)
or unaffiliated (34%). Among Christians, 20% were Protestant (10%
evangelical, 10% non-evangelical), 10% Catholic, or Orthodox
Christian or Latter-day Saint (1% each). Almost 3 in 10 (29%)
belonged to a non-Christian faith, including 11% Hindu, 9% Buddhist,
8% Muslim, 1% another religion, and less than 1% Jewish (Jones et
al., 2020). Furthermore, AANHPI people can be highly syncretic in
their religious faith, switching between different religions or embracing
more than one religion at the same time (Iwamura et al., 2014).

Given this diversity, it is not surprising that spiritual beliefs and

expressions range from highly religious to highly secular. For
example, 76% of unaffiliated AANHPI people say that religion is
either “not too important” or “not at all important” in their lives
compared with 58% of the total of unaffiliated U.S. adults. Conversely,
AANHPI evangelical Protestants rank among the most religious
groups in the United States; 76% reporting weekly church attendance
compared to 64% of white evangelicals (Pew Research Center,
2012b). Furthermore, it should be noted that typical expressions of
religion and spirituality (e.g., belief in God, frequency of prayer,
religious service attendance) may not be the best indicators for this
population, especially for those who practice a non-Christian faith or
who are unaffiliated. For example, while Hindu respondents may rank
“living a very religious life” as less important than “being a good
parent” or “having a successful marriage,” this indicator masks the
reality that meeting family obligations is viewed as a religious
obligation within this group. Additionally, lower attendance at formal
religious services does not take into account the practice of
worshipping at home altars or shrines or recognizing that any place
can be a setting for enlightenment. Therefore, for many AANHPI
individuals, it is more accurate to understand that they may be
differently spiritual or religious, not less so (Iwamura et al., 2014).

As with other groups, the AANHPI population has faced

discrimination and oppression throughout U.S. history. The arc of
these experiences has been described as “from ‘yellow peril’ to
‘model minority’ to the ‘Chinese virus’” (De Leon, 2020). As early as
1765, Filipino sailors, working as crew or indentured servants on
Spanish ships, established the first Filipino American communities in
what was later to become Louisiana. They fought with U.S. forces in
the War of 1812, intermarried with local Cajun and Creole families,
and established enduring communities. By the 1830s, however, the
infamous “Coolie Trade” was a global system established to bring
indentured Asian workers to Southern plantations as replacements
for African enslaved labor. Although allegedly legitimized by a “labor
contract,” these workers often experienced dangerous and brutal
working conditions like those held in bondage (Waxman & Cachero,
2021).

Perhaps the first example of governmental legal discrimination

against AAHNPI peoples was the 1854 California Supreme Court
case of People v. Hall, which ruled that Chinese people could not
testify in court against white defendants. Approximately 30 years
later, the 1882 Chinese Exclusion Act specifically barred Chinese
people from emigrating to the United States. This law remained in
place until 1943 and, to date, is the only U.S. immigration law that
restricted immigration purely based on race (Waxman & Cachero,
2021). More discriminatory actions were taken against Chinese
immigrants during the California Gold Rush in the mid-1890s and
later toward arrivals from Japan and Korea working in agriculture,
logging, fishing, and service industries. These immigrants were often
referred to as the “yellow peril” or as an “invading horde” threatening
to take over the country. They faced harsh and unsafe working
conditions, segregated housing, undue tax burdens, and legislative
barriers to immigration and citizenship, culminating in the 1924
amendment to the 1882 Chinese Exclusion Act that denied citizens
from any Asian nation to immigrate to the United States. People
identified as Asian faced attacks and mob violence, as well. In 1907,
the Bellingham Riots in the state of Washington, which involved
hundreds of white workers attacking Indian workers, was the first
incident in a wave of violence against Asian immigrants that occurred
up and down the U.S. and Canadian west coast. Perhaps the most
well-known and egregious violations of constitutional rights occurred
in 1941 when an executive order by President Franklin Roosevelt
resulted in the forced removal of the entire Japanese population on
the U.S. west coast (the majority who were citizens) to internment
camps, where they remained for the duration of World War II (Gover
et al., 2020).

When immigrants from Asian countries were finally allowed to enter

the United States after the Immigration Act in 1965, a new way of
“othering” took place. The myth of the “model minority” promoted the
idea that AANHPIs are a monolithic group who are successful due to
a strong work ethic, natural intelligence, and a family emphasis on
education and achievement. While seemingly a positive stereotype,
these ideas work to suggest that AANHPIs do not experience racial
discrimination, making it harder to speak out. It also suggests that all
racial groups operate on an equal playing field (both within and
outside of the AANHPI community), thus pitting groups against one
another. Overall, this myth fosters suspicion and resentment toward
those within the AANHPI community, often branding them as the
“perpetual foreigner.” Finally, the COVID-19 pandemic ushered in a
new wave of fear and scapegoating for this community, as political
narratives described the pandemic as the “Chinese flu” or “Kung flu”
and people were told to “go back to China” regardless of where they
were born (Gover et al., 2020). Even more alarming, hate crimes
against the AANHPI community have increased by 77% since 2019
(Federal Bureau of Investigation [FBI], 2020). Throughout this history,
many AANHPI persons have relied on religious institutions and
spiritual beliefs and practices to cope with these challenges (Boddie
et al., 2011; Ecklund & Park, 2005; Komendi & Brown, 2021).

Given this history, the literature supports paying attention to religion

and spirituality as an important part of providing culturally sensitive
practice with the AANHPI community. Among youth, religious identity
is associated with higher self-esteem, greater positive affect,
presence of meaning in life, and reduced depression symptoms for
high school students (Davis & Kiang, 2016). Religious practices and
spiritually based counseling have also been found to be associated
with several family-level outcomes, including better marital quality,
improved family relationships, and better adjustment following divorce
(Lawson & Satti, 2016; Pandya, 2021; Perry, 2016). There is also
evidence of a positive impact of religion and spirituality with various
physical and mental health challenges, such as cancer, depression,
and engagement in substance abuse treatment (Chang et al., 2017;
Gonzales et al., 2016; Tonsing & Ow, 2018). Furthermore, religious
organizations, such as churches, temples, and other religious
settings, have been found to be the most trusted source of health and
health care information (J. S. Lee, 2010). Religious faith and values,
spiritual practices, and involvement in faith-based communities and
organizations has also been reported as a protective role in buffering
acculturation stress, depression, and negative affect among AANHPI
immigrants (Diwan et al., 2004; E. O. Lee & Chan, 2009: Mui & Kang,
2006). In addition, understanding the role of spirituality and cultivating
working relationships with relevant clergy are recommended for
providing culturally and spiritually sensitive services to AANHPI
refugees (Whipple et al., 2015).

Other Groups.
It is important to remember the experience of other groups that have
been more extensively assimilated into the dominant culture of the
United States (e.g., Irish, Italian, and Jewish Americans). Many of
these groups also have histories of discrimination and religious
intolerance, the effects of which are felt by succeeding generations
(Aguirre & Turner, 2004). After the terrorist attacks of September 11,
2001, we witnessed increased discrimination and oppressive acts
against Muslim Americans, especially those of Middle Eastern
descent (Crabtree et al., 2008). The 2001 anti-Islamic hate crime
incidents reported to the FBI hit a high of 481, and although they
have not reached that mark since then, they have never returned to
their pre-9/11 levels (FBI, n.d.). And most recently, the reemergence
of heightened antisemitism is noteworthy. The Anti-Defamation
League (ADL; 2022) reported 2,717 incidents of assault, harassment,
and vandalism in 2021, the highest number of incidents on record
since the ADL began tracking in 1979. Attacks against Jewish
community centers and synagogues were up 61%, incidents at K–12
schools increased 106%, and incidents on college campuses rose
21%. Given this atmosphere, it is imperative that social workers are
sensitive to the specific history and spiritual traditions of all racial and
ethnic groups.

Critical Thinking Questions 6.3

Racialized groups have faced a long history of discrimination and

marginalization in the United States. How do you understand the role
of religion in contributing to the oppression of different groups? How
do you understand the role of religion and spirituality as a source of
solidarity, resilience, and coping with these experiences?
Native American dance is a cultural and highly spiritual form of
expression.

© iStockphoto.com/Juan Monino

Sex and Gender

Women are more likely than men to report that they believe in God
(69% vs. 57%), view religion as very important (59% vs. 47%), attend
religious services at least once a week (40% vs. 31%), pray at least
daily (64% vs. 46%), and meditate at least once a week (43% vs.
37%) (Pew Research Center, 2014a). Women also make up the
majority of members of most religious bodies in the United States and
play important roles in the life of many religious communities (Braude,
1997). These findings are striking given that influential religious
leaders—Abraham, Baháʼu’lláh, Moses, Jesus, Muhammad,
Siddhartha Gautama (the Buddha)—tend to be predominantly male.
Women who are members of traditional Judeo-Christian and Islamic
faiths generally experience conceptualizations and symbols of the
divine as masculine, suggesting that men are closer to (and thus,
more like) God than women (Reuther, 1983). Furthermore, in several
faith traditions, women’s participation has been significantly
restricted, prohibiting them from holding leadership positions or
performing certain religious rites and ceremonies. For example,
Roman Catholics, Latter-day Saints (Mormon), Southern Baptists,
and Muslims only allow men to be clergy (although women can lead
other women in prayer in Islam) (Masci, 2014).

These restrictions have been lifted over the last 50 years in some
denominations. For example, in seven mainline Protestant
denominations (United Methodist, Episcopal, Presbyterian, American
Baptist Churches-USA, Disciples of Christ, Evangelical Lutheran
Church in America, and United Church of Christ) the percentage of
female clergy increased from 2.8% in 1977 to 32% in 2017.
Furthermore, women make up half the clergy (50%) in United Church
of Christ congregations and are in the majority (57%) in Unitarian
Universalist congregations (Campbell-Reed, 2018). In Judaism, since
the first ordination of a woman rabbi in 1972, an estimated 1,500
women have become rabbis across every major Jewish
denomination, although this is still rare in Orthodox Jewish
congregations (Balin, 2022). These changes have been in response
to calls for increased ordination of women and more women in
leadership positions within religious institutions to create a more
woman-affirming environment (Roberts & Yamane, 2021).

Although most women who belong to mainstream denominations in

the United States report being generally satisfied with their affiliations
(Corbett-Hemeyer, 2016), many advocate for greater participation of
women in both leadership roles and religious rites and rituals, as well
as the use of gender-inclusive language and theological
understandings. Other women have determined that participation in
traditional patriarchal religions is not desirable or feasible for them,
with some becoming religiously unaffiliated (agnostic, atheist, or
nothing in particular) or joining more gender-inclusive denominations.
Others have embraced non-Christian, Eastern faiths, such as
Buddhism or Daoism, which have positive feminine or gender-neutral
representations of the sacred, and in some cases, greater roles for
women (Canda et al., 2020). There has also been a movement
toward alternative women’s spiritualities or feminist-identified
theology. These include Goddess worship (Manning, 2010), Wicca
(Starhawk, 1989; Warwick, 1995), Jewish feminism (Breitman, 1995),
and Christian womanist spirituality (Jackson, 2002). These spiritual
traditions emphasize the feminine aspect of the divine; the
sacredness of women’s bodies, rhythms, and life cycles; the power
and creativity of women’s spirituality; a connection to earth-centered
practices; and the care of all people and the planet (Kidd, 1996; J. G.
Martin, 1993; Ochsborn & Cole, 1995; Warwick, 1995).

Regardless of affiliation, research reveals several ways that women

utilize religious or spiritual resources in dealing with a variety of life
situations or challenges. For example, studies on domestic or
intimate partner violence identify both institutional (e.g., church
involvement and support, advice from religious leaders) and personal
resources (e.g., relying on God or a higher power as a lifeline; prayer;
development of a personal spirituality vs. relying on organized
religion) as helpful in surviving abuse and moving to a place of
resilience and post-traumatic growth (Anderson et al., 2012; Drumm
et al., 2013). In another study investigating the role of religion and
spirituality among women living with HIV, participants reported both
negative (e.g., feeling judged by religious leaders, ostracized by faith
communities, punished by God) and positive effects (e.g.,
reconnecting with God; internalized faith in a healing God;
mobilization of hope and healing) (Himelhoch & Njie-Carr, 2016).
Studies on postpartum depression generally report religious or
spiritual factors (e.g., religious commitment, religious attendance,
private spiritual practices) as predictive of lower depression
symptoms (Cheadle & Dunkel Schetter, 2018; Clements et al., 2016;
Mann et al., 2008). Several religious or spiritual indicators have been
found to facilitate women’s recovery from substance abuse and other
trauma, including reclaiming spirituality and reconnecting to spiritual
practices, finding meaning, trusting the process, and active faith
involvement (Blakey, 2016; Kruk & Sandberg, 2013; Walton-Moss et
al., 2013). Finally, in an interesting study of structural sexism and
women’s health using two nationally representative surveys,
researchers measured the level of sexism within congregations using
several indicators: whether a qualified woman could serve as head
clergyperson; serve as board member; teach co-ed classes; or
preach at a main worship service. Results showed that women who
attend more sexist congregations had worse self-rated health scores
than women who attended more inclusive congregations (Homan &
Burdette, 2021).

It is important to acknowledge another current-day issue impacting

women that can be impacted by religion—namely, abortion and
women’s reproductive rights. On June 24, 2022, the U.S. Supreme
Court decision Dobbs v. Jackson Women’s Health Organization
overturned both the 1973 Roe v. Wade and 1992 Planned
Parenthood v. Casey decisions, which had affirmed the constitutional
right to abortion, stating that the authority to regulate or prohibit
abortion belonged “to the people and their elected representatives”
(Supreme Court of the United States, 2022, p. 8). Thus, after 50
years, the right to abortion services is no longer federally protected
but is determined by each individual state. In November 2022, access
to abortions was legal in 23 states plus Washington, DC. Twenty-one
states had laws that ban most or all abortions, but eight of these are
currently blocked by courts while various legal challenges proceed.
Finally, there were six states where abortion is currently legal, but
access is viewed as potentially under threat (Kitchener et al., 2022).
As this book goes to press, U.S. state abortion laws are fluid.

It is generally known that the push to overturn federal protection for

abortion rights in the United States has been supported for many
years by conservative religious groups, particularly conservative
Christians, but less has been reported on the role of liberal or
progressive religious leaders and congregations in safeguarding
reproductive rights. After the Dobbs v. Jackson decision, these efforts
have increased, including facilitating training on reproductive rights
for faith leaders and providing both concrete and spiritual support to
women seeking abortions (Cauterucci, 2022). In the social work
profession, the National Association of Social Workers (NASW)
continues to support reproductive rights, recently stating that “all
individuals have a right to bodily autonomy ... [and] the right to
freedom of choice in accessing essential health care services, most
especially their reproductive health” (NASW, n.d., para. 1). As
individual social workers, regardless of personal religious or spiritual
perspectives or views regarding abortion, supporting women’s
reproductive rights is inherent to professional ethics and values.

Sexual Orientation and Gender Identity

Nonheterosexual and noncisgender persons are often linked together

as the LGBTQ+ (lesbian, gay, bisexual, transgender, queer, plus)
community. However, it is important to understand the difference
between sexual orientation and gender identity. For example, just like
cisgender persons, transgender, nonbinary, and gender-fluid persons
may identify as heterosexual, bisexual, homosexual, pansexual, or
asexual in terms of their sexual orientation—in other words, gender
identity is a matter of sex and gender, not sexual orientation.
However, as a group, they have much in common with gay men,
lesbians, bisexual, and persons identifying as queer when it comes to
experiences with discrimination and oppression and thus are included
with these groups in this discussion of spirituality.

As an oppressed population, LGBTQ+ persons have suffered greatly

at the hands of some groups affiliated with organized religion. Some
egregious examples are the pronouncement by certain religious
leaders that AIDS is a “punishment for the sins” of LGBTQ+ persons
and the picketing of funerals of victims of antigay hate crimes by
religiously identified individuals. Recently, there has been a
proliferation of “religious exemption” laws proposed or passed by
state legislatures that allow discrimination against LGBTQ+ in the
areas of adoption and foster care, physical and mental health care,
and access to some goods and services (Human Rights Watch,
2018). More pervasively, many LGBTQ+ members of various faiths
have had to struggle with religious teachings that tell them their
feelings and behaviors are immoral or sinful. A growing body of
literature reveals the serious impacts of religious rejection and abuse
experienced by many LGBTQ+ persons, resulting in spiritual loss,
depression, internalized shame, lower psychological well-being,
substance abuse, and suicidal thoughts and attempts (e.g., Barnes &
Meyer, 2012; Barton, 2010; Meanley et al., 2016; Super & Jacobson,
2011), as well as various strategies used to resolve conflict between
sexual or gender identity and faith (Levy & Lo, 2013; Pitt, 2010).
Other studies show LGBTQ+ persons remaining connected to their
faith despite negative experiences and relying on spirituality as an
important source of coping and support (e.g., Bozard & Sanders,
2011; Gandy, 2021; Murr, 2013; Yarhouse & Carr, 2012). Importantly,
involvement in gay-affirming congregations has been shown to
provide significant benefits to LGBTQ+ persons facing conflict
between their sexual and religious identities (Gandy, 2021; Sherry et
al., 2010).

Every major religious and spiritual tradition has LGBTQ+ adherents.

For decades, the Metropolitan Community Church, the Unitarian
Universalist Church, and United Church of Christ have had policies of
LGBTQ+ inclusion, including performing same-sex weddings,
ordaining LGBTQ+ clergy, and advocating for LBGTQ+ equality under
the law. Although the Society of Friends (Quakers) have no central
authority that speaks for all Quakers, many congregations are “open
and welcoming” of LGBTQ+ people and take same-sex marriages
under their care. More recently, the Episcopal Church, the
Evangelical Lutheran Church in America, the Presbyterian Church
(USA), and the Reconstructionist, Reform, and Conservative
branches of Judaism have also adopted policies of LGBTQ+ inclusion
(Human Rights Organization, n.d., Gay & Lesbian Alliance Against
Defamation, n.d.). There are also associations within every major
religion that are working for full inclusion of LGBTQ+ persons.
Examples include Affirmation: LGBTQ+ Mormons Family & Friends,
Affirmation (United Methodist), Association of Welcoming & Affirming
Baptists, Dignity USA (Roman Catholic), Extraordinary Lutheran
Ministries, Gay Buddhist Fellowship, Gay and Lesbian Vaishnava
Association-108 (Hindu), More Light Presbyterians, Muslims for
Progressive Values, Queer Sikh Network, Seventh-day Adventist
Kinship International, and many others (Human Rights Organization,
n.d., Gay & Lesbian Alliance Against Defamation, n.d.).

LGBTQ+ persons who grew up in or currently attend less tolerant

religious communities experience considerable tension between their
faith and their sexual and gender identities. They, and others close to
them, must decide how to respond to this tension. Canda et al. (2020)
have identified four alternative responses to lesbian women and gay
men, which also have implications for people of all gender and sexual
minorities, since bias against gay and lesbian people usually extends
to all people who are not heterosexual, cisgender, or do not fit a
gender binary expectation (see Table 6.2 ). The first three refer to the
faith’s views within the Christian context and the fourth as a reaction
against it. Even though Canda et al. (2020) discuss these four
alternatives as particular to Christian denominations, the four
responses are generally applicable to other faiths as well.

Table 6.2

Four Christian Ideological Responses to Diverse Sexual

Orientations/Gender Identities
Source: Spiritual Diversity in Social Work Practice (3rd ed., p. 170),
by E. R. Canda, L. D. Furman, and H.-W. Canda, 2020, Oxford
University Press.

These four responses have implications for both LGBTQ+ persons

and social work practitioners. For LGBTQ+ persons, involvement with
religious institutions characteristic of the first response
(Condemnation) exacerbates both the direct and internalized
oppression that many experience because of living in a society that
privileges heterosexual orientation and cisgender identity, while
viewing any other identities as deviant or “less than.” For social work
practitioners, the National Association of Social Workers (2021) Code
of Ethics takes a clear stance in this area as part of its mandates on
diversity and oppression. Specifically, it requires social workers to (1)
obtain education about sexual orientation and gender identity or
expression (Standard 1.05), and (2) eschew directly or indirectly
practicing any form of discrimination based on sexual orientation and
gender identity or expression (Standard 4.02). Thus, Canda et al.
(2020) point out that the first response is clearly antithetical to social
work values and ethics.

The second position (Accept the Person, Reject the Behavior)

continues the tension and internal conflict that LGBTQ+ individuals
experience when an important part of their identity is “not welcome at
the table.” This response also brings up questions concerning how
this stance would affect the practitioner’s work with LGBTQ+ clients.
It is challenging enough to affirm a positive self-identity as an
LGBTQ+ person in a heterosexist, homophobic, and transphobic
society without experiencing negative attitudes from one’s social
worker. If the practitioner cannot transmit the level of empathy and
respect for LGBTQ+ persons and their sexual orientation and gender
identity required by the NASW Code of Ethics, referral to another
practitioner is warranted. However, the decision to refer should be
based on what is best for the client, not the practitioner’s personal
beliefs. Furthermore, the practitioner would need to engage in a
process of reflection and self-examination to provide a more positive
and ethical response to LGBTQ+ clients, which may require
advanced training and supervision.
The third response (Affirmation), involvement with congregations that
offer affirmation and acceptance, would allow LGBTQ+ persons to
honor both their sexual and gender identities and their faith
commitments. Thus, this third position is congruent with ethical
standards of practice. While keeping client self-determination in the
forefront, the practitioner may play a supportive role in a client’s
exploration of open and affirming congregations and still be
congruent with social work ethics and values.

The final reaction of leaving one’s faith (Reject Christianity) may be

unsatisfactory for those LGBTQ+ persons who want to be involved
with communal religious experiences and desire a spiritual
community welcoming of their whole self. For others, leaving
represents a choice that is self-affirming and liberating. For a
practitioner working with a client who is considering this option, it is
important to provide support for the client’s own discernment and self-
determination in making the decision, while refraining from pushing
any particular outcome based on the practitioner’s personal beliefs.
This may be particularly important for social workers who are not
religious or have left a faith tradition due to disagreement with
teachings on sexual orientation, gender identity, or any other issue.
Practitioners need to be vigilant that they are not transmitting
negative or disrespectful attitudes toward religion with religious
clients, whether their clients are LGBTQ+ or not.

Most importantly, social workers must respect the unique spiritual

journeys that individual LGBTQ+ persons may take. If you were
working with Leon as he struggles with the conflict between his
church and his sexual identity, it would be important to work
collaboratively with him to discern what option was best for him,
providing him information about alternatives while maintaining respect
for his self-determination.

Disability

I want to begin this section with a note about language. Early in the
disability rights movement, people in the movement preferred the
person-first language of “people with disabilities.” More recently,
many in the movement have argued for the language of “disabled
people,” arguing that it is the environment that disables and not that
the disability is a part of their personhood. In this section, both
approaches are used, but it should be stressed that, as with any other
identity group, we should always use the language preferred by the
person.

Estimates of the number of adults living with a disability in the United

States range from 41.1 to 61.4 million (Okoro et al., 2018; U.S.
Census Bureau, 2021a) and an additional 3 million children are
estimated to be living with a disability (U.S. Census Bureau, 2021b).
These numbers make persons with a disability comprising the largest
minority group in the United States. They are also the most
heterogenous, as disability is not defined by race, gender, sexual
orientation, or any other social group membership. The lived
experience of disability is also diverse. Disabilities can be congenital
or acquired, static or progressive, episodic or chronic, remittent or
persistent, visible or invisible, and create varying challenges to
everyday functioning. Perhaps one of the commonalities that all
people with disabilities share is having to navigate the societal
barriers that impede their lives. As Eiesland (1994) writes: “The
difficulty for people with disabilities has two parts really—living our
ordinary but difficult lives, and changing structures, beliefs, and
attitudes that prevent us from living ordinarily” (p. 13).

These structures, beliefs, and attitudes have evolved slowly in the

United States. Historically, people with disabilities faced significant
barriers limiting their participation in social interaction and curtailing
their full rights as U.S. citizens. Until the 19th century, many disabled
people were locked in poorhouses, almshouses, or jails if their
families could not care for them at home. These actions reflected the
moral model of disability, which viewed disability as a defect caused
by a moral lapse or sin and often as a test or failure of faith. The
wrongdoing was seen as residing within the disabled person or their
family or ancestors. This understanding of disability created shame,
stigma, and the need to conceal the disability or the person with the
disability. This viewpoint continued into the 1800s, when institutions
became increasingly utilized as places for disabled people to reside.
Most of these early facilities focused on restraining and controlling
patients, with little treatment or therapy being provided (Olkin, 2002;
Waldman et al., 2021).

Institutionalization became even more popular when the pseudo-

science of eugenics gained prominence in America in the late 1800s.
Laws were passed that permitted the forced institutionalization and
sometimes sterilization of anyone deemed to not “improve the stock
of humanity,” continuing well into the 1970s. These actions coincided
with the emergence of the medical model of disability, which viewed
disability as a defect or failure of a bodily system that is inherently
abnormal or pathological, sometimes due to genetics. The goal of
intervention based on this understanding was to cure or ameliorate
the disability to bring the person as close as possible to “normal”
(Olkin, 2002; Waldman et al., 2021).

The 1960s and 1970s ushered in the independent living and disability
rights movements, which were largely grounded in the social model of
disability (Olkin, 2002; Waldman et al., 2021). This perspective places
the emphasis on environments that fail to provide appropriate
accommodations and supports for inclusion. In other words, it is the
political, economic, social, and policy systems that are disabling that
is the problem, not the individual with a disability. This era brought
increased activism and legislation that gradually resulted in
improvements in the areas of education, housing, and access to
public buildings. Later, the 1990 Americans with Disabilities Act
sought to eliminate discrimination in employment, services rendered,
public accommodation, transportation, and communication. These
developments also saw an increased realization that persons with
disabilities were a minority group that experienced discrimination and
oppression, like groups defined by other social groups memberships
(e.g., race, sex, sexual orientation). Although substantial progress
has been made, there are still attitudes stemming from earlier
understandings of disability that limit opportunities and hamper the
full inclusion of disabled people.

An exploration into religious and spiritual teachings regarding

disability reveal various theological attempts to explain why disability
exists. In pre-monotheistic times, disability was seen as a common
experience dictated by one’s fate in a world controlled by spiritual
deities. Early Judaism and Christianity viewed disability as an act of
God that was a punishment for sins or a lack of faith on the part of the
person or their family members. Christianity added the perspective
that disabled people should be seen as afflicted or suffering and must
be “saved” to be healed. Later, Islam interpreted disability as an
opportunity to endure suffering and display submission to receive
Allah’s grace. The Qur’an also has passages that suggest persons
with disabilities are not to be blamed for their disability and should be
protected by the community. In Eastern religions, such as Buddhism,
Hinduism, and Daoism, belief in karmic cycles meant that disability
could be a result of transgressions committed in a prior life that could
be an opening for spiritual growth in the present life. Finally, there are
various religious messages as to how nondisabled persons were to
treat disabled people, including expressions of pity, charity, justice,
protection, or compassion. These expressions were sometimes seen
as a way to acquire spiritual status for those who displayed them
(Fitzgerald, 1997; Miles, 1995; Niemann, 2005; Schuelka, 2013).

Although some of these views have moderated in present-day

religious teachings (e.g., disability as a punishment for sin), persons
with disabilities still face challenges when it comes to full inclusion in
religious life. Faith communities often create barriers to inclusion with
their physical architecture (e.g., no wheelchair ramps), liturgy (e.g.,
rituals or sacraments not adapted to meet individual needs),
communication (e.g., lack of hearing devices), programming (e.g.,
religious education activities not accessible), and attitudes (e.g.,
assuming persons with disabilities would not get much out of religious
services). In his book Including People With Disabilities in Faith
Communities, Carter (2007) summarizes several studies that provide
a fuller picture of these hurdles. A 2004 national Harris survey by the
National Organization of Disability reported that adults with disabilities
attended a place of worship substantially less often than nondisabled
persons (44% vs. 57%). Another 2003 study showed that fewer than
one-half of children and youth with disabilities had participated in
religious group activities at any point in the previous year. In a 2004
study of family members of children with intellectual and
developmental disabilities, some reported that their children were not
accepted or did not have the support to participate fully. Data on
congregations suggest some of the reasons for these low levels of
participation. A 2005 survey of 91 Christian, Jewish, and Muslim
congregations revealed that most were only in the early stages of
increasing accessibility; 69% reported that they had not yet started or
were only getting started in creating an environment where disabled
people were “welcomed, fully included and treated with respect”
(Carter, 2007, p. 7).

These barriers are even more notable when one considers the
literature on the benefits of spirituality for persons with disabilities. For
example, religion and spirituality have been found to provide meaning
and purpose and enhance self-efficacy among persons with hearing
loss (Cuevas et al., 2019; McClain, 2009) and as a positive factor
affecting adaptation and mental health among persons with vision
impairment (Brennan, 2004; Wang et al., 2008). Another study of
persons with various chronic health disabilities revealed positive
spiritual experiences and willingness to forgive were related to better
physical health, while negative spiritual experiences were related to
worse physical and mental health (Johnstone & Yoon, 2009). In a
qualitative study of persons with a variety of disabilities, participants
identified spirituality as an essential dimension in their lives, involving
five major themes: purpose, awareness, connections, creativity, and
acceptance (Boswell et al., 2007). In another qualitative study of
youth with developmental disabilities, involvement in their faith
communities were identified as an important source of belonging,
help, friendship and love, healing, and protection (Liu et al., 2014).
Other studies show religion and/or spirituality can be an important
source of coping and recovery in the lives of people with serious
mental disabilities (Corrigan et al., 2003; Starnino & Canda, 2014;
Tepper et al., 2001). Spirituality also has been noted as a vehicle
toward positive self-definition for disabled people (Hurst, 2007; Parish
et al., 2008; Swinton, 2012).

Age
Research on spirituality and age is revealing the role it plays at both
the beginning and final chapters of life. There are two divergent views
concerning the depth and substance of spirituality in the lives of
children and adolescents. One perspective posits spiritual
development as dependent on cognitive capacities and full ego
development and, thus, presumes younger persons don’t have the
requisite levels of cognitive functioning required to fully experience
and incorporate spiritual experiences (Elkind, 1997; Washburn,
1995). Several writers have contested this assertion, proposing that
childhood is a unique time of enhanced, not diminished, spiritual
awareness (Bloom, 2007; Coles, 1990; Levine, 1999; Richert &
Barrett, 2005). For example, in-depth interviews with children ranging
in age from 6 to 11 revealed a richness and depth regarding
spirituality that is generally not expected of people of this age,
including a variety of spiritual experiences and epiphanies such as
archetypical mythical dreams; visionary experiences; profound
insights about self-identity, life, and death; and heightened capacities
for compassion for all living things (Hay & Nye, 2006). In his book
based on 500 interviews with children from all over the world, ages 6
through 12, Coles (1990) shares children’s concerns, questions, joys,
and struggles around issues of faith, religion, God, and morality. He
emphasizes that childhood is a pivotal time for questioning and
curiosity, including about the spiritual realm. These findings are
supported by results from a national survey of seasoned social
workers who work with children and adolescents, which revealed that
practitioners generally see the relevance of religion and spirituality in
the lives of children and that they encounter youth who present
spiritual issues in practice (Kvarfordt & Sheridan, 2007).

Others note the importance of spirituality for overall positive youth

development (Cheon & Canda, 2010). For example, spirituality can
play a central role in identity formation and positive self-concept for
young people (Garbarino & Bedard, 1996; King, 2003; Marcia, 2002)
as well as providing a sense of cultural identity (Crompton, 1998;
Kyere & Boddie, 2021). Spirituality has been identified as an
important element in the development of meaning and
connectedness to others, supporting pro-social behavior (Lerner et
al., 2008; M. Wilson, 2008). Spirituality has also been found to
correlate with the five Cs of positive youth development (competence,
confidence, connection, character, and compassion/caring), as well
as a sixth domain, “contribution,” or the capacity to contribute to
family, community, and civil society (James et al., 2012; Lerner et al.,
2002).

Spiritual factors have been found to serve as protective factors for

youth. For example, two meta-analyses of the literature reported
various indicators of religiosity were inversely related to four types of
substance abuse: alcohol, cigarettes, marijuana, and other illicit drugs
(Russell et al., 2020; Yeung et al., 2009). Another meta-analysis
revealed a protective influence on sexual risk taking by adolescents
and emerging adults, showing greater religious faith related to older
age of sexual debut and fewer sexual partners (Koletic et al., 2021).
Several studies have reported religion and spirituality acting as a
buffer against mental health issues, such as depression, anxiety, and
suicidality, while being positively related to measures of psychological
well-being (Boyas et al., 2019; Dew et al., 2008; Fruehwirth et al.,
2019; Nkansah-Amankra, 2013; Schottenbauer et al., 2007; Yonker et
al., 2012). A meta-analysis of both public and private spiritual
involvement showed a stronger relationship with constructive (e.g.,
volunteer work, concerted study habits, and parent–child cohesion)
than destructive (e.g., drug use, theft, drunk driving, delinquency)
behaviors (Cheung & Yeung, 2011).

Finally, it’s important to understand the complex relationships

between religion, spirituality, and trauma. Children and youth who
have experienced physical, emotional, or sexual abuse may have
difficulty maintaining their religious or spiritual beliefs (Walker et al.,
2009; Van Dyke et al., 2009). This can be particularly true if the
abuser is clergy or a religious leader (Ellis et al., 2022). It can also be
the case if youth perceive the abuse because of God judging,
punishing, or condemning them (Pargament, 1997), which can then
lead to more negative outcomes. For example, Van Dyke et al. (2009)
found that youth who gave up on God, never attended church, or
never prayed again following abuse developed more depressive
symptoms. On the other hand, survivors who can maintain an image
of their higher power as benevolent are more likely to experience less
depression and have a greater sense of personal growth, hope, and
resolution of the abuse (Gall et al., 2007). Additionally, religion and
spirituality can provide positive coping, resilience, and empowerment
for youth experiencing discrimination and oppression due to racial,
religious, or immigrant identity (Abo-Zena & Barry, 2013; Butler-
Barnes et al., 2018; Davis & Kiang, 2016; Edwards & Wilkerson,
2018; Habashi, 2013; Kyere & Boddie, 2021; Rose et al., 2020).

At the other end of the life course, religion and spirituality are seen as
particularly relevant as we grow older. Pew Research Center’s
(2014b) Religious Landscape Study reveals that the percentage of
people reporting that they have a certain belief in God is higher for
those between 50 and 64 and 65+ (69% and 70%, respectively)
compared to those between 30 and 49 and 18 and 20 (62% and 51%,
respectively). This pattern was also noted for other indicators,
including viewing religion as very important in your life, attending
religious services at least once a week, praying at least daily, and
reading scripture at least once a week. These data showing less
involvement of younger persons compared to older persons may
simply reflect the overall decline in religious behavior in the U.S.
population, but there is also evidence that interest in things spiritual
increase as we age regardless of our birth cohort. For example, a 40-
year longitudinal study that tracked two cohorts (younger and older)
from their 30s to their late 60s/mid-70s found that, irrespective of
gender and cohort, participants increased in spirituality between late
middle age and older adulthood (Wink & Dillon, 2002).

These findings are supportive of the theory of gerontranscendence,

developed by Lars Tornstam in the 1990s (Tornstam, 1994; 1997).
His work was in response to inconsistencies between prevailing
notions that old age was a time of disengagement from life,
accompanied by loneliness, and data from studies that revealed a
different picture of aging, with increased life satisfaction and lower
levels of loneliness than young people (Tornstam, 2011). To counter
what he called the “misery-based” perspective of aging, Tornstam
proposed that human aging had the potential to mature into a new
outlook and understanding of life, from “a materialistic and rational
view of the world to a more cosmic and transcendent one” (p. 166).
This suggests that a reorientation toward a new perspective and
experience of life among elders can be understood as a process of
spiritual maturity, rather than simply as a withdrawal from the
mainstream of life.

Specifically, Tornstam (2011) outlined positive developmental

changes in three dimensions. In the Cosmic dimension, there are
changes in perception of time and space, a sense of connection with
earlier generations, a lessening of a fear of death, an acceptance of
the mystery of life, and greater rejoicing in large and subtle aspects of
life. In the Self dimension, there is the discovery of hidden aspects of
the self (both good and bad), a decrease in self-centeredness, less
identification and concern with the body, increased altruism, and
experiences of ego-integrity. In the Social and Personal Relationships
dimension, there is a different level of meaning and importance found
in relationships, an increased need for contemplative solitude, less
interest in playing roles and more comfort with displaying the
authentic self, more freedom to let go of conventions, less interest in
material possessions, and more acceptance that there is seldom a
“right answer” to the complexity of life questions. Tornstam
emphasized that some of these changes are often misinterpreted and
used to pathologize older persons when they may indicate continued
growth and development. Jewell (2014) summarizes some
challenges to the theory of gerotranscendence, highlighting that this
may not be a universal experience, and there is a need to consider
the cultural context, socioeconomic factors, and other life experiences
that may either support or hinder the development of these changes
proposed by the theory.

As with studies of children and adolescents, there is considerable

literature reporting religion and spirituality serving as protective
factors among older persons. Studies report significant relationships
between various indicators of organizational and private religiosity
and physical health variables, including better perceived health, more
engagement in physical activity, higher functional status, lower
cigarette smoking, lower incidence of stroke, lower risk of
hypertension, and lower mortality rates (Colantonio et al., 1992;
Lutgendorf et al., 2004; Musick et al., 2000; Roff et al., 2006;
Ysseldyk et al., 2013). Reviews of religious and spiritual involvement
have also been found to support better cognitive functioning (Agli et
al., 2015; Hosseini et al., 2019), while spiritual practices such as
meditation and prayer have been linked to better brain health,
including memory and concentration (Newberg, 2011). There is also
considerable evidence for the role of religion and spirituality in
enhancing better mental health, including lowered risks of
depression, anxiety, and suicide (Kim et al., 2014; Koenig et al.,
1993; Rushing, 2013; Whitehead, 2018), as well as supporting overall
well-being, quality of life, and life satisfaction (Cowlishaw et al., 2013;
C. Frazier et al., 2005; Idler et al., 2009). Various religious and
spiritual indicators have also been identified as a means for coping
with difficult life challenges, such as losses, illness, disability, and
facing death (Crowther et al., 2002; Daaleman & Dobbs, 2010;
Koenig & Cohen, 2006; Nelson-Becker et al., 2016). Finally, there is
evidence that spirituality is linked to greater participation in
community service among older persons (Wink & Dillon, 2003), with
those with stronger religious identification more involved in a variety
of civic activities, including volunteering, philanthropy, and social and
political groups (Okun et al., 2015; Putnam & Campbell, 2010).

Critical Thinking Questions 6.4

Previously you were asked to consider the role of religion and

spirituality in the lives of people with diverse racial and ethnic
identities. How do you understand this role (both positive and
negative) for other aspects of diversity, including sex and gender,
sexual orientation and gender identity, disability, and age? How have
you seen religious and spiritual beliefs used to discriminate against
some groups of people? How have you seen religious and spiritual
beliefs used to promote social justice?

Spiritually Sensitive Social Work Practice

A holistic understanding of human behavior and the human condition

requires social workers to respond sensitively to the diverse religious
and nonreligious forms of spirituality when working with individuals,
families, groups, and communities. This involves utilizing effective
assessment approaches and identifying the relevance of spirituality
within micro, mezzo, and macro practice.

Assessment

Given the important role of spirituality in understanding both human

diversity and human experience, it has become evident that gathering
information about a client’s religious or spiritual history and assessing
spiritual development and current interests are as important as
learning about biopsychosocial factors. Assessment needs to go
beyond the surface features of faith affiliation (e.g., Protestant,
Catholic, Jewish, or Muslim) to include deeper facets of a person’s
spiritual life (Sheridan, 2002). For example, talking with Caroline
about where she is in her unfolding spiritual development would be
helpful in supporting her exploration of different faith perspectives.
Asking Matthew what brings him meaning, purpose, and connection
right now would be valuable in assisting him in the next chapter of his
life. And in working with Leon, it would be useful to know what
aspects of his current religious affiliation are the most important and
meaningful to him as he struggles with the conflicts regarding his faith
and his sexual identity. None of this knowledge would be gleaned by
a simple response to “What is your current religious affiliation?”

Social workers also need to assess both the positive and negative
aspects of clients’ religious or spiritual beliefs and practices (Canda et
al., 2020). For example, Naomi’s and David’s understanding of the
meaning of illness may be either helpful or harmful in dealing with
Naomi’s health crisis; Trudy’s current spiritual practices may be
supportive or detrimental to her physical, emotional, and social well-
being; and Jean-Joseph’s synthesis of Catholic and Vodoun beliefs
and practices may be very positive for his personal and family life but
may be problematic in his interactions with the wider social
environment. Assessing the role and impact of all these factors would
be important areas for exploration in developing a spiritually sensitive
relationship with any of these individuals.
A growing number of assessment instruments and approaches are
available to help social workers. These include brief screening tools,
which can provide an initial assessment of the relevance of religion or
spirituality in clients’ lives. Examples include the HOPE (Anandarajah
& Hight, 2001), the FICA (Puchalski & Romer, 2000), the MIMBRA
(Canda et al., 2020), and the Brief RCOPE (Pargament et al., 2000).
There are also more comprehensive assessments that focus on
religious/spiritual history of self and significant others (Bullis, 1996)
and current life circumstances, such as key memberships, beliefs,
and sources of support (Canda et al., 2020). Finally, Canda et al.
(2020) offer questions for assessing the helpful or harmful impacts of
participating in various groups or organizations.

There are also more implicit assessment approaches that do not

directly refer to religion or spirituality but are composed of open-
ended questions that tap into spiritual themes (see Table 6.3 for
examples of these kinds of questions). Other nonverbal strategies
have also been developed, including the use of spiritual timelines
(Bullis, 1996); spiritual lifemaps, genograms, ecomaps, and
ecograms (Hodge, 2015); and spiritual trees (Raines, 1997).

Table 6.3
Source: Spiritual Diversity in Social Work Practice (3rd ed., p. 170),
by E. R. Canda, L. D. Furman, and H.-W. Canda, 2020, Oxford
University Press.

Social workers also must be able to distinguish between a

religious/spiritual problem and a mental disorder. The V62.89
(Religious or Spiritual Problem) code in the Diagnostic and Statistical
Manual of Mental Disorders (American Psychiatric Association, 2022)
identifies spiritual issues that might suggest treatment but do not
involve a mental disorder. This framework would be helpful in
understanding any extraordinary or mystical experiences that Trudy,
Jean-Joseph, or any of the other people in the case studies might
share with you. Accurate assessment of such an occurrence can help
determine whether the experience needs to be integrated and used
as a stimulus for personal growth or whether it should be recognized
as a sign of mental instability.
Finally, social workers also need to assess spirituality when working
with larger client systems as well. This can include determining
openness to spiritual wellness within an organization, analyzing the
religious underpinnings of a proposed policy, assessing spiritual
resources within a community, or identifying spiritual motivations for
social change (Sheridan, 2014).

Micro, Mezzo, and Macro Social Work Practice

Social work scholars are increasingly calling for spiritually sensitive

social work at multiple levels of practice (Canda et al., 2020; Ellor et
al., 1999; Parada, 2022; Sheridan, 2014). At the micro level of
practice with individuals, couples, families, and small groups, this
entails integrating a focus on spirituality in work with individuals facing
a wide range of problems in living, including physical and mental
health issues (Koenig, 2005; Koenig et al., 2023; Oxhandler &
Pargament, 2014), abuse and violence (Benavides, 2012; Bowland et
al., 2011); poverty and houselessness (Greeff & Fillis, 2009; Jindra &
Jindra, 2021); natural disasters (Tausch et al., 2011), loss
(Damianakis & Marziali, 2012; Muselman & Wiggins, 2012), and
ethnic trauma, war, displacement, and terrorism (Drescher et al.,
2009; Markovitzky & Mosek, 2005; Meisenhelder & Marcum, 2009).
Paying attention to religion and spirituality has also been highlighted
in work with couples (Duba & Watts, 2009), families (Bell-Tolliver &
Wilkerson, 2011; Walsh, 2009), and small groups (Cornish et al.,
2014). Finally, growing number of articles promote the use of
spiritually derived approaches for supporting well-being, including the
use of stress management, relaxation, and mindfulness techniques
(Brantley et al., 2008; M. J. Lee et al., 2018).

At the mezzo level, the literature offers exemplars of spiritually

informed organizational and community practice. Examples include
faith-based organizations providing social services to a variety of
populations, including refugees (Ives et al., 2010), substance users
(MacMaster et al., 2007), previously incarcerated persons (Roman et
al., 2007), families seeking adoption (Morris et al., 2005), rural
families (Harr & Yancey, 2014), and youth (Sinha, 2007). Other
articles highlight the influence of faith in human service programs,
including both benefits and pitfalls (Hugen & Venema, 2009; Sherr et
al., 2009; Thomas, 2009). There is also a body of work describing
congregational-based services (Hodge, 2020; Vennen et al., 2020;
Wilke & Howard, 2021; Williams et al., 2019) and faith-academic
collaborations (Campbell & Szaflarski, 2021; Cnaan & Boddie, 2001;
International Panel on Social Progress, 2016). Other writings focus
on the role of spirituality and faith-based entities in community
practice, including identifying community needs and strengths,
organizing community power, building social capital and community
networks, and providing community space and other resources
(Botchwey, 2007; Cnaan et al., 2005; Haugh, 2011; Hill & Donaldson,
2012; Wood, 2002).

There is also recognition of the role of religion and spirituality in

macro social work, including policy practice, political action, and
movements for social justice and social change. Religion has had a
consistent but at times controversial and contentious role in
developing public policy. As stated in the introduction to a book on
faith and policy: “Whether we like it or not, the connections between
religion and public policy choices are profound and unavoidable.
Government policy and religious matters are not the same thing, but
neither do they exist in isolation from each other” (Heclo & McClay,
2003, p. 18). Both historical and current issues reflect this truth as
there are numerous examples of religious views influencing policy
and legislation on abolition and civil rights, child labor, voting rights,
alcohol control, welfare reform, school prayer and educational
curriculum, the death penalty, stem cell research, reproductive rights,
marriage equality, access to sex-affirming health care, sanctuary for
immigrants—to name a few. Although conventional political analysis
has often linked religious considerations with conservative policy
development, while viewing liberal policymaking as a largely secular
enterprise, there are efforts to close “the God gap” in progressive
policy efforts by actively identifying the moral “good” inherent in
proposed policies (Braunstein et al., 2017). Religious and spiritual
values are also reflective in larger movements for social justice and
social change. As Hutchison (2012) outlines in her article on
progressive social movements, there can be religious or spiritual
elements in building and maintaining social change initiatives. These
include: (a) providing political pressure through congregational efforts
and allyship; (b) mobilizing needed structures, such as shared
values/culture, leadership, material resources, communication
networks, and physical space; and (c) cultural framing for identifying
the problem, perceiving times of opportunity, establishing goals, and
determining pathways for action. Social workers are also becoming
acquainted with “spiritual activism,” which goes beyond a focus on
political and economic forces as primary mechanisms for social
change to incorporate a spiritual framework for activism. Emerging
principles of this new model include such themes as recognition of
interdependence, acceptance of not knowing, openness to suffering,
and outer change requiring inner work (Sheridan, 2012). This more
holistic approach is viewed as having greater potential for achieving
social justice than previous efforts embedded in a conflict
perspective.

Critical Thinking Questions 6.5

How comfortable are you in discussing religious and spiritual themes

with others? Which of the questions in Table 6.3 would you be
comfortable asking a client? Which would you be uncomfortable
answering? How do you view the place of spirituality in social work
practice at micro, mezzo, and macro levels?

Implications for Social Work Practice

Spiritually sensitive social work practice involves gaining knowledge

and skills in the areas discussed in this chapter, always keeping in
mind that this approach must be grounded within the values and
ethics of the profession. The following practice principles are offered
as guidelines for effective and ethical social work practice in this area.

1. Maintain clarity about your role as a spiritually sensitive

practitioner, making a distinction between being a social worker
who includes a focus on the spiritual dimension as part of holistic
practice versus being a religious leader or spiritual director.
 2. Be respectful of different religious or spiritual paths and be willing
to learn about the role and meaning of various beliefs, practices,
and experiences for various client systems (individuals, families,
groups, organizations, communities).
3. Critically examine your own values, beliefs, and biases
concerning religion and spirituality and be willing to work through
any unresolved or negative feelings or experiences in this area
that may adversely affect your work with clients.
4. Inform yourself about both the positive and negative role of
religion and spirituality in the fight for social justice by various
groups and be sensitive to this history in working with members
of oppressed and marginalized populations.
5. Develop a working knowledge of the beliefs and practices
frequently encountered in your work with clients, especially those
of newly arriving immigrants/refugees or nondominant groups
(for example, Buddhist beliefs of Southeast Asian refugees,
spiritual traditions of Native Americans).
6. Conduct comprehensive spiritual assessments with clients at all
levels and use this information in service planning and delivery.
7. Acquire the knowledge and skills necessary to employ spiritually
based intervention techniques appropriately, ethically, and
effectively.
8. Seek information about the various religious and spiritual
organizations, services, and leaders pertinent to your practice
and develop good working relationships with these resources for
purposes of referral and collaboration.
9. Engage in ongoing self-reflection about what brings purpose,
meaning, and connection in your own life and make disciplined
efforts toward your own spiritual development—however you
define this process.

Chapter Review

Key Terms

Ecocentric
Faith
 Faith stages
First force therapies
Fourth force therapies
Ideology (personal)
Levels of consciousness
Religion
Second force therapies
Spiritual bypassing
Spirituality
Third force therapies
Transpersonal approach
Ultimate environment
Worldcentric

Active Learning

1. Consider any of the case studies presented at the beginning of

the chapter. Using Fowler’s stages of faith development,
construct a timeline of the person’s spiritual development. Trace
the overall growth patterns through the different stages, including
any ups and downs, as well as plateau periods. Identify the
significant points or transitions you consider pivotal to the
person’s spiritual development.

How would this information help you to better understand

the person’s story and overall development? How would this
information help you work with them as a social worker?
What would your own spiritual timeline look like, including
patterns throughout various stages and significant points or
transitions that were particularly significant for your own
growth and development?

2. Select a partner for this exercise. This chapter provides a brief

overview of the spiritual diversity in the United States. Given both
your knowledge and experiences with different spiritual
traditions, both religious and nonreligious, address the following
questions. Take a few moments to reflect on each question
 before answering it. Partners should take turns answering the
questions.

To which spiritual perspectives do you have the most

positive reactions (e.g., are in the most agreement with, feel
an appreciation or attraction toward, are the most
comfortable with, find it easiest to keep an open mind and
heart about)? What is it about you that contributes to these
reactions (e.g., previous knowledge, personal experiences,
messages from family or larger culture)?
To which perspective do you have the most negative
reactions (e.g., are in the most disagreement with, feel a
repulsion or fear about, are the most uncomfortable with,
find it most difficult to keep an open mind and heart about)?
What is it about you that contributes to these reactions (e.g.,
previous knowledge, personal experiences, messages from
family or larger culture)?
What impact(s) might your reactions (both positive and
negative) have on work with clients (especially with those
who may hold different spiritual perspectives from yourself)?
What personal and professional “work” on yourself is
suggested by your positive and/or negative reactions?

3. Select a partner for this exercise. Together select one of the

open-ended questions questions listed in Table 6.3 to consider
as it applies to your own lives. After a few moments of quiet
reflection, write your response to the question, allowing yourself
to write freely without concern for the proper mechanics of writing
(e.g., spelling, grammar). Then sit with what you’ve written,
reading it over with fresh eyes. When you’re ready, share this
experience with your partner, sharing as much or as little of what
you’ve written as you feel comfortable with. Then talk together
about the following questions:

What was the experience like of answering this question and

then reading the response to yourself (e.g., easy, difficult,
exciting, anxiety-producing, confirming)?
 Are there previous times in your life when you considered
this question? Did you share your thoughts about it with
others? If so, what was that like? What is it like to do that
now with your partner?
Can you see yourself asking this kind of a question with a
client? What do you think that experience might be like for
both the client and you?

Descriptions of Images and Figures

Back to Figure

The pie chart is described as follows.

White evangelical Protestant: 14; White mainline (non-evangelical)

Protestant: 16; White Catholic: 12; Latter-day Saint (Mormon): 1;
Orthodox Christian: 0.5; Black Protestant: 7; Hispanic Protestant: 4;
Other Protestant of color: 4; Hispanic Catholic: 8; Other Catholic of
color: 2; Jehovah's Witness: 1; Jewish: 1; Muslim: 1; Buddhist: 1;
Hindu: 0.5; Unitarian/Universalist: 0.2; Other Religion: 1; Unaffiliated:
23; Don't know/Refused: 2.

Back to Figure

The x axis shows the ethnicities, and the y axis shows the percentage
from 0 to 100 in increments of 10.

In the Black, Non-Hispanic group, the percentage who identify as:

Evangelical Protestant: NA, Non-Evangelical Protestant: 21, Catholic:

4, Other Christian: NA, Jewish: NA, Other world religions: 7,
Unaffiliated: 28, Don't know/Refused: 35.

In the White, Non-Hispanic group, the percentage who identify as:

Evangelical Protestant: NA, Non-Evangelical Protestant: 23, Catholic:

NA, Other Christian: NA, Jewish: NA, Other world religions: 19,
Unaffiliated: 27, Don't know/Refused: 23.
In the Native American group, the percentage who identify as:

Evangelical Protestant: 7, Non-Evangelical Protestant: 28, Catholic:

4, Other Christian: NA, Jewish: NA, Other world religions: 11,
Unaffiliated: 19, Don't know/Refused: 28.

In the Multiracial group, the percentage who identify as:

Evangelical Protestant: 4, Non-Evangelical Protestant: 34, Catholic:

6, Other Christian: NA, Jewish: 3, Other world religions: 11,
Unaffiliated: 18, Don't know/Refused: 23.

In the Hispanic group, the percentage who identify as:

Evangelical Protestant: NA, Non-Evangelical Protestant: 19, Catholic:

NA, Other Christian: NA, Jewish: NA, Other world religions: 50,
Unaffiliated: 10, Don't know/Refused: 14.

In the Asian or Pacific Islander group, the percentage who identify as:

Evangelical Protestant: NA, Non-Evangelical Protestant: 34, Catholic:

29, Other Christian: NA, Jewish: 3, Other world religions: 10,
Unaffiliated: 10, Don't know/Refused: 10.

Back to Figure

The x axis shows the age groups from 18 to 65 plus, and the y axis
shows the percentage from 0 to 100 in increments of 10.

In the 18 to 29 age group, the percentage who identify as:

White evangelical Protestant: 7, White mainline Protestant: 12, White

Catholic: 8, Latter-day Saint (Mormon): NA, Black Protestant: 5,
Hispanic Protestant: 5, Hispanic Catholic: 9, Other Christian: 6,
Jewish: 5, Other world religions: 9, Unaffiliated: 36, Don't
know/Refused: NA.

In the 30 to 49 age group, the percentage who identify as:

White evangelical Protestant: 12, White mainline Protestant: 17,
White Catholic: 10, Latter-day Saint (Mormon): NA, Black Protestant:
7, Hispanic Protestant: 5, Hispanic Catholic: 10, Other Christian: 3,
Jewish: NA, Other world religions: 3, Unaffiliated: 25, Don't
know/Refused: NA.

In the 50 to 64 age group, the percentage who identify as:

White evangelical Protestant: 17, White mainline Protestant: 17,

White Catholic: 14, Latter-day Saint (Mormon): NA, Black Protestant:
9, Hispanic Protestant: 3, Hispanic Catholic: 7, Other Christian: 7,
Jewish: NA, Other world religions: NA, Unaffiliated: 18, Don't
know/Refused: 3.

In the 65 plus age group, the percentage who identify as:

White evangelical Protestant: 22, White mainline Protestant: 20,

White Catholic: 15, Latter-day Saint (Mormon): NA, Black Protestant:
8, Hispanic Protestant: NA, Hispanic Catholic: 5, Other Christian: 6,
Jewish: NA, Other world religions: NA, Unaffiliated: 14, Don't
know/Refused: 3.

Back to Figure

The graphs are as follows.

Most major religious groups are expected to increase in number by

2060. But some will not keep pace with global population growth,
and, as a result, are expected to make up a smaller percentage of the
world's population in 2060 than they did in 2015.

The population of Jews in 2015 was 0.01 billion (0.2 percent), and in
2060, it is expected to increase to 0.02 billion (0.2 percent).

The population of other religions in 2015 was 0.06 billion (0.8

percent), and in 2060, it is expected to stay at 0.06 billion (0.6
percent).
The population of Folk religions in 2015 was 0.42 billion (6 percent),
and in 2060, it is expected to increase to 0.44 billion.

The population of Buddhists in 2015 was 0.50 billion (7 percent), and

in 2060, it is expected to decrease to 0.42 billion.

The population of Hindus in 2015 was 1.10 billion (15 percent), and in
2060, it is expected to increase to 1.39 billion (14 percent).

The population of Unaffiliated in 2015 was 0.17 billion (16 percent),

and in 2060, it is expected to increase to 1.20 billion (13 percent).

The population of Muslims in 2015 was 1.75 billion (24 percent), and
in 2060, it is expected to increase to 2.29 billion (31 percent).

The population of Christians in 2015 was 2.28 billion (31 percent),

and in 2060, it is expected to increase to 3.05 billion (32 percent).

The unaffiliated population will increase by 3% in the decades ahead,

but from 2015 to 2060, the religiously unaffiliated will decline as a
share of the global population. Over the next 45 years, Islam will grow
faster than any other major world religion. By 2060, Christians and
Muslims will make up nearly equal shares of the world's population.
Part III The Multiple Dimensions of Environment
Social workers have always recognized the important role the
environment plays in human behavior and, equally important, have
always understood the environment as multidimensional. Although
all dimensions of environment are intertwined and inseparable,
social scientists have developed specialized literature on several
specific dimensions. Both the environment and the study of it
become more complex with each new era of technological
development, making our efforts to understand the environment ever
more challenging.

The eight chapters in Part III provide you with an up-to-date

understanding of the multidisciplinary theory and research about
dimensions of environment. The section begins with Chapter 7, on
an important dimension often overlooked in the social work literature,
the physical environment. Next comes Chapter 8, which
demonstrates how we all live at the intersection of multiple cultures
and considers the processes by which cultures create power and
how they change. Chapter 9 explores the macro environment,
focusing on contemporary trends in social structure and social
institutions, placing U.S. trends in a global context. Chapters 10 and
11 cover the smaller-scale configurations of families and small
groups. Part III ends with Chapters 12, 13, and 14 on the moderate-
size configurations of organizations, communities, and social
movements. In Part II, you learned about the multiple dimensions of
persons. When you put that together with the knowledge gained
about multiple dimensions of environments, you will be better
prepared to understand the situations you encounter in social work
practice. This prepares you well to think about the changing
configurations of persons and environments across the life course—
the subject of the companion volume to this book, The Changing Life
Course.
7 The Physical Environment

Elizabeth D. Hutchison

Learning Objectives

7.1 Analyze one’s own emotional and cognitive reactions to two

case studies.
7.2 Summarize three categories of theories about the
relationship between the physical environment and human
behavior (place, spatial behavior, and behavior settings).
7.3 Give examples of positive and negative effects of human
interaction with the natural environment.
7.4 Give examples of the impact of the built environment on
human behavior.
7.5 Analyze contemporary ecological, sustainability, and
environmental justice efforts and challenges from the perspective
of social, racial, economic, and ecological justice.
7.6 Apply knowledge of the relationship between the physical
environment and human behavior to recommend guidelines for
social work engagement, assessment, intervention, and
evaluation.

Two Case Studies of Human Behavior and the Physical Environment

Case Study 7.1: Ben Watson’s Experience With Accessible and Inaccessible Environments

Ben Watson’s experience with the physical environment changed in a

minute when he fell 500 feet while rock climbing with friends. He had
just finished his final semester in a Bachelor of Architecture program
and had a job lined up with a small architecture firm in North Carolina.
He doesn’t remember much about the rescue, the trip to the nearest
hospital, or the medivac to the trauma center. He does remember the
physician who told him he had an incomplete spinal cord injury and
would have some sensation below the lesion but no movement. For
several days, Ben was depressed and angry and wanted to give up.
He appreciated a chance to talk with the rehabilitation social worker
about his grief.

After five challenging months in the hospital and rehabilitation center,

Ben and his new titanium wheelchair went home to live with his
parents, who had rearranged the home so that Ben could have the
first-floor master bedroom and bath. Ben had heard the word access
used in some of his architecture courses, but now he began to learn
the importance of accessibility. When his friends wanted to take him
out to a bar, they had a tough time finding one that was accessible to
Ben’s wheelchair, and when they got to the bar they found that stairs
had to be used to get to the bathroom.

The architecture firm was holding the position for Ben; after a few
months of recuperation, even though he still needed a lot of personal
care, he began to talk with his parents about making the 350-mile
move to North Carolina. From an earlier visit, he knew that the firm is
accessible to him and his wheelchair; it is in a relatively new building
with a ground-level entrance, a spacious elevator, wide doors, and
accessible bathrooms. His father drove him down to look for housing.
They were looking for a ground-floor apartment with open
architectural features that make wheelchair mobility possible, and
they were able to find one that Ben could afford in a location he
loved. Ben was excited to finally have more privacy, after living with
his parents, but the open floor plan would allow him to have friends
over without feeling cramped. Ben also loved the abundance of
windows that would allow for good natural lighting. With financial
assistance from his parents at first, Ben hired a personal assistant to
help with personal care in the mornings and evenings.

Twelve years later, Ben has become the local expert on accessible
architectural design. His colleagues at work have turned out to be
good friends as well as good colleagues. He has developed a close
set of friends and has an active life. He and his friends have learned
where the streets are that don’t have curb cuts, which bars and
restaurants are truly accessible, where the “accessible” entry is really
some dark-alley back entrance, and to watch out for retail doorways
blocked by displays of good. During the first year of the COVID-19
pandemic, Ben liked the convenience of working from home.

The natural environment was always an important part of Ben’s life,

providing beauty and serenity, and he and his friends have found
wonderful hiking trails that are wheelchair accessible. They felt
comfortable getting together in natural settings throughout the
pandemic with masks in place. In the past few years, Ben has
become deeply concerned about the ways human are damaging the
natural environment and has become involved with a local group
working to protect the city’s natural environments.

Case Study 7.2: Shanthi’s Need for Healthy Affordable Housing in Chennai, India

Shanthi lives in Chennai, a city of approximately 10 million people in

Southern India. Hundreds, sometimes thousands, of people migrate
to Chennai every day in search of work. Shanthi’s parents came to
Chennai looking for work in the mid-1980s. When they arrived in
Chennai, they set up a thatched house made of coconut leaves and
consisting of a 10 × 10 square-foot room with a kitchen and a
sleeping space. The house was in an impoverished neighborhood
called SS Puram, located on the banks of the Coovam River. Shanthi
and her two brothers were born here. There was no toilet and, to
answer nature’s call, the residents of SS Puram went to the railway
track early in the morning or late at night when there were no trains.
During the day, they had to use the banks of the river. The water they
used came from a tank that was never cleaned, and Shanthi’s family
used a cloth to filter the water. When the heavy rains came in
November and December, the house always flooded and the family
had to bring all their belongings and seek shelter in the nearby
government school.

According to tradition, when Shanthi reached puberty at age 12, she

should be secluded in a separate hut for four days. Because there
was no such space inside or outside the family home, Shanthi spent
four days in a neighbor’s house where she was provided a private
corner space. At the end of this time, Shanthi became very ill and
was hospitalized with an acute urinary tract infection. When Shanthi
was 14 years old, her youngest brother developed malaria and
cholera and had to drop out of school for a year. When Shanthi was
16 years old, her family’s house and the houses of many neighbors
burned to ashes. The family lived temporarily in the local community
center, and after one month Shanthi’s mom took a loan from her
employer to rebuild the house. Soon after, Shanthi’s dad died from a
chronic respiratory disease.

Shanthi had missed school to care for her dad and decided to join her
mother as a domestic maid and milk deliverer. Her workdays started
at 4:00 a.m. and ended at 5:00 p.m. Shanthi’s mom and the
neighbors were concerned that Shanthi needed to get married, and
they found a suitable young man named Sarath, who worked as an
auto driver and wanted a house as a dowry. Shanthi’s mother and
brothers moved to a rented hut and gave the family home to Shanthi
to use as dowry. One day when Shanthi returned home from work
she found a note pasted to her door. The note said “This is to inform
you that you have to vacate your house in 3 months. You are living on
public property and this land is being taken over for development
purposes.” Shanthi learned that the government was clearing all
houses located on the banks of the Coovam River. The residents of
SS Puram were distraught and attended meetings to protest. They
lived in squalid conditions, but they had a home to call their own.

At the end of 3 months, trucks and bulldozers came to demolish SS

Puram. Shanthi and Sarath were denied housing in the new tenement
where other residents of SS Puram were being relocated because
their house was not registered in their name. For 2 weeks, they
stayed on a bridge with their belongings, taking turns going to work
and staying on the bridge to watch their belongings. Finally, they were
offered a sixth-floor concrete apartment 30 miles away, in a
community that housed 50,000 people within a space of 2 acres. The
apartment had a toilet inside the house, but the toilets often
overflowed and the water supply was erratic. There were not enough
jobs in the area, and Sarath could only find part-time work. There was
no good nearby hospital. Shanthi gave birth to a baby with health
problems, and the baby did not survive. The monsoons were very
bad in 2019 and the apartments in the neighborhood were flooded,
with overflowing toilets and no clean drinking water for almost 7 days.
Shanthi and Sarath had to seek shelter in a nearby school. And then,
in March 2020, COVID-19 hit and a lockdown was announced.
Shanthi and Sarath lost their jobs for over a year, and Sarath still has
not found full-time work. They feel hopeless and their housing
situation remains a threat to their health and well-being.

Story provided by Gladston Xavier

Theories of Human Behavior and the Physical Environment

As with most stories we hear as social workers, the stories of Ben

Watson and Shanthi are multidimensional stories of person and
environment interactions over time. These stories present issues of
life course development; family, friend, and neighbor relationships;
physical disability; challenging health conditions; a struggle for
emotional well-being; loss and grief; natural disaster; and interactions
with communities and formal organizations. And, of course, a
supremely important dimension of these unfolding stories is the
physical environment. Ben’s and Shanthi’s stories remind us that all
human behavior occurs in a physical environment context, and they
also remind us of the impact that human behavior has on the physical
environment.

Three broad categories of theory about human behavior and the

physical environment are introduced in this chapter: theories of place,
theories of spatial behavior, and behavior settings theories. Each of
these categories of theory, and the research they have stimulated,
provides useful possibilities for social workers to consider as they
participate in person–environment assessments and consider
possibilities for intervention at multiple levels of person and
environment interactions. Table 7.1 presents the key ideas and
important concepts of these three types of theories.

Table 7.1
Theories of Place

Ben Watson’s apartment and some natural settings have become

important places to him. Although the physical conditions of SS
Puram were not good, it was home to Shanthi and she was sad to
leave. The concepts of place, place attachment, and place identity
have been a part of the study of the relationship between the physical
environment and human behavior for several decades. Placemaking
is a relatively new concept in theories of place.

Let’s look first at the concept of place . The most often-used definition
of place is Cresswell’s (2015) simple definition of “a meaningful
location” (p. 12). Other theorists and researchers suggest three
elements of sense of place: the physical properties of the setting, the
activities and behaviors that happen in the setting, and the emotional
and cognitive conceptualizations of the setting (Donald, 2022;
Stedman, 2003). Social worker Danielle Littman (2021) reminds us
that when we think of theories of place, it is important to keep in mind
that some people have limited access to locations that are meaningful
to others, including many older adults, incarcerated persons, and
people who are unhoused. I would add many people with mobility
disabilities and many economically marginalized people like Shanthi
(Case Study 7.2).

When a particular place becomes an important part of our self-

identity, this merger of place and self is known as place identity .
Place identity may be with a particular physical location, or it may be
with a type of physical environment. We sometimes hear people say
things like “I’m a New Yorker,” “I’m a mountain person.” Some people
identify themselves as city people and others identify themselves as
rural people. It is possible to identify with more than one place and to
identify with places at various levels, such as neighborhood, city,
state, or nation. When Scannell and Gifford (2017) asked one
Canadian sample to identify the types of places with which they had a
sense of attachment, 14 types of places were identified. The most
commonly identified types were house, outdoor area, city/town, and
vacation place. Some people develop a sense of self-esteem from
their place identity and other people have their self-esteem
undermined by the place with which they identify. In Case Study 7.2,
Shanthi’s self-esteem seems to be undermined by her current
housing situation, even though the physical conditions of her concrete
apartment are not worse than her house on SS Puram.

Place attachment is a deep bond that a person feels with a particular

place and a desire to maintain close contact with the place (Donald,
2022; Lewicka, 2011). Place attachment may occur with any scale of
the physical environment, from specific physical objects to the planet
Earth. Research indicates that humans report more attachment to
home or dwelling and city or region than to the neighborhood.
Researchers studying place attachment conceptualize it as a
multidimensional phenomenon involving a person, a place, and
psychological processes of attachment (Scannell & Gifford, 2010). In
terms of person, researchers explore how place attachment occurs at
both the individual and group levels. At the individual level, place
attachment develops out of personally important experiences. At the
group level, attachment develops out of symbolic meanings of a place
shared by a group. In terms of the psychological processes of
attachment, an interplay of emotions, cognitions, and behaviors
appears to be what forges the people–place bond (Donald, 2022;
Scannell & Gifford, 2010).

Researchers have been interested in the psychological benefits of

place attachment (see López-Mosquera & Sánchez, 2013; Scannell &
Gifford, 2016, 2017). In one study, Scannell and Gifford (2017)
identified 13 benefits of place attachment. The four most commonly
identified benefits were memory support, sense of belonging,
relaxation, and stimulation of positive emotions. Other identified
benefits include activity support, comfort/security, personal growth,
freedom, entertainment, connection to nature, practical benefits,
privacy, and aesthetics.

There are both dark sides and bright sides to place identity and place
attachment (Toruńczyk-Ruiz & Martinović, 2020). A strong sense of
place identity and place attachment can lead to efforts to exclude
diverse newcomers if one holds the belief that the place to which one
is attached should not change over time (Wnuk et al., 2021). In these
situations, racial and ethnic integration as well as other types of social
integration are resisted. However, for people who value the evolution
of places and do not hold strong exclusionary beliefs, place identity
and place attachment are associated with openness to diverse
newcomers (Toruńczyk-Ruiz & Martinović, 2020). As the climate crisis
is producing more natural disasters, place attachment has been
found to play a role in people taking risks to stay in or return to an
endangered place (Chamlee-Wright & Storr, 2009). In Case Study
7.2, Shanthi’s mother was determined to rebuild in SS Puram after a
fire destroyed their thatched house. Place attachment has also been
found to lead residents of endangered places to engage in more
disaster preparedness activities (Mishra et al., 2010). Even though
the findings are inconsistent, there does appear to be a tendency for
people with a strong sense of place attachment to underestimate the
risks of climate-caused disasters such as fires and floods (Bonaiuto
et al., 2016). Donald (2022) argues that the available research
indicates that governments and developers should understand the
emotional bonds that people have with places when trying to
introduce new environmental programs to communities.

Researchers have been interested in the distress and grief people

experience when a place of attachment and identity is lost,
particularly in situations of forced relocation like the one faced by
Shanthi and her family in Case Study 7.2 (Albers et al., 2021;
Scannell & Gifford, 2010). We should pay particular attention to
issues of disrupted place attachment and place identity when we
work with immigrant and refugee families and families displaced by
disaster. Another group that faces disruptions in place attachment are
older adults who must leave their homes because of failing health
(see Afshar et al., 2017; Kylén et al., 2017; Soilemezi et al., 2017).
Broken place attachment has been associated with physical health
problems, sadness, disorientation, longing, and lower grades in
children (Scannell & Gifford, 2017). After a review of literature on
place attachment and resettlement, Albers et al. (2021) note that
migration is becoming a more common experience, and there is
growing evidence that people create new place attachments while
also maintaining bonds with places left behind. It is important for
social workers to consider the long-term consequences of early
experiences, such as being unhoused or frequent movement
between foster homes, in which no stable place of attachment forms
or that result in a negative place attachment.

Urban planners, real estate developers, and community psychologists

are interested in placemaking , a communal process of shaping
public spaces to strengthen the connections between people who
share these spaces (Toolis, 2017). The goal is to turn public spaces
into places, locations that have meaning to people. Urban planners
often use design elements such as lighting, plantings, art
installations, movable furniture, street closures, and food trucks to
make public spaces more appealing and places to which people can
become attached. Douglas (2022) suggests that contemporary
placemaking projects create “spaces of privilege and consumption,
designed around white, middle-class priorities with white, middle-
class aesthetics” (p. 5). These projects focus on revitalizing,
beautifying, and cleaning public spaces, attempting to erase visible
poverty from those spaces. Placemaking often involves displacing
people who were already there (Moran & Berbary, 2021). This kind of
placemaking seems to be behind the eviction of the residents of SS
Puram (Case Study 7.2), and it is a type of placemaking that is
occurring around the world, in both poor countries and wealthy
countries. Toolis (2017) proposes a critical placemaking theory as a
tool for reclaiming public spaces to build more inclusive, democratic
communal places that do not deny poor people a sense of place.
Douglas (2022) suggests that unhoused people who develop
encampments are engaged in informal placemaking, building
meaningful connections with both a group of people and a place.
Case Study 13.1, in Chapter 13 of this book, tells the story of such an
encampment.

Theories of Spatial Behavior

Theories of spatial behavior consider how people use structures,

natural elements, and space to control social interaction, achieve
goals, and reduce stress (Donald, 2022). These theories focus on the
issue of how much control we have over our physical environments
and the attempts we make to gain control (Gifford, 2014). Four
concepts are central to theories of spatial behavior: privacy, personal
space, territoriality, and crowding. Personal space and territoriality are
boundary regulating mechanisms that we use to gain greater control
over our physical environments.

Altman (1975, p. 18) defines privacy as “selective control of access to

the self or to one’s group.” This definition contains two important
elements: Privacy involves control over information about oneself as
well as control over interactions with others. Kupritz (2003) extended
Altman’s work by making a distinction between speech or
conversational privacy (being able to hold conversations without
being overheard) and visual privacy (being free of unwanted
observation). Al-Bishawi et al. (2017) add physical privacy and
olfactory privacy.
In contemporary times, the house has been recognized as the center
of private life (de Macedo et al., 2022). There are two types of
housing privacy: (1) privacy among occupants within the house, and
(2) privacy between occupants of the house and the outside world
(Aljawder & El-Wakeel, 2022). When they lived in SS Puram, there
was little privacy within the house for Shanthi and her family (Case
Study 7.2). It is not clear how much privacy there was between
occupants of the house and the outside world. In a systematic
literature review on privacy and housing, de Macedo et al. (2022)
found an increase in concern about privacy within the house since the
beginning of the COVID-19 pandemic, especially in small apartments.
The pandemic led to greater contact between occupants of a house
and less face-to-face contact with people outside the house.
Researchers have identified two types of issues related to privacy
between occupants of the house and the outside world. The first
issue is how to balance privacy and connectedness—how to create
sufficient visual privacy for the occupants of the home while allowing
the occupants to remain connected to the world outside the house
(Aljawder & El-Wakeel, 2022; Willems et al., 2020). The second issue
is one that has been addressed by researchers in the Middle East
and North Africa: how to create sustainable housing that protects
against extreme heat in the summer months, maximizes the house’s
use of daylight, and provides the desired privacy from the outside
world (Aljawder & El-Wakeel, 2022; Hammad et al., 2019). The size
and placement of windows is an important consideration to be
addressed when considering both of these issues. Aljawder and El-
Wakeel (2022) note that in Islamic countries, protecting the privacy of
women is important in both the external and internal design of
houses. Other Muslim researchers describe how elements of
architecture in old Muslim villages managed women’s privacy—
elements such as high windows on homes and roof gardens where
women could socialize with other women without being seen from the
street. They conclude that as Muslim communities became more
urbanized, architects did not typically consider the need for women’s
privacy, and women have had to find other ways to maintain privacy,
with more extensive veiling being one solution (Al-Bishawi et al.,
2017; Rahim, 2015). de Macedo and colleagues (2022) found that
most of the research on housing privacy has been conducted in
American, European, and Islamic countries and notes that privacy
may be a bigger concern in these countries than in other parts of the
world. Privacy does not appear to be a central issue in the story of
Shanthi and her family (Case Study 7.2).

Privacy on the Internet is a frequent topic in recent research (see Lin

et al., 2022). Privacy concerns about health technologies such as
electronic health records, contact tracing apps during a pandemic,
apps to broadcast one’s whereabouts during a disaster, and mobile
robots deployed to assist older adults in their homes are also studied
(Fox, 2020; Hogan et al., 2021; Reinhardt et al., 2021; Sanfilippo et
al., 2020). Another privacy concern is the concern about being
overheard while interacting with voice-based digital assistants such
as Siri, Alexa, and Google Assistant (Vimalkumar et al., 2021).

Some of us require more privacy than others, and some situations

stimulate privacy needs more than other situations. Ben Watson was
accustomed to sharing a house with his university pals and didn’t
mind the lack of privacy that came with that situation. He felt
differently about lack of privacy in his parents’ home after rehab and
was eager for a more private living situation, even though his privacy
in some areas would be compromised by his need for a personal care
assistant. Shanthi grew up in a 10 × 10 square-foot house where
privacy did not appear to be a concern until she reached puberty.
One research team examined the privacy concerns of people with
visual impairments (Ahmed et al., 2017). They found that the most
common privacy concern, noted by a majority of study participants,
was other people eavesdropping on their conversations or looking
over their shoulders at the private information they were sharing from
smartphones and other communication devices. This concern arises
because of their compromised ability to know when other people are
close by. Of specific concern was the need to provide health
information with health care staff in waiting rooms where they are not
sure if other people are present. The study participants also reported
loss of privacy when they need to ask other people for assistance
with tasks, such as filling out medical forms or loan applications, or
how to find the restroom. It is well documented that the design of
hospital emergency departments enables unauthorized individuals to
hear information about patients (Zibrowski et al., 2019). Like Ben
Watson, people with other types of impairments also face some loss
of privacy, including physical privacy.

Personal space , also known as interpersonal distance or body buffer

zone, is the physical distance we choose to maintain in interpersonal
relationships, a space into which others cannot intrude without
provoking discomfort. Research emphasizes that personal space is
not stable but contracts and expands with changing interpersonal
circumstances and variations in physical settings (Gifford, 2014). We
tend to require more space in the back and front of us than at the side
of us (Gifford, 2009; Welsch et al., 2019). The distance we desire
when talking with a best friend is smaller than the distance we prefer
when talking with distant friends and acquaintances, and smaller yet
than when talking with strangers (Qian & Gao, 2021; Smith & Faig,
2014; Sorokowska et al., 2017). The desired distance for any of these
interpersonal situations is likely to expand in small spaces or in
situations in which we do not perceive that we have control (Iachini et
al., 2016). We will want to recognize our own personal space
requirements in different situations and be sensitive to the personal
space requirements of our coworkers and clients.

Variations in personal space are also thought to be related to age,

gender, and culture, although the findings are not always consistent.
Personal space requirements have been found to increase with age
until late middle adulthood and then begins to gradually decrease, but
young adults prefer a larger space when interacting with elderly
people than when interacting with children or other young adults
(Iachini et al., 2016; Sorokowska et al., 2017; Wang et al., 2021). In
earlier research, males were often found to require greater personal
space than females, but more recent research finds that females
prefer greater personal space than males when interacting with
strangers and acquaintances (Sorokowska et al., 2017; Wang et al.,
2021). Some researchers suggest that the #MeToo” movement has
empowered women to claim the personal space they desire,
particularly in public spaces (Baptist & Coburn, 2019). Research
indicates that the largest interpersonal distances are kept in male-
male pairs and the smallest in female-female pairs, with mixed-
gender pairs in the middle (Hecht et al., 2019; Sicorello et al., 2019).
Research also indicates that, in general, women prefer greater
personal space when interacting with men than men prefer when
interacting with women (see Schienle, Wabnegger, Schöngassner et
al., 2015). Neuroimaging studies have found that both males and
females respond with greater discomfort when their personal space is
invaded by a male than if it is invaded by a female (Wabnegger et al.,
2016).

In The Hidden Dimension, Edward Hall (1966) reported field research

indicating that members of contact-oriented, collectivist cultures (e.g.,
Latin, Asian, Arab) prefer closer interpersonal distances than
members of noncontact-oriented, individualist cultures (e.g., northern
European, North American). Sicorello and colleagues (2019) report
evidence that East Asian cultures prefer larger interpersonal space
than European and North American cultures. In research from 42
countries, Sorokowska et al. (2017) suggest that a drawback of
earlier studies of cultural variations in personal space is that they did
not distinguish between interactions with strangers, acquaintances,
and close relationships. They found that people in colder countries
keep greater distance when interacting with strangers while people in
warmer countries keep smaller distances when interacting with
strangers and greater distances when interacting with people in close
relationships. When interacting with acquaintances, Sorokowsk et al.
(2017) found that, on average, the country with the largest preferred
social distances (Romania) preferred a distance that was about twice
the distance preferred in the country with the smallest preferred
personal space (Argentina). Within-culture differences in
interpersonal distance preferences have also been noted (Evans et
al., 2000; Sicorello et al., 2019). There is some evidence that people
require less personal space when interacting with people they
consider to be like themselves in some important category (Novelli et
al., 2010).

In recent years, researchers have examined personal space desires

in different groups of people and found a number of groups that
desire larger than average personal space. These groups include
people high in introversion (Park, 2015), adults with anxious
attachment style (Nasiriavanaki et al., 2021), physically abused
children (Vranic, 2003), individuals diagnosed with schizophrenia
(Holt, Boeke et al., 2015; Zapetis, Nasiriavanaki, Luther et al., 2022),
individuals diagnosed with autism spectrum disorder (Kennedy &
Adolphs, 2014), and violent offenders (Schienle, Wabnegger, Leitner
et al. 2017). A study of combat veterans in Croatia found that
veterans diagnosed with post-traumatic stress disorder (PTSD)
preferred significantly larger interpersonal distance than veterans
without PTSD (Bogovic et al., 2014).

The discussion of personal space has been updated by researchers

who are raising questions about how personal space is affected by
digital technology. Researchers have examined how much personal
space people need when using automatic teller machines and other
technology where private information is stored and found that people
report larger desired space than the space actually provided (Shu &
Li, 2007). Researchers are also investigating how personal space
applies to virtual worlds and finding that people tend to keep and
protect a space around their avatars in much the same way they do in
the “real” world (Holt, Zapetis et al., 2022; Tootell et al., 2021).
Developers of artificial intelligence systems are concerned about
active personal space (APS) in human–robot interactions; they want
to program service robots in such a way that they do not invade the
personal space of humans (Leichtmann & Nitsch, 2020).

For centuries, reducing interpersonal contact and increasing

interpersonal distance have been common adaptations to control
pandemics (Sorokowska et al., 2017), and those methods were used
across the globe during the early days of the COVID-19 pandemic.
Researchers have found that preferred personal space boundaries
expanded significantly during the pandemic. The level of discomfort
during personal space intrusions also increased significantly during
the pandemic (Holt, Zapetis et al., 2022; Zapetis, Nasiriavanaki,
Hughes et al., 2021). There was less expansion in personal space
when the research partner was masked. It is not yet known whether
this expanded personal space will be maintained and reinforced over
time.
Personal space and territoriality are two mechanisms for securing
privacy.

©iStock/jorgeantonio

Neuroscientists are investigating brain functioning involved in

personal space, and currently personal space-related behaviors are
thought to be linked to a network of parietal and frontal cortical brain
regions (Holt, Zapetis et al., 2022; Nasiriavanaki et al., 2021; Vieira et
al., 2020). One research team found that the amygdala is activated
when one feels one’s personal space is being intruded upon
(Wabnegger et al., 2016). This is not surprising, given the discussion
in Chapter 2 about the important role of the amygdala in assessing
danger. Dureux et al. (2022) found that personal space regulation is
disrupted by lesions in the area surrounding the amygdala. Holt,
Zapetis et al. (2022) note that it is not known whether the structure or
function of this network was changed in parallel with the expansion in
personal space that occurred during the pandemic.

Personal space is a concept about individual behavior and the use of

space to control the interpersonal environment. Territoriality refers
primarily to the behavior of individuals and small groups as they seek
control over physical space (Taylor, 1988), but the concept has also
been used to refer to attempts to control objects, ideas, roles, and
relationships (Gifford, 2014). Territoriality leads us to mark, or
personalize, our territory to signify our “ownership” and to engage in a
variety of behaviors to protect it from invasion (Wang & Li, 2021). The
study of animal territoriality has a longer history than the study of
human territorial behavior.

Territoriality refers to the behavior of individuals and small groups as

they seek control over physical space.

© iStockPhoto.com/Vitezslav Vylicil
Irwin Altman (1975) classified our territories as primary, secondary,
and public. A primary territory is one that evokes feelings of
ownership that we control on a relatively permanent basis and that is
vital to our daily lives. For most of us, our primary territories include
our home and perhaps our place of work. Secondary territories are
less important to us than primary territories, and control of them does
not seem as essential to us; examples might be our favorite table at
the local coffee shop, our favorite cardio machine at the gym, or our
favorite seat in the classroom. Public territories are open to anyone in
the community, and we generally make no attempt to control access
to them—places such as public parks, public beaches, sidewalks,
public libraries, and stores. For people who are unhoused and lack
access to a typical primary territory, however, public territories may
serve as a primary territory.

Much of the literature on territoriality draws on the functionalist

sociological tradition, emphasizing the positive value of territorial
behavior to provide order to the social world and a sense of security
to individuals (Taylor, 1988). We know, however, that territorial
behavior can also be the source of conflict, domination, and
oppression. Ongoing national conversations about “securing our
borders” are prime examples of territorial behaviors, and wars are still
being fought to assert or protect both geographical boundaries and
ideas.

Crowding is often used interchangeably with density, but

environmental psychologists have traditionally made a distinction
between these terms (Stokols, 1972; Baldassare, 1978). Density is
the number of persons per unit area of a space. Crowding is the
subjective feeling of having too many people around. Crowding is not
always correlated with density; the feeling of being crowded seems to
be influenced by an interaction of personal, social, and cultural as
well as physical factors. In recent years, researchers in several
disciplines have been using the concept overcrowding to be
synonymous with density and finding negative effects of
overcrowding in housing, emergency medical departments, prisons,
and public transportation. These researchers suggest that
overcrowding is being produced globally and across physical settings
because of the great increase in the world human population in the
past century (Nkosi et al., 2019). In 1900, the world human population
was 2 billion; it exceeded 8 billion in 2022. The 2022 combined
population of China and India exceeded the 1900 world population by
almost a billion people (Hackett, 2022). Hundreds and thousands of
people migrate to Chennai, India (Case Study 7.2) every day and that
presents a major challenge to the housing infrastructure of the city.

Although the measure of housing overcrowding varies slightly from

study to study, the findings are consistent. Household overcrowding is
associated with poor indoor air quality, respiratory illnesses,
gastrointestinal illnesses, and symptoms of depression (Nkosi et al.,
2019; Pengcheng et al., 2021; Ruiz-Tagle & Urria, 2022). The air
quality could not have been good in the 10 × 10 square feet of
Shanthi’s family (Case Study 7.2), and Shanthi’s father died of a
chronic respiratory disease when Shanthi was only 16. Housing
overcrowding is associated with health problems even when research
respondents do not perceive their housing situation as crowded
(Nkosi et al., 2019). Health problems associated with housing density
are intensified with a pandemic like COVID-19 (Dinh & Berendsen
Russell, 2021). It is important to note that housing overcrowding is
associated with economic marginalization and other types of
deprivation, and untangling the causative factors of disease is
difficult. Overcrowding in medical emergency departments (EDs) is
defined as a situation in which the performance of the ED is
compromised because of the excessive number of patients for the
available human and space resources. It is partially caused by a
decline in the number of EDs around the world while the number of
patients is increasing. It is reported to be a global problem and has
been found to have negative effects on mortality and morbidity
(Lindner & Woitok, 2021; Ouyang et al., 2022; Sartini et al., 2022).
Prison overcrowding, when the number of prisoners exceeds the
prescribed prison capacity, is another global problem that is
associated with disease and violence (Baggio et al., 2020; Di Vita,
2020). Agrawal and colleagues (2020) suggest that public
transportation overcrowding is thwarting the use of public
transportation as an antidote to the environmental hazard of traffic
congestion pollution involved with the increase in private motor
vehicle use. The world population is growing faster than cities can
grow their infrastructures, leading to situations like that of Shanthi’s
(Case Study 7.2) housing situation, with 50,000 people living in a
space of 2 acres—50,000 people competing for space and services.

Behavior Settings Theories

A third major category of theories about the relationship between

human behavior and the physical environment is behavior settings
theories. According to behavior settings theories , human behavior is
a function of the setting in which it occurs; consistent, uniform
patterns of behavior occur in particular places, or behavior settings.
Behavior settings are physical and social milieus where routine
patterns of behavior are performed (Sands & Aunger, 2020).
Examples of behavior settings are a school classroom, a bar, a
basketball game, and a worship service. All behavior occurs in a
setting, and the setting may have a more powerful influence on
behavior than characteristics of the individual (Aunger, 2020;
Awamleh & Hasirci, 2022; Curtis et al., 2019). Each setting has a
purpose, a designated place, a set of objects, and a prescribed set of
behaviors. People learn what is expected in a given behavior setting
and are reinforced for matching behaviors to the setting. Physical
structures and objects are designed to facilitate particular kinds of
behaviors (Jewitt et al., 2022; Parke et al., 2022).

Behavior settings theory was developed by Roger Barker (1968),

who, unexpectedly, found that observations of different persons in the
same setting were more similar than observations of the same person
in different settings. Environmental psychologist Ian Donald (2022, p.
1) puts it this way: “A person’s behavior can be more accurately
predicted from knowing where they are than knowing who they are.”
Barker suggested that programs —consistent, prescribed patterns of
behavior—develop and are maintained in many specific settings. For
example, when you enter a grocery store, you grab a cart, travel
down aisles collecting items and putting them in the cart, and then
take the cart to a checkout counter where you wait while store
employees tabulate the cost of the items and bag them. Imagine how
surprised you would be if you went into the grocery store to find
everybody kicking soccer balls! Behavioral programs are created
conjointly by people and their inanimate surroundings, and behavior
settings are distinctive in their physical-spatial features as well as
their social rules.

Behavior settings as conceptualized by Barker had a static quality,

but Allan Wicker (2012) has more recently written about the changing
nature—the life histories—of behavior settings. Some settings
disappear (have you spent time at a library card catalogue lately?),
and some become radically altered. These days, that trip to the
grocery store often involves getting your own reusable grocery bags
from the car before entering the store (or making a trip back to the car
to get them when you are almost at the store’s door). It may also
include running your own items through a scanner and bagging them
yourself. Think about the early days of the COVID-19 pandemic when
many people had to suddenly perform education and work programs
from home and how that changed both the nature of education and
work programs but also the nature of the home behavior setting.
Think about how the programs needed to change in many medical
settings. It is no wonder that many of us lost some of our patterns of
conduct as we faced those disruptions in behavior settings.

Another key concept in behavior settings theory is the level of staffing

, the participants in a particular behavior setting (Awamleh & Hasirci,
2022; Barker, 1968). Different behavior settings attract different
numbers of participants, or staff. It is important to have a good fit
between the number of participants and the behavioral program for
the setting. Overstaffing occurs when there are too many participants
for the behavioral program of a given setting; understaffing occurs
when there are too few participants. In a study of a long-term Gaza
refugee camp in Jordan, Awamleh and Hasirci (2022) found that the
administrators thought the camp was overstaffed, with the number of
occupants exceeding resources. The occupants, however, thought
the camp was understaffed, without sufficient administrative positions
to meet occupant needs.
Public health researchers are using behavior settings theory and
behavior mapping techniques to consider how to change physical
aspects of behavior settings to disrupt behaviors that compromise
health. Examples include poor hand hygiene in hospitals (Sands &
Aunger, 2020), sedentary behavior in neighborhood parks in China
(Wang & Wu, 2020), and poor water and cooking hygiene in
Bangladesh, Nepal, and Nigeria (Curtis et al., 2019; Jewitt et al.,
2022). For example, in Bangladesh, a school toilet behavior setting
was modified by painting brightly colored footprints on the ground
between the toilets and handwashing facilities (Curtis et al., 2019).
Behavior settings theory has implications for social work assessment
and intervention. It suggests that patterns of behavior are specific to a
setting and, therefore, we must assess settings as well as individuals
when problematic behavior occurs. Behavior settings theory also
suggests that the place where we first learn a new skill helps re-
create the state necessary to retrieve and enact the skill. When
assisting people with skill development, we should pay particular
attention to the discontinuities between the settings where the skills
are being “learned” and the settings where those skills must be used.

Critical Thinking Questions 7.1

What have you observed about the impact of the physical

environment on your behavior and the behavior of others? What
impact does the physical environment have on Ben Watson and
Shanthi from India? What places are important and have meaning to
you? Do you have enough privacy in your home and work
environments to feel some sense of control over who has access to
you and your interpersonal interactions? What have you observed
about how your behavior changes from setting to setting? How did
you react to the changes in behavior settings during the first wave of
the COVID-19 pandemic?

The Natural Environment

Humans are one element of nature, and human well-being is totally

intertwined with the non-human elements of nature. Research shows
that places in the natural environment —that part of the non-human-
made environment made up of all living and nonliving things naturally
occurring—are among people’s favorite places (Li & Seymour, 2019).
It is not true that natural settings are favorite places for all people, but
some researchers have found it to be true for the majority of people in
all cultures (Wolsko & Hoyt, 2012). Brain imaging studies suggest that
humans have an inherent preference for natural settings over the
environment built by humans (Kim et al., 2010; Mahamme et al.,
2020). Most of the research on the relationship between human
behavior and the natural environment has examined how aspects of
the natural environment affect our thinking, feeling, social interaction,
and health. Research shows that time spent in nature has both
positive and negative effects on human behavior and well-being, and
that humans can have both positive and negative effects on other
elements of nature.
The physical environment (both natural and human-made) impacts
our behavior. Researchers have found a strong preference for
elements of the natural environment and positive outcomes of time
spent in nature.

© iStockphoto.com/Xavi Arnau

Positive and Negative Effects of Human Interaction with the Natural Environment
Do you find that you feel refreshed from being in the natural
environment—walking along the beach, hiking in the mountains, or
even walking in your neighborhood? As it has for many people, the
natural environment has always been a place of serenity for Ben
Watson (Case Study 7.1). For decades, multidisciplinary research
about human interactions with the natural environment focused on
the positive effects humans derive from spending time in nature,
placing humans apart from and above other elements of nature. In
this research, non-human elements of nature are appreciated for their
benefit to humans. In recent years, this research has been based on
two theories developed by environmental psychologists. Attention
restoration theory (ART) proposes that interacting with nature
restores depleted cognitive resources (Kaplan & Berman, 2010).
Psychophysiological stress recovery theory (PSRT) is interested in
how interacting with nature helps people to recover emotionally and
physiologically (Ulrich et al., 1991).

There is now an abundance of research that finds many positive

outcomes of time spent in the natural environment and suggests that
you should consider the benefits of interacting with nature for both
you and the people with whom you work. These benefits are
summarized in Table 7.2 , but because of the extensive research in
this area only a few of the recent findings are discussed here.

Table 7.2
There are consistent findings from research using a variety of
methods that interaction with natural environments can restore
depleted emotional and cognitive resources (Kondo et al., 2018;
Pichler et al., 2022). Because of the role that stress plays in physical
and mental health, perhaps the most important consistent finding is
that time spent in nature reduces psychophysiological stress and
enhances emotional states (Aerts et al., 2018; Daniels et al., 2022;
Marselle, Hartig et al., 2021). These findings of benefit from
interaction with the natural environment have been supported even
when controlling for individual characteristics, being alone or with a
group, type of activities, and length of interaction. It is not clear which
aspects of the natural environment provide benefit, but research
indicates that environments with water, woodlands, and mountains
have great positive effect (Pichler et al., 2022). There is considerable
evidence that interactions with domestic and companion animals
have emotional and physiological benefits for humans (Carr et al.,
2020; Conway et al., 2022).

The findings just discussed are not surprising, given the distinctive
place accorded to the natural environment in the cultural artifacts—
music, art, literature—of all societies. Sociobiologists propose that
humans have a genetically based need to affiliate with nature; they
call it biophilia (Sachs, 2022; Schiebel et al., 2022; Wilson, 2007).
They argue that humans have a 2-million-year history of evolving in
natural environments and have only lived in cities for a small fraction
of that time and therefore we are much better adapted to natural
environments than built environments. It is important to note that
access to nature is not equally shared by all groups. For example,
Ben Watson has ample access to nature while Shanthi appears to
have little in her current apartment. Adding green spaces in urban
areas often increases property values near the green spaces, pricing
many people out of these neighborhoods (Fyfe-Johnson et al., 2021;
Remme et al., 2021; C. Williams et al., 2022). This may be what
happened to Shanthi and her family.

There is a growing call for ecotherapy , exposure to the natural

environment as a component of psychotherapy, as a major agenda
for mental health promotion and treatment (see Chaudhury &
Banerjee, 2020; Hinde et al., 2021). Examples of ecotherapy include
community gardening, animal-assisted interventions, care farming,
nature-guided mindfulness meditation, assigned walks in nature, use
of plants and photos of natural settings in therapist offices, use of
nature metaphors, green exercise, environmental conservation
activities, and wilderness therapy. Chaudhury and Banerjee (2020)
report that ecotherapy interventions have been shown to be effective
in physical health conditions such as hypertension, obesity, post-
surgical recovery, and for stress reduction. Hinde et al. (2021) report
that their scoping review of the literature indicated that ecotherapy is
a potentially cost-effective intervention for people with mild to
moderate mental health problems.

Patuano (2020) calls into question the biophilia assumption that

humans have a genetically based need to affiliate with nature, noting
research on biophobia , the adaptive fear of and aversion to natural
elements. Roger S. Ulrich (1993) suggested that humans have an
innate genetic tendency to fear or have strong negative responses to
certain natural elements or settings which were hazardous to humans
during evolution. Ulrich suggested that these responses are
unconscious and difficult to extinguish. Orr (1993) has a different take
on biophobia, suggesting that humans have a culturally acquired
preference to join with technology and human artefacts rather than
the natural environment. It is true that there are negative as well as
positive effects for humans in their interactions with the natural
environment (Fyfe-Johnson et al., 2021; Patuano, 2020; Soga &
Gaston, 2022). Soga and Gaston (2022, p. 1126) call the negative
effects “the dark side of nature experience.” The negative effects
have received much less research attention than the positive effects;
research evidence on the negative effects appears in Table 7.2 along
with the positive effects.

Here is an example of how non-human beings in nature can have

both positive and negative effects on human behavior. Ben Watson
made special note of the ample sunlight in his apartment. Design
innovations for school settings are emphasizing the benefit of natural
over artificial light (Norcera et al., 2018; Porras Álvarez, 2020).
However, the relationship between sunlight and human behavior is
curvilinear, with benefit coming from increasing amounts until a
certain optimum point is reached, after which increasing amounts
damage rather than benefit. Excessive sunlight can have negative
impacts, such as glare and overheating, and inadequate sunlight has
been identified as a contributor to depression, sometimes referred to
as seasonal affective disorder (SAD), in some persons (Madsen et
al., 2021).

The great majority of research on the positive and negative effects of

human interaction with the natural environment is anthropocentric
(human-centered) rather than ecocentric (earth-centered).
Researchers have taken an ecosystem service perspective to
examine how non-human elements of the natural environment are in
service to human health and well-being (Aerts et al., 2018; Remme et
al., 2021). As the human population grows and human habitats
become increasingly urbanized, many humans have more and more
contact with the built environment and less and less contact with the
natural environment. Consequently, humans know less and less
about the non-human natural environment and too often fail to
respect non-human beings (Kimmerer, 2013). When we don’t
understand and respect the contributions made by non-human beings
to the overall functions of the ecosystem or the mechanisms used by
plants and animals to protect their own health and well-being, we may
react to nature with fear, disgust, domination, and destruction rather
than finding ways to live in harmony in our natural habitats (Barragan-
Jason et al., 2022). There are many ways that humans destroy the
natural environment, including overpopulation; pollution of the soil,
air, and water; increasing the carbon dioxide level by burning fossil
fuels and deforestation; using farming methods that degrade the soil
and use higher volumes of water; overharvesting and overfishing; and
diminishing the planet’s biodiversity.

Recently, researchers have emphasized the mutuality of human

health and planetary health and made clear that humans need to be
in service to nature as well as being serviced by nature. These
researchers have been interested in human-nature connectedness
(HNC) —humans seeing themselves as a part of nature—as a human
attribute that can lead to pro-nature conservation behavior that helps
to better preserve planetary health (see Barragan-Jason et al., 2022;
Hernández-Blanco et al., 2022; Richardson & Hamlin, 2021). HNC is
enhanced by mindful noticing of nature (Parker & Simpson, 2020;
Richardson & Hamlin, 2021). A number of researchers have called for
humans to promote and protect biodiversity as a way to further both
human health and planetary health. Biodiversity is variability among
living organisms from all sources, including diversity within species,
between species, and of ecosystems (Aerts et al., 2018; Marselle,
Hartig et al., 2021). As the human population grows, humans
encroach more and more on plant and animal ecosystems, producing
a decline in biodiversity (Marselle, Lindley et al., 2021). Biodiversity
has been found to be associated with human physical and mental
health (see Aerts et al., 2018; Methorst et al., 2021). Habitats with
diverse organisms have been shown to be more resilient in the face
of both human and non-human intrusion (Aerts et al., 2018). Dense
and diverse vegetation can buffer urban noise, reduce urban air
pollution, and reduce air temperatures (Aerts et al., 2018; Marselle,
Lindley et al., 2021). Marselle, Hartig and colleagues (2021) propose
four pathways that link biodiversity and human health (see Figure
7.1). As you can see from Figure 7.1, biodiversity can cause harm as
well as reduce harm for human health and well-being, but research
indicates an overall benefit to humans as well as the planet.

Description
Figure 7.1 Pathways Linking Biodiversity and Human Health and
Well-Being

Source: “Pathways Linking Biodiversity to Human Health: A

Conceptual Framework,” by M. R. Marselle, T. Hartig, D. T. C. Cox, S.
de Bell, S. Knapp, S. Lindley, M. Triguero-Mas, K. Böhning-Gaese, M.
Braubach, P. A. Cook, S. de Vries, A Heintz-Buschart, M. Hofmann,
K. N. Irvine, N. Kabisch, F. Kolek, R. Kraemer, I. Markevych, D.
Martens, R. Müller, . . . A. Bonn, 2021, Environment International,
150, 106420. Licensed under CC-BY 4.0,
https://creativecommons.org/licenses/by/4.0/.

Pandemics like COVID-19 originate in non-human animals and are

driven by human activities that destroy biodiversity, activities such as
deforestation, conversion of forest land into agricultural land,
intensification of livestock production, and increased hunting and
trading of wildlife (Brema et al., 2022). Ironically, research shows that
humans around the world spent more time in nature during the
pandemic and highly valued interactions with nature as a way of
coping with the stress of the pandemic (Dushkova et al., 2022; Lee et
al., 2022; Richardson & Hamlin, 2021; Robinson et al., 2021).

Natural Disasters and Human Behavior

Natural disasters have great force, sudden onset, large scope, and
put excessive demands on human coping.

©iStockphoto.com/Xavi Arnau

Although the natural environment can be a positive force in the lives

of humans, it also has the potential for great harm to humans when
natural disasters occur. Natural disasters are catastrophic severe
weather events that can cause serious damage to human health and
safety, property, and both the natural and social environments. They
include events such as floods, droughts, monsoon storms,
hurricanes, earthquakes, mudslides, avalanches, tornadoes, volcanic
eruptions, extreme temperature events, and forest fires. Natural
disasters have great force, sudden onset, large scope, and put
excessive demands on human coping. They have immediate effects
on health and mortality, but they also have indirect long-term effects
because they lead to disruptions in shelter, food supplies, water,
income, and access to health care. Case Study 7.2 illustrates the way
that natural disasters (monsoon storms) disrupt the lives of Shanthi
and her family. Social workers play active roles in providing services
to communities experiencing natural disasters.

For the past three decades, natural disasters have been becoming
increasingly common and intense and affecting a larger portion of the
world’s population. As the earth warms, scientists predict that the
ongoing climate change will escalate the frequency and intensity of
natural disasters (Pleninger, 2022; Protopopova et al., 2021). This
situation presents a number of challenges to humans as they interact
with each other and the natural environment. The first and most
important challenge is to find a way to cooperate across national and
ideological lines to engage in meaningful climate action. A second
challenge is to address issues of social, racial, economic, and
environmental justice that exacerbate the societal impact of natural
disasters. A third challenge is to organize and fund the most
vulnerable communities for disaster preparedness. A fourth challenge
is for governments to respond to natural disasters in equitable ways
that avoid exacerbating the impact. A fifth challenge is to engage
community input in the disaster recovery process.

In a study of natural disasters in 92 countries, Khurana et al. (2022)

found that, overall, natural disasters have a negative effect on
national social institutions. The measures of social institution quality
included government stability, socioeconomic conditions, investment
profile, internal conflict, external conflict, corruption, military
involvement in politics, religious tensions, law and order, ethnic
tensions, democratic accountability, and bureaucracy quality. The
higher the number of people in a country affected by natural
disasters, the lower the quality of major social institutions. They found
regional and income differences, however. Social institutions were
adversely affected by natural disasters in countries in East Asia and
Pacific (EAP) region and in South Asia (SA), including India where
Shanthi (Case Study 7.2) lives. In Latin America and the Caribbean
(LAC), social institutions were strengthened in the immediate period
after a natural disaster but deteriorated in the later aftermath. Social
institutions were improved in both the short and long run following a
natural disaster in the Middle East and North Africa (MENA), where
there are high revenues from energy industries.
Sovacool and colleagues (2018) suggest that human
mismanagement of natural disasters worsen their impact. They
identify four disaster management processes that interact with natural
phenomena to worsen the impact of climate change: enclosure,
exclusion, encroachment, and entrenchment. Enclosure involves
privatizing of the disaster response, introducing a profit motive.
Exclusion involves marginalizing some community groups in the
decision-making process. Encroachment involves responses that
further degrade the natural environment and intrude upon
biodiversity. Entrenchment involves responding in ways that worsen
existing inequalities and power relationships. They present three
policy approaches for more just and equitable disaster recovery,
approaches that are consistent with social work values:

Creation of an insurance system that provides a more equitable

sharing of disaster risks and ensures sufficient resources to
assist poor and vulnerable communities.
Development of a process of open and informed dialogue about
disaster recovery that gives voice to all people affected by the
disaster.
Requirement that all organizations providing disaster recovery
projects forfeit compensation when their projects damage
communities or the natural environment.

Natural disasters can present a major challenge to health care and

public health institutions before, during, and in the aftermath of the
disaster. Health care facilities are overtaxed and understaffed during
the disaster event and the time immediately following (Scrymgeour et
al., 2020). Ghazali et al. (2018) summarize the research that shows
that a large number of health risks are associated with natural
disasters. Extreme temperatures increase the risk of stroke and
cardiovascular events, respiratory disease, and renal disease. During
hurricanes, tropical storms, and floods, populations are at increased
risk of drowning, burns, electrocutions, snake bites, and wound
infections. Changes in the ecosystem related to climate change
increase the risks of infectious diseases such as malaria, dengue
fever, yellow fever, West Nile fever, and Lyme disease. Rising
temperatures, flooding events, and abnormal water accumulation
challenge access to safe drinking water, which creates risk for
bacterial, viral, and parasitic infections. Natural disasters also have a
negative effect on average mental health and are associated with an
increase in post-traumatic stress disorder (Baryshnikova & Pham,
2019; Ghazali et al., 2018).

Environmental psychologists have been interested in how individuals,

groups, and communities behave in natural and other types of
disasters. They note that natural disasters, while on the increase, are
still rare events for which people have little experience to draw on.
They are often complex, ambiguous, and rapidly changing (Donald,
2022). Earthquakes give little warning, the advance warning for
hurricanes can shift rapidly, and it is nearly impossible to predict the
twists and turns of forest fires. In the language of behavior settings
theory, people do not have programs for navigating a behavior setting
that has been invaded by a catastrophic force of nature.

Environmental psychologists also report that there are many public

misconceptions about how people respond in the midst of a natural
disaster. They note a set of enduring “disaster myths” that are held by
disaster response professionals as well as the general public but are
contradicted by research spanning seven decades and across North
America, Europe, and East Asia (Donald, 2022; Drury et al., 2019;
Lorenz et al., 2018; Nogami, 2018). Table 7.3 describes four disaster
myths and the state of research about each one. When held by
disaster response professionals, the disaster myths can impede the
ability of professionals and community members to work together to
contain the damage of the disaster. When professionals assume that
disaster victims will panic, they may withhold vital information from
disaster victims because they are afraid the community will panic if
given accurate information. They may also fail to use the community
human resources at the scene. If they assume that looting typically
occurs during disasters, they will likely take a law enforcement
approach rather than a collaborative approach with community
members. What the research shows is that people often fail to
recognize the danger and delay taking action. It is important for
disaster response professionals to keep disaster victims accurately
informed and build collaborative relationships with them where
possible.

Table 7.3

Critical Thinking Questions 7.2

What have you observed about how time spent in nature affects your
emotions, cognitions, and behavior? How would you evaluate your
own human-nature connectedness? How might social workers
incorporate ecotherapy into their practice in different settings? Have
you seen examples of this being done? Given her ongoing
experience with monsoon storms, would you expect Shanthi (Case
Study 7.2) to experience more biophilia or biophobia? Explain.

The Built Environment

It is the uncontrollable quality of the natural environment that humans

try to overcome in constructing the built environment —the portion of
the physical environment attributable to human effort. The built
environment includes tools, structures, buildings, and technologies of
various sorts designed and built by humans to create comfort and
controllability and to extend their abilities to meet goals. The built
environment is produced by human behavior, and what humans build
has a great effect on human behavior. Winston Churchill is often
quoted as saying, “We shape our buildings, and afterwards our
buildings shape us” (UK Parliament, 2017). This is true for all aspects
of the built environment, whether tools, buildings, structures, or
technologies.

For several decades, environmental psychologists have been

studying the impact of the built environment on such factors as
physical and mental health, mood, problem-solving, productivity, and
violent behavior. People spend a lot of time in the built environment;
researchers have found that people in wealthy countries spend up to
90% of their lifetime indoors (Capasso & D’Alessandro, 2021). The
built environment needs to meet several goals including congruence
with the needs of the occupants, promotion of health and well-being,
positive impact on behavior in the setting, enhancement of personal
control of the occupants, facilitation of social support and cooperation
in the setting, and provision of adequate cues for wayfinding in the
setting (Gifford & McCunn, 2019). Recent developments in
biomedical science, particularly new understandings of the brain and
the immune system, have allowed more sophisticated analysis of how
the built environment affects physical and mental health and can be a
source of healing. In the past two decades, researchers have also
been interested in how information, communication, and other
technologies are affecting human behavior. In this chapter, we focus
on four important features of the built environment: housing,
technology, healing environments, and accessible environments.

Housing

No feature of the built environment has more impact on human health

and well-being than housing. Research indicates that residents in the
United States and Europe spend 69% of their time in residential
settings over the life course (Sharpe et al., 2018). Around the world,
housing stability is a challenge for individuals and families with the
lowest incomes (Sharpe et al., 2018). This is certainly the case for
Shanthi in Chennai, India. Housing instability includes a number of
challenges, such as difficulty paying rent, mortgage foreclosure,
eviction, moving frequently, spending the bulk of household income
on housing, or overcrowding (Healthy People 2030, 2022). Both the
quantity and quality of low-income housing is a problem in both high-
income and low-income countries (Iddi et al., 2022). In 2022, the
National Low Income Housing Coalition reported that, in the United
States, 6.8 million more affordable housing units were needed for the
families with extremely low income, almost 600,000 people are
unhoused on any given night, 70% of families with extremely low
income pay more than half of their income on rent, and only 1 in 4
families with extremely low income who need housing assistance
receive it. No state in the United States has an adequate supply of
affordable rental housing for renters with the lowest incomes
(National Low Income Housing Coalition, 2022). The COVID-19
pandemic exacerbated the problem. In 2020, during the early wave of
the pandemic, there was a 250% increase in people falling at least
three months behind on mortgage payments, and renters struggled
even more than homeowners (Consumer Financial Protection
Bureau, 2021).

Unfortunately, the quality of available low-income housing is also a

major problem. Common problems include space too small for the
number of people; poor indoor air quality; unsafe drinking water;
absence of hot water for washing; ineffective waste disposal; lead
exposure; damp, cold, and moldy rooms; overheating; old, dirty
carpeting; pest infestations; noise pollution from road, rail, and air
transportation; and inaccessibility (Capasso & D’Alessandro, 2021;
Krieger & Higgins, 2002; Sharpe et al., 2018). Low-income housing is
also often located in neighborhoods with high density; poor air quality,
water supply, and waste management; as well as noise pollution and
lack of access to green spaces (Capasso & D’Alessandro, 2021). The
U.S.-based National Center for Healthy Housing (2022) suggests that
healthy homes are dry, clean, pest-free, ventilated, safe,
contaminant-free, well-maintained, thermally controlled, accessible,
and affordable. What is considered adequate housing varies in
different regions of the world. In a study of development in Asian
cities, the Asian Development Bank (2019) suggested four basic
criteria of adequate housing: (1) a finished roof that protects the
occupants from weather, (2) sufficient living area so that no more
than three people need to share a bedroom, (3) access to safe
drinking water, and (4) adequate sanitation, including a flush toilet or
ventilated latrine not shared by more than two households. The
house that Shanthi’s family lived in in SS Puram had a finished roof
but did not meet any of the other three criteria. Shanthi’s concrete
apartment does a better job of meeting the criteria on some days but
not when the monsoons come. Iddi et al., (2022) developed a healthy
housing index (HHI) to study housing in sub-Saharan Africa (SSA).
The HHI has eight variables: main wall, roof, floor materials, toilet,
safe source of drinking water, type of cooking fuel, presence of
electricity, and frequency of smoking in the household. Using the HHI
to measure healthy housing in a study of 15 SSA countries, Iddi et al.
(2022) found that unhealthy housing remains quite high in SSA, with
variations across countries and low-income families more likely to live
in unhealthy housing than wealthier families.

Building characteristics interact with resident behaviors to produce a

number of health problems. Small household space and
overcrowding are associated with increased anxiety, depression, and
infectious diseases (Capasso & d’Alessandro, 2021; Sharpe et al.,
2018). Poor indoor air quality is associated with increased likelihood
of asthma, respiratory tract infections, chronic obstructive lung
disease, allergic diseases, lung cancer, cardiovascular disease,
eczema, and cognitive decline (Capasso & D’Alessandro, 2021;
Sharpe et al., 2018). Damp housing is associated with concentrations
of bacteria and house dust mites (Sharpe et al., 2018). Indoor
overheating is associated with increased mortality among older adults
(Sharpe et al., 2018). Indoor noise pollution is associated with
increased risk for sleep disturbance, hearing loss, heart disease, and
diabetes (Sharpe et al., 2018).

Houselessness
After being evicted from SS Puram, Shanthi and Sarath were
unhoused for two weeks. Substandard housing poses risks to health
and well-being, and living unhoused poses even greater risks.
Although official data suggest that almost 600,000 people are
unhoused on any given night in the United States, sources such as
the National Law Center on Homelessness and Poverty think a more
accurate count is between 2.5 and 10.2 times greater (Kilduff &
Jarosz, 2020; Opeifa, 2021). People who are unhoused face major
challenges in hygiene, nutrition, finding and keeping employment,
access to health care, place attachment, social inclusion, among
others. In a study of unhoused persons with a sample of housed
persons matched on age, gender, education, race, and ethnicity,
Ahuja et al. (2020) found that the unhoused study participants
reported statistically significant lower mean overall well-being scores
than the housed participants. The unhoused participants also
reported statistically significant lower means scores on social
connectedness, resilience to stress, physical health, and financial
well-being than the housed participants. The unhoused participants
reported significantly higher levels of spirituality and religiosity than
the housed participants, and qualitative interviews highlighted the use
of spiritual and religious coping among unhoused study participants.

In this brief discussion, it is helpful to think about houselessness in

the context of theories of place and spatial behavior, because these
approaches can be used to understand the proactive ways that
unhoused people try to navigate their vulnerable positions in the
physical environment. In the context of theories of place, it is clear
that unhoused people have a major challenge to create a stable
sense of place, place identity, and place attachment. In the context of
theories of spatial behavior, it is clear that unhoused people have
limited access to primary, and even secondary, territories that are
available to people who are housed. Therefore, it is not surprising
that they attempt to gain greater access to public territories and to
sometimes claim them as primary or secondary territories.

The inhabitants of encampments of unhoused people engage in

placemaking as they try to create private territory by claiming a piece
of public territory. Localities respond in different ways to these
attempts at placemaking. Too often they respond with governmental
sweeps, also known as abatements or move-along orders, in which
governmental authorities remove one or more persons, sometimes
arresting those who refuse to move and confiscating and even
discarding their belongings. Chang and colleagues (2022)
interviewed unhoused people who had faced such abatement
practices in Santa Clara, California, between 2018 and 2020. The
participants identified four ways in which the abatements harmed
their health: (1) forced relocation and property seizures stripped
people of personal belongings and supportive relationships; (2)
eviction pushed unhoused people into hazardous and isolated places
and reduced access to health outreach workers; (3) abatements
caused negative encounters with law enforcement, leading to anger,
stress, and distrust; and (4) distrust of authorities led to reluctance to
seek or accept formal forms of support and protection.

Researchers have used qualitative research methods to study how

unhoused people use public spaces and the attachments they form
with those spaces. Casey et al. (2008) explored the strategies
unhoused women in England use to negotiate public spaces where
they are generally not welcomed. The women reported carrying out
day-to-day activities in “libraries, art galleries, museums, book shops,
public toilets (on-street and in public buildings such as hospitals),
business and retail parks, airports, parks, car parks, the space
surrounding public and private buildings (steps, stairwells), and the
streets” (p. 903). These spaces were used to eat, sleep, wash
themselves, provide shelter from the weather, launder and change
clothes, charge their mobile phones, and engage in leisure activities.
The women also reported that they had to be strategic in the use of
these spaces. They were careful to use the public spaces at
particular times of the day and to try to blend in with both their
behaviors and their appearance. Some reported sleeping upright on
benches rather than lying down so as not to appear to be sleeping.
Others reported appearing to listen to CD music in the library in order
to catch a nap or reading a book in a bookshop while charging a
mobile phone. The researchers found that some cities and localities
had more permissive policies than others about the rights of
unhoused people to occupy public spaces.
Public libraries are often mentioned as public spaces frequented by
people who are unhoused. A study in central Michigan found that
58% of the unhoused respondents reported visiting libraries at least
once a week (Kelleher, 2013). The respondents reported using the
library to read for entertainment, to use the Internet to look up
information or to correspond with people, to study for classes or do
homework, to look for a job or a place to live, and to watch movies
and listen to music CDs. Libraries vary in their policies about
providing library cards to unhoused persons, with the requirement of
a permanent address being a stumbling block in some libraries.
Some public libraries are creating innovative programs to employ
unhoused patrons or to provide technology training or book clubs for
them (Kelleher, 2013).

Other researchers have studied the ways that unhoused people use
public parks and the attachments they make to the parks. The
findings of two such pieces of research indicate that parks in different
cities are used in different ways, influenced in large part by the
different ways that cities try to limit the rights of unhoused people to
be present in public parks and the actions taken to remove them.
Shaheen (2010) found a group of long-term unhoused people using
Jackson Square in New Orleans’ French Quarter as both home and
workplace. Some called the park home, even when they had housing
in shelters and other places. Some slept on benches or on grassy
areas. They called the network of unhoused people that they
interacted with in the park their “everyday family.” Some also used the
park as their workplace, panhandling in the park; vending jewelry, art,
and crafts; or reading tarot cards and palms for the tourists who also
frequented the park. Like the women in the Casey et al. (2008) study,
the unhoused people in Jackson Square had strategies for being
allowed to stay in the park: They tried to blend in with their dress and
behavior; they frequented the park at certain times of day and for
limited time; and they knew the patterns of police checks, sweeps,
and arrests in the park.

Reitzes and colleagues (2015) did a field investigation of the activities

in a public downtown park in Atlanta. They found that a large group of
unhoused people, including a number of young adults, families, and
women, tended to stay in the park several hours every day. Many of
them expressed some place attachment to the park. They felt
proprietary about the park but did not claim exclusive rights to it. They
used the park to meet other unhoused people and engage in social
networking, information exchange, and simple entertainment. They
used the park as a convenient and trustworthy place to share
information about employment, housing, food distribution, and
shelters. The strategies used by the unhoused community to avoid
being removed from the park focused on following the rules as they
understood them: They didn’t lie down on the benches, walk on the
grassy areas, litter, or panhandle (something that was allowed in
Jackson Square in New Orleans). They saw the park as a safe place
because of the presence of police, guards, and close-circuit cameras,
and they valued that safety.

Laborde (2021) reports that before police displaced an encampment

of unhoused people in Echo Park in Los Angeles, California, in March
2021, the residents managed their own showers, a community
garden that was open to housed people as well as the unhoused
residents, a kitchen and pantry, a job training program, and donation-
funded paid sanitation and security workers. Laborde notes that the
preexisting infrastructure of parks—water, power, parking, services,
and maintenance—as well as their beauty make them appealing to
unhoused people.

Substandard housing, housing poverty (paying a high percentage of

income on housing), and houselessness seriously compromise the
health and well-being of economically marginalized people. These
situations are associated with low wages, lack of housing that people
with low incomes can afford, displacement of low-income people
caused by gentrification, and racial discrimination. In the United
States, government agencies, nonprofit organizations, and unhoused
activists are all proposing and trying out policies and programs to
right this serious societal failure. It is beyond the scope of this
discussion to provide an overview of those efforts, but it is important
to say that while they are bringing relief to some, the problems will not
be solved without serious effort to increase the income of the poorest
members of society as well as the stock of affordable housing.
Coordinated efforts that include the participation of unstably housed
and unhoused people are needed at the local, state, and national
levels. Social workers should be involved in these efforts and join the
call to decriminalize the basic survival strategies of unhoused people
(Carroll et al., 2022; Craven et al., 2022; Townley et al., 2022).

Race-Based Housing Segregation and Racial Health Disparities

Social science theory and research are in an early stage of identifying

mechanisms by which institutional racism produces health inequities
in the United States. Race-based housing segregation is being
proposed as a key mechanism of racial health disparities (Lane et al.,
2022; Rothstein, 2017; D. Williams & Collins, 2001). Governmental
legislation, supported by economic institutions, enforced by the
courts, and advocated by religious organizations, intentionally
produced the physical separation of races that exists today to protect
whites from social interaction with Blacks (D. Williams & Collins,
2001). In his book The Color of Law: A Forgotten History of How Our
Government Segregated America, Richard Rothstein (2017) presents
a detailed history of this intentional housing segregation of the races
in the United States. It is beyond the scope of this discussion to do
justice to Rothstein’s analysis, but a few examples can begin to
demonstrate how systematic and wide-ranging these efforts were.

As early as the 19th century, some cities had restrictive

covenants that forbade selling houses to African Americans.
Governments at all levels became involved in promoting and
enforcing restrictive covenants.
In the early 20th century, many cities developed zoning rules that
required separate living areas for Black and white families, and
these zoning laws persisted until the latter half of the century.
During the Great Depression, the Public Works Administration
(PWA) created by the Franklin Roosevelt administration racially
segregated housing projects, even in areas that had once been
racially integrated.
The Home Owners’ Loan Corporation (HOLC), established in
1933, color-coded every urban neighborhood by race.
When the Federal Housing Administration (FHA) was created in
1934, its appraisers gave higher ratings to mortgage applications
if there were no African Americans living in or nearby the
neighborhood and also gave lower risk estimates for properties
with restrictive covenants. Banks refused loans in areas
identified as high risk, a system known as redlining.
When housing was needed for workers in the war industries
during World War II, the federal government built new housing
that was officially and explicitly segregated by race. The federally
financed housing for African Americans was poorly constructed
and intended to be temporary.
In the late 1940s, the FHA and the Veterans Administration (VA)
refused to insure mortgages for African Americans in designated
white neighborhoods and would not insure mortgages for whites
in neighborhoods where African Americans lived. The FHA
encouraged and approved whites-only suburban housing
developments.
Churches and synagogues often led efforts to promote restrictive
covenants.
During much of the 20th century, police tolerated and even
promoted cross burnings, arson, vandalism, and other acts of
violence done to maintain residential segregation.
Local governments engaged in many activities that displaced
African American communities, including condemning property to
build parks and designing interstate highway routes to destroy
urban African American communities.
In the 1960s and 1970s, public housing projects were built in
predominantly low-income African American neighborhoods.
In 1973, President Nixon announced that public housing should
not be forced on white communities.
In 1991, the Environmental Protection Agency (EPA) issued a
report that confirmed that a disproportionate number of toxic
waste facilities—approved by local zoning boards—were located
in African American communities.
Before the housing collapse in 2008, banks, thrift institutions, and
mortgage companies engaged in excessive marketing of
 exploitive mortgage loans in African American communities, a
process known as reverse redlining.

Race-based housing segregation led to racialized communities with

high population density, poor housing stock, poor schools, restricted
employment opportunities, and lack of access to quality health care
(D. Williams & Collins, 2001). Lane et al. (2022) analyze how current
air pollution disparities in the United States, with Black and African
American and Latinx communities exposed to higher-than-average
levels of pollution, can be traced to redlining. Although redlining is no
longer legal, race-based housing segregation is entrenched in the
United States. When the federal interstate highway system was
developed, beginning in the late 1950s, homes in Black communities
were demolished to build the highways, cutting off Black
neighborhoods from each other and the wider community, and
creating air pollution in these communities from the traffic on the
highways (Needham et al., 2022).

Figure 7.2 provides an overview of current thinking about how

institutional racism related to race-based housing segregation affects
the physical and social environments of racialized communities and
how those environments produce pathways to disease. The last
column reflects syndemic theory, whose core tenets are that (1) there
are biological interactions between different disease states, and (2)
social, political, and economic power inequities interact with biological
processes to produce a concentration of interacting disease states in
marginalized communities (see Gravlee, 2020). In the first wave of
the COVID-19 pandemic, we learned that the SARS-CoV-2 virus
acted in a synergistic way with other disease states to produce
greater likelihood of death. The best available research indicates that
Black/African American, Latinx, and Indigenous people experienced
higher rates of COVID-19 cases and deaths compared to white
people during the first wave of the pandemic before vaccines were
available (Hill & Artiga, 2022).
Description

Figure 7.2 Proposed Mechanisms by Which Race-Based Housing

Segregation Produces a Concentration of Interacting Disease States

Source: Adapted from “Systemic Racism, Chronic Health Inequities,

and COVID-19: A Syndemic in the Making?” by C. Gravlee, 2020,
American Journal of Human Biology, 32, e23482, Figure 1.

Rothstein (2017) argues that we cannot begin to reverse a century or

more of intentional government-supported race-based housing
segregation unless we develop a broadly shared understanding of
our common history. He recommends we begin with high school and
middle school curricula. Unfortunately, there are strong efforts by
white supremacist groups in the United States to ensure that the story
of government-supported race-based housing segregation, like many
other stories of the country’s racial history, will not be told in public
schools. It is important that social workers join other voices at the
local level to push for an accurate telling of this history.

Technology

In Chapter 2 in this book, we read about Donna Haraway’s (1991,

2016) theory that technology of many types is so pervasively used to
extend human abilities—to travel, communicate, fight wars, learn, do
business, and live in comfort—that we are all effectively cyborgs,
cybernetic organisms that are a hybrid of human and machine. Ben
Watson (Case Study 7.1) is in a partnership with his sophisticated
titanium wheelchair and, no doubt, makes use of a variety of
computer tools in his architectural design work. Since they first
appeared on the earth, humans have used their cognitive capacities
to build tools to extend their abilities. Humans are not the only
animals that have developed tools, but, to date, humans are the only
animals to develop the types of complex tools resulting in rapid
changes in our individual and collective behaviors. For the purposes
of this discussion, technology is defined as the tools, machines,
instruments, and devices developed and used by humans to enhance
their lives. There are many types of technologies; examples include
construction technology, industrial technology, transportation
technology, information technology, communication technology,
energy technology, weapon technology, agricultural technology,
security technology, and medical technology. There is clear evidence
that the pace of technological development is speeding up.
Contemporary technology is often invisible, operating by sensors,
signals, and so on.

Technological advancements evolve, accumulate over time, and build

on each other. Some, when widely diffused, lead to cultural and
societal changes. Different groups have made different lists of the
technologies that have had the biggest impact on human history, with
the greatest influence on cultural and societal change. Table 7.4 lists
the technologies that often appear on those lists, along with the
approximate date of their invention for public use in the left-hand
column. As I work on this chapter in the last week of 2022, I am
hearing stories of the most important technological innovations during
2022. Some of those are listed in the right-hand column in Table 7.4 .
It is important to remember that technological innovations often
evolve over time with contributions from different people and often
take some time to be widely adopted around the world.

Table 7.4
Across time, and certainly since the industrial revolution, there have
been proponents and critics of technological development.
Proponents have had confidence that technology will benefit society.
The most optimistic have believed that technology will allow humans
to master all problems and control the future. They suggest that
technological fixes for situations such as the damage caused by
climate change are easier and less painful than getting large numbers
of people to change their behavior (Johnston, 2018). Critics have
argued that depending on technological fixes underestimates the
complexity of social issues and fails to consider human values and
ethics (Johnston, 2018). They also note that technology can limit our
freedoms and have negative effects on our psychological health. And
recently, the ecological justice movement has emphasized the ways
in which new technologies destroy the natural environment.

As with earlier technological revolutions, the rapid developments in

digital technologies we are currently experiencing have both
proponents and critics. We can now access almost unlimited amounts
of information and process and store massive amounts of data. We
can constantly connect with large numbers of other people by digital
devices—smartphones, tablets, computers—and social media. We
were spending enormous amounts of time online before the
beginning of the COVID-19 pandemic, and then almost overnight
nearly all of our personal, educational, occupational, cultural,
economic, religious, health care, and political activities were moved
online (Hoehe & Thibaut, 2020). We do not yet know what the long-
term impact of that will be.

Two groups of researchers—cyberpsychologists and neuroscientists

—are considering the benefits and costs of digital technologies for
human behavior. Cyberpsychologists are interested in how
psychological processes intersect with computer technology to
influence human behavior (Elhai & Rozgonjuk, 2020). They have
found benefits of computer use for human behavior, including
expansion of social networks and social capital (Cheng et al., 2019),
building romantic relationships (van Ouytsel et al., 2020), aiding
education and learning (Crompton & Burke, 2018; Tausczik & Huang,
2020), and facilitating mental health care (Anderson & Molloy, 2020;
Vasser & Aru, 2020). Cyberpsychologists have also identified adverse
consequences of human interaction with computers, including
adverse effects of overuse (Brandt et al., 2020; Elhai et al., 2017;
Kircaburun et al., 2020; Hussain & Starcevic, 2020); adverse effects
of interruptive notifications from smartphone (Kushlev & Leitao,
2020); fake news and filter bubbles (Sindermann et al., 2020);
cyberbullying (Machackova, 2020); and challenges to online security
and privacy (Chen, 2020; Lustgarten et al., 2020). After a review of
the research literature, Elhai and Rozgoniuk (2020) conclude that
digital technology is not inherently good nor bad for human behavior;
rather, it is the way we use it that produces positive or adverse
consequences. They also note the importance of digital technology
for social connection, learning, work, and health care during the early
days of the COVID-19 epidemic.

Neuroscientist researchers are interested in how digital technology

use affects human brains and behavior (Hoehe & Thibaut, 2020). It is
well known that the high plasticity of the human brain means that our
brains are affected by how we use them. Neuroscientists are finding
that digital technology use affects human brains and behavior in both
positive and negative ways, and also in ways that we might not yet
understand. Such use affects visual perception, language, and
cognition. Touching the screen repetitively leads to an enlargement
and reorganization of the sensory cortex and reshapes
somatosensory processing in the thumb and fingertips. It is not
known if this occurs at the expense of other motor coordination skills
(Korte, 2020). Engagement with digital technology can have a
particularly strong impact during stages of rapid brain growth in early
childhood. For example, extensive childhood experience with the
game Pokémon has been found to impact the organization of the
visual cortex and affects the perception of visual objects decades
later. In addition, early extensive screen use is associated with lower
integrity of brain white matter that supports language and literacy
skills (Korte, 2020). Adolescence is a period of significant brain
reorganization, and social media use can affect this process (Korte,
2020). In a review of available research, Small and colleagues (2020)
found that extensive screen time can lead to attention problems,
technology addiction, social isolation, impaired cognition, and
reduced sleep. They also found, however, that digital technology has
several benefits for the aging brain, providing mental stimulation and
improving memory. Odgers and Jensen (2020) found that available
research does not support a linkage between the quantity of
adolescents’ digital technology use and mental health problems. They
did find, however, that offline personal vulnerabilities shape the risks
of online use. Similarly, Dienlin and Johannes (2020) found that
available research does not support the view that digital technology
use has a negative impact on adult mental health. Hoehe and Thibaut
(2020) conclude that the preponderance of the evidence indicates
that digital technology use does not affect mental health or well-
being. Its use can have both positive and negative effects, and
individuals shape the experiences they have with technologies. This
echoes the findings of cyberpsychologists that digital technology is
not inherently good nor bad for human behavior; rather, it is the way
we use it that produces positive or adverse consequences.

Hoehe and Thibaut (2020) suggest that one benefit of digital

technology is its use for mental health interventions. Hegerl and
Oehler (2020) report on the promises and risks for web-based
interventions for depressive symptoms. Bell and colleagues (2020)
review the benefits of virtual reality as a clinical assessment tool. The
COVID-19 pandemic led to a quantum leap in telemedicine and
telepsychiatry, and there is growing evidence that these digital
methods of health care delivery will continue to be a feasible and
appropriate approach for supporting patients and their family
members (Di Carlo et al., 2021). One concern is the racial and
socioeconomic disparities in provision of digital services, with
disparities in individual technology availability as well as disparities in
the offering of telemedicine by providers (Jacobs & Ellis, 2021).
In the early days of the COVID-19 pandemic, almost overnight nearly
all of our personal, educational, occupation, cultural, economic,
religious, health care, and political activities moved online.

Kyodo News/Getty Images

Critical Thinking Questions 7.3

What roles do you see for social workers to alleviate housing

instability for people with the lowest incomes? What rights do you
think unhoused people have in public territories? What are your
thoughts about race-based housing segregation as a mechanism of
racial health disparities? How have you seen that idea presented in
the media? Do you consider yourself a proponent or a critic of digital
technologies? Provide reasons for your position.

Healing Environments
By many accounts, the concept of healing environment was first
proposed by Florence Nightingale, an English social reformer and
founder of modern nursing (Dovjak et al., 2018; Gashoot, 2022;
Gregory et al., 2022). Nightingale (1859) argued that the physical
environment of hospitals should be manipulated to be more
therapeutic, focusing on quiet, warmth, fresh air, light, and sanitation.
Roger Ulrich (1984) is thought to be the first researcher to measure
the effects of the physical environment on physical health of hospital
patients. He studied patients who had undergone gallbladder surgery
and had different views out their hospital room windows—a brown
brick wall for one and a small stand of trees for another group. The
patients who had views of the trees left the hospital almost a day
sooner, required less pain medication, received fewer negative
comments from nurses, and had slightly fewer postoperative
complications than the patients with views of a brick wall. Ulrich
(1991) later developed a theory of healing environments that
emphasized the importance of creating physical spaces that reduced
stress. As the concept is used in theory and research today, a healing
environment is a physical setting that supports patients, families, and
staff with the stresses involved in illness, hospitalization, medical
care, and healing.

Based on his early research, Ulrich has collaborated with architects,

environmental psychologists, and public and private agencies and
foundations to develop a field called evidence-based design, which
uses physiological and health outcome measures to evaluate the
health benefits of hospital design features (Center for Health Design,
2022; Ulrich, 2006). By 2006, 700 rigorous studies had been
identified (Ulrich, 2006), and the Center for Health Design had been
established to engage in ongoing hospital design innovations and
evaluations. The early research focused on the association between
one design feature and one health outcome.
A long tradition in architecture proposes a connection among nature,
architecture, and healing.

© iStockphoto.com/Lisa F. Young

Early researchers were interested in the association between one

design feature (e.g., nature, noise, or sunlight) and one outcome
(e.g., length of stay; pain medication use; patient satisfaction, stress,
and mood), but evidence-based design researchers have recently
been interested in the cumulative effect of using multiple empirically
supported design features in one setting (see Ulrich et al., 2018;
Zhang et al., 2019). Several researchers have proposed conceptual
models for the design features to be included in healing
environments. Table 7.5 presents a synthesis of several of those
models.

Table 7.5
Inclusion, Diversity, Equity, and Accessibility in Built Environments

When Ben Watson (Case Study 7.1) felt ready to move to North
Carolina to begin his career as an architect, he knew that the firm
where he would be working was accessible to him, with a ground-
level entrance, a spacious elevator, wide doors to accommodate his
wheelchair, and accessible bathrooms. After a search, he was able to
find an accessible apartment he loved. The barriers he finds to
traveling around the streets of his neighborhood—narrow sidewalks,
uneven or broken sidewalk surfaces, absence of ramps or steep
ramps, absence of sidewalk curb cuts or steep curb cuts, and
obstructions of various kinds—are also barriers to many people not
traveling in wheel chairs, including many older people, people with
temporary mobility limitations, people pushing baby carriages, and
young children (Abdrassilova & Murzagaliyeva, 2020; Gani et al.,
2019). In the past few decades, we have been reminded that built
environments can exclude some people and prevent their full social
participation in social life.

Current attention to inclusion, diversity, equity, and accessibility in

built environments has roots in disability rights activism but is also
beginning to move beyond the disability/non-disability binary to take a
more intersectional approach to human diversity (Erdtman et al.,
2021). The movement toward inclusive and accessible built
environments is evolving as theoretical models of disability evolve.
Although other models of disability have been proposed, this
discussion follows the evolution of four main models: religious/moral
model, medical model, social model, and human rights model. One
version of the religious/moral model, thought to be the oldest model
of disability, saw present disability as a just punishment for past or
ancestral violation of religious, moral, or social taboos. A second
version of the religious/moral model proposes that disabled people
are chosen by God to endure disability and they are seen as
inspirational. Although both religious/moral models are now seen as
antiquated, the second version is still embraced in some religious
groups (Retief & Letšosa, 2018; Wells-Jensen & Zuber, 2020). From
the mid-1800s, the medical model of disability gradually replaced the
religious/moral model. The medical model of disability views disability
as an impairment or defect within the person that is outside the range
considered “normal.” The disability is not connected to social and
physical environments and is a problem to be solved by medical
professionals (Jackson, 2018; Retief & Letšosa, 2018; Wells-Jensen
& Zuber, 2020).

With theoretical models of disability focused solely on the person,

built environments were for centuries designed and constructed with
little or no consideration of bodily diversity. Inspired by the disability
rights movement of the 1960s and 1970s, the social model of
disability emphasizes the barriers people with bodily impairments
face as they interact with the physical and social world, arguing that
disability is a result of the relationship between the individual and the
environment (Jackson, 2018; Retief & Letšosa, 2018; Wells-Jensen &
Zuber, 2020). In the social model, impairment is an aspect of the
physical body and disability is restricted activity or social exclusion
that comes from aspects of the organization of the physical and social
environments. In a conference of United Kingdom disability
advocates in 1976, the relationship between impairment and disability
was summarized this way: “Disability is something imposed on top of
our impairments, by the way we are unnecessarily isolated and
excluded from full participation in society” (Union of the Physically
Impaired Against Segregation and the Disability Alliance, 1976, p. 4).
(A note about language here: As noted in Chapter 6 of this book,
early in the disability rights movement people in the movement
preferred the person-first language of “people with disabilities.” More
recently, many in the movement have argued for the language of
“disabled people,” contending that it is the environment that disables
and not that the disability is a part of their personhood. In this section,
we use the language used by cited researchers. As with any other
identity groups, we should always use the language preferred by the
person.)

This way of thinking about disability was the impetus for development
of the Disabled Peoples’ International (2022) in 1981, a global
network of organizations that promotes the rights of people with
disabilities worldwide. In the United States, the social model of
disability led to legislation at all levels of government during the
1970s and 1980s, most notably two pieces of federal legislation. The
Rehabilitation Act of 1973 (Pub. L. No. 93–112) was the first federal
act to recognize the need for civil rights protection for persons with
disabilities. It required all organizations receiving federal assistance
to have an affirmative action plan to ensure accessibility of
employment to persons with disabilities. The Americans with
Disabilities Act of 1990 (ADA) (Pub. L. No. 101–336) extended the
civil rights of persons with disabilities to the private sector. It seeks to
end discrimination against persons with disabilities and promote their
full participation in society. The five titles of the ADA seek to eliminate
environmental barriers to the full participation of persons with
disabilities. You will want to be aware of the legal rights of people with
disabilities.
 Title I addresses discrimination in the workplace. It requires
reasonable accommodations, including architectural
modification, for disabled workers.
Title II requires that all public services, programs, and facilities,
including public transportation, be accessible to persons with
disabilities.
Title III requires all public accommodations and services
operated by private organizations to be accessible to persons
with disabilities. It specifically lists 12 categories of
accommodations: hotels and places of lodging; restaurants;
movies and theaters; auditoriums and places of public gathering;
stores and banks; health care service providers, hospitals, and
pharmacies; terminals for public transportation; museums and
libraries; parks and zoos; schools; senior centers and social
service centers; and places of recreation.
Title IV requires all intrastate and interstate phone companies to
develop telecommunication relay services and devices for
persons with speech or hearing impairments to allow them to
communicate in a manner similar to that of persons without
impairments.
Title V covers technical guidelines for enforcing the ADA.

Ben Watson has discovered that, in spite of the law, he still

encounters many physical barriers to his full participation in society. A
major reason for this is that compliance with the law is not monitored
and the only way to seek protection under the law is to bring a
complaint. Different states have developed different architectural
codes to comply with the ADA. Table 7.6 presents some design
elements of inclusive accessible environments.

Table 7.6
Sources: Based on Design Innovations for Aging and Alzheimer’s, by
E. Brawley, 2006, Wiley; People With Disabilities Explain It All for
You, by M. Johnson (Ed.), 1992, Advocado Press; 521 CMR,
Mass.gov, 2022. Retrieved from https://www.mass.gov/law-
library/521-cmr; “Accessible Park Environments and Facilities for the
Visually Impaired,” by K. Siu, 2013, Facilities, 31(13/14), 590–609.

The social model of disability was also the driving force behind the
United Nations Convention on the Rights of Persons with Disabilities
(CRPD) that entered into force in May 2008 (United Nations
Department of Economic and Social Affairs Disability, 2022). The
CRPD recommends the following elements of accessible
environments: accessible housing and built infrastructures,
accessible transportation, accessible public spaces and public
services, accessible information and communication technologies,
and full and active participation of persons with disabilities in the
planning of inclusive and accessible natural and built environments.
President Barack Obama signed the CRPD in July 2009, but in July
2022 the United States remained one of eight countries that had not
ratified the CRPD (Widakuswara, 2022).

Although it was the social model of disability that inspired the CRPD,
the language of the CRPD is human rights language and underscores
an evolving human rights model of disability. In Chapter 1 of this
book, we noted that the Council on Social Work Education (CSWE;
2022, p. 9) states that “Social workers understand that every person
regardless of position in society has fundamental human rights.” The
human rights model of disability argues that the basic human right to
access to and inclusion in the physical environment does not require
a particular body status (Degener, 2016). It acknowledges the impact
of impairment on the lives of people with disabilities and recognizes
impairment as a natural aspect of human diversity that governments
have a responsibility to support. It recognizes the diversity of
impairments among disabled people. It insists on the right of disabled
people to participate in the planning of inclusive built environments
(Degener, 2016).
In response to the failure of built environments to meet the needs of
disabled people, in 1985 architect Harry Mace called for universal
design, which involves designing all products and built environments
to be usable by all people, to the greatest extent possible, without the
need for adaptation or specialized design (Mace, 1985). The concept
of universal design starts from the position of recognizing diverse
human bodies, abilities, and needs (Erdtman et al., 2021; Watchorn
et al., 2021; Zallio & Clarkson, 2021). It recommends that the design
of places and products should be done in such a way so as not to
draw attention to a person’s bodily conditions, to avoid creating a
situation in which a person will face discrimination and stigmatization.
Universal design is also used to describe services, especially
educational services, but this discussion focuses on universal design
of the built environment, including buildings, structures, products, and
technologies. Universal design is included in Article 2 of the CRDP
(Erdtman et al., 2021). In recent years, several terms have been used
to describe the process of designing and constructing built
environments that address issues of inclusion, diversity, equity, and
accessibility, including universal design, accessible design, barrier-
free design, inclusive design, design-for-all, and trans-generational
design (Erdtman et al., 2021; Kim & Jeong, 2020; Watchorn et al.,
2021).

Designing built environments, products, and technologies for the

whole population with a diversity of bodies, ages, abilities, and needs
is a challenging and worthwhile goal (Zallio & Clarkson, 2021). For
example, a public park may be made more accessible for Ben
Watson to travel through in his wheelchair without being accessible at
all for someone with a visual impairment. Likewise, an urban
intersection may be reengineered to allow Ben to travel through it
safely in his wheelchair but still be quite unsafe for someone with a
hearing impairment. When designing a space for a particular person
with a particular need or body status, design professionals can
consult with that particular person during the design process.
However, when designing public spaces, it is important for design
officials to get input from a great variety of people about the way they
interact with the environment (Zallio & Clarkson, 2021). And, indeed,
people’s needs, abilities, and body situations change over time, and
the use of universal design in the original design process can prevent
environments from becoming disabling as the body changes over
time. There has been some criticism that universal design strategies
have focused on design for people with mobility disabilities without
consideration of diverse body sizes and sensory and cognitive
disabilities (Erdtman et al., 2021; Zallio & Clarkson, 2021). To date,
there is no clear set of design features for universal design and some
disabled people fear that as universal design evolves beyond a
disability focus, their right for specialized design feature
accommodations may not be recognized if universal design replaces
existing accessibility laws (Erdtman et al., 2021; Watchorn et al.,
2021). These are important concerns that deserve serious
consideration. Specialized technologies for specific mobility, sensory,
and cognitive impairments will continue to be needed to promote
inclusion and equity whether or not they become a part of universal
design.

Critical Thinking Questions 7.4

Have you seen any design features of healing environments in your

visits to health care facilities? Describe what you have seen. How
much thought have you given to accessible environments for people
with a mobility disability like the one Ben Watson has? How easy
would it be for Ben to visit your neighborhood, your home, your
favorite restaurant, or your classroom (if you go to one)? How hard do
you think it would be to design built environments for the whole
population (universal design)? Explain your answer.
The kitchen in the Michael Ciravolo Jr. Wheelchair Suite, dedicated
specifically by the Hotel Delmonico in New York City to accommodate
people with mobility disabilities.

© Diane L. Cohen/Getty Images

Ecological Justice, Sustainability, and Environmental Justice: A Social-

Racial-Economic-Ecological Justice Perspective

Any current discussion of human interactions with the physical

environment must include three ideas that are getting international
attention across multiple disciplines and spawning international social
movements: ecological justice, sustainability, and environmental
justice. In this brief discussion, I will provide an overview of theory
and research about each of these ideas. But, more importantly, I will
consider the conflicts and tensions in current discussions and actions
regarding them from a social-racial-economic-ecological justice
perspective.
Ecological justice emphasizes humans’ moral responsibility to non-
human elements of nature. It is based on the understanding that the
earth is the home not only of humans but of a huge number of other
species with rights (Jähnichen, 2022). It requires humans to work with
rather than against non-human beings for mutual well-being
(Grabowski et al., 2022; Yaka, 2019). It insists that humans must not
deprive non-human beings of their continued existence and ability to
reproduce without a strong moral reason (Bhakuni, 2021).
Proponents of ecological justice emphasize the ways that humans
destroy the natural world and fail to respect and give gratitude and
dignity to non-human species. They insist that humans must address
the harms, needs, and futures of non-human beings and restore
habitats that have been destroyed (Grabowski et al., 2022; Yaka,
2019).

Ecological justice is not a new idea. It is embedded in Indigenous

wisdom, knowledge, and culture that humans have a responsibility to
non-human beings and must live in reciprocity with them (Dhillon,
2018; Grabowski et al., 2022; Kimmerer, 2013). Indigenous wisdom
also suggests that humans must look to other species for guidance
about how to live in harmony in the ecosystem. In Chapter 8,
Cultures, we will look at how cultures shape language and language
shapes cultures. Indigenous botanist Robin Wall Kimmerer (2013)
provides an excellent explanation of this. She remarks that in the
English language, as well as other European languages, if you are a
human you are assigned a gendered pronoun (which produces its
own problems), but if you are not human you are assigned the
pronoun “it.” You are either a human or a thing. Most Indigenous
languages do not make that grammatical distinction between humans
and other elements of nature. The same language is used for all
animate objects—and the understanding of what is animate is quite
expansive. Kimmerer suggests that this distinction between humans
and things (its) gives permission to disrespect other elements of
nature. Kimmerer (2013) uses the language of “nonhuman persons”
to recognize other beings in nature and calls attention to the common
use of the language of “natural resources” to talk about many non-
human elements of nature, as if their only value is in providing
resources for humans.
As it became more and more obvious that human activity was
degrading and destroying other elements of the natural environment
and changing the climate in a way that is not sustainable for future
generations, sustainability was introduced as a transformational idea
(Grossmann et al., 2022). Like ecological justice, sustainability, or
sustainable development, is not a new idea. In ancient Indigenous
wisdom, we should think of a sustainable world for seven generations
in the future as we interact with non-human persons in the natural
environment (Kimmerer, 2013). Today, sustainability is commonly
used to mean the fulfillment of the needs of current generations
without compromising the needs of future generations, balancing
ecological, economic, and social priorities (Krings & Schusler, 2020).
The ecological, economic, and social priorities are not always clearly
spelled out, but they appear to be something like this. The ecological
priorities are to live in such a way not to exceed the capacity of the
ecosystem to support human life or jeopardize biodiversity
(Grossman et al., 2022; Krings & Schusler, 2020). The main
economic priority is to ensure that basic human needs are met
around the world and is generally identified within the context of
neoliberal free-market capitalism with its emphasis on economic
growth (Ciplet & Harrison, 2020; Krings & Schusler, 2020). The social
priorities are typically stated as fair representation in decision-making
and fair distribution of benefits and burdens (Eizenberg & Jabareen,
2017).

The discussion of sustainability is beginning to recognize the conflicts

and tensions involved in balancing ecological, economic, and social
priorities (see Ciplet & Harrison, 2020; Eizenberg & Jabareen, 2017;
Grossman et al., 2022; Krings & Schusler, 2020). Although ecological
priorities are a part of sustainability, the concept is human-centered,
not nature-centered. The priority is to preserve nature in such a way
that it continues to support human needs (wants?), not the rights of
non-human persons. Two major tensions exist in the balancing of
economic priorities with ecological and social priorities. First, it is not
likely that ecological priorities can be met while holding on to the
principle of economic growth, with its continuing search for new
markets and increased consumption. Second, it is unlikely that the
social priority of fair distribution of benefits and burdens can be met in
the context of neoliberal free-market capitalism, which produces high
rates of inequality and marginalizes some groups. What is likely to
happen is that policies and programs to slow human-caused damage
to the natural environment will continue to re-create high levels of
economic inequality and inequitable distribution of the benefits and
burdens of human interactions with the physical environment.
Recently, a large literature is focusing on the injustices that are
occurring as efforts are made to transition to more sustainable
development. A theory of just transition has been proposed to ensure
a transition that is both just and sustainable (Ciplet & Harrison, 2020;
Grossman et al., 2022; McCauley & Heffron, 2018). Issues of just
transition will be examined with the discussion of environmental
justice, which appears in the following paragraphs. Another challenge
in balancing ecological, economic, and social priorities is that the
social priority of democratic representation in the decision-making
process around environmental issues may compromise a timely
response to the current ecological crisis.

As noted in Chapter 1 in this book, the Council on Social Work

Education (CSWE, 2022) identifies the promotion of environmental
justice as a social work competency. It is often reported that the
international environmental justice movement got its start in the
United States when poor racialized communities began to protest the
unequal burden of environmental hazards and degradation imposed
on their communities, including the unequal burden of pollution and
toxic waste facilities (Álvarez & Coolsaet, 2020; Ranganathan, 2022).
Similar patterns were reported in the United Kingdom, Canada, the
Netherlands, Scotland, Sweden, France, Germany, and Australia
(Nesmith & Smyth, 2015). In those early days, environmental justice
was defined as the equal sharing of the burdens of environmental
hazards and degradation across all demographic groups or
communities (Hutchison, 2019). As the environmental justice
movement grew and developed internationally, attention was called to
the ways that wealthy nations have been exploiting the natural
resources of poor nations, extracting and depleting those resources
and exacerbating the poverty in those nations since colonial times.
The degradation of the world ecosystems has been growing
significantly worse, and the burdens of that degradation go
increasingly to the most marginalized populations, poor people,
racialized people, older people, women, and children (Forbes et al.,
2021; Hayward & Joseph, 2018; Rambaree, 2020). The people
carrying the greatest burden of environmental degradation seldom
have a seat at the table where environmental policies are developed
(Rambaree, 2020).

In the past decade or so, the environmental justice literature has

increasingly used a tripartite theory of environmental justice to
consider not only the burdens of environmental damage but also the
benefits of policies that make improvements to the natural
environment or slow ecological damage. This theory of environmental
justice is based on Nancy Fraser’s (2005) theory of three dimensions
of justice: redistribution, recognition, and participation. Redistribution
refers to the fair distribution of both burdens (e.g., pollution) and
benefits (e.g., access to clean energy) of human interaction with the
natural environment (Eizenberg & Jabareen, 2017; Jähnichen, 2022).
Environmental justice scholars note that the greatest damage to the
environment is caused by wealthy nations and wealthy people, high-
income consumers who benefit from the extraction of natural
resources and emit the highest levels of greenhouse gases. And yet,
the burdens of those activities go disproportionately to poor people
(Sovacool et al., 2017). Just transition theorists and researchers point
out that as countries transition to more ecologically sustainable
development, the benefits of those developments go primarily to the
wealthy. Here are examples from that literature. Let’s look first at the
transition to cleaner energy. Labor unions argue that workers in the
fossil fuel industries must have labor protections such as retraining
opportunities, relocation, unemployment benefits, and early
retirement, as the transition to clean energy is made and their jobs
become extinct (Ciplet & Harrison, 2020; Grossman et al., 2022). As
governments provide economic incentives to adopt renewable energy
products, these products remain economically inaccessible to people
of low incomes, and there is a fear that the costs of energy will
become prohibitive for the lowest income earners who cannot afford
to adopt new energy products (Grossman et al., 2022). Urban
greening is another popular ecological and sustainability strategy.
Just transition theorists point out that low-income communities may
resist green projects such as new parks in the neighborhoods
because they add fuel to already troublesome rising housing costs
and reduce the stock of affordable housing (Grossman et al., 2022;
Krings & Schusler, 2020). This process is referred to as green
gentrification or eco-gentrification. Ranganathan (2022) reports that
ecological improvement is often used as the reason for massive
evictions in impoverished areas of India. It appears that may be what
happened to the SS Puram community where Shanthi’s family lived
(Case Study 7.2).

In the tripartite model of environmental justice, there are different

approaches to the dimension of recognition. At its most basic level,
recognition refers to the need to recognize the dignity and worth of all
individuals, understanding the diversity of values and belief systems
they hold and their different life experiences (Pandey & Sharma,
2021; Pellegrini-Masini et al., 2020). In the context of environmental
justice, recognition also means acknowledging that not all cultures
and human groups are responsible for the current environmental
crisis, recognizing the effects of the lifestyles of wealthy people in the
Global North on the environmental circumstances of less privileged
people in both the Global North and the Global South (Jähnichen,
2022). It is also suggested that recognition justice must include an
explicit connection between the history of colonialism and current
ecological and environmental injustices (Grabowski et al., 2022;
Pulido & De Lara, 2018). Writing from Latin America, Álvarez and
Coolsaet (2020, p. 59) argue that recognition justice includes
“acknowledging the role psychological processes play in the
misrecognition of communities who have been deprived, excluded,
racialized, and oppressed.” It should involve some sort of remedy for
historic distortions and engrained negative perceptions of such
cultural groups (Eizenberg & Jabareen, 2017; Álvarez & Coolsaet,
2020; McCauley et al., 2013; Pellegrini-Masini et al., 2020). The
environmental justice literature speaks about the need to recognize
the historic role of Indigenous people in ecological justice, including
their recent leadership in many parts of the world. And, finally, non-
human beings should be recognized for the roles they play in healthy
ecosystems (Álvarez & Coolsaet, 2020; Yaka, 2019).
In environmental justice theory, participation means that all groups
should be able to participate in deliberations about environmental
matters and their decisions should be taken seriously (McCauley et
al., 2013). Environmental justice scholars also acknowledge that
there are currently many barriers to the participation of marginalized
groups and that they are often co-opted when they find ways to
participate (Álvarez & Coolsaet, 2020). Eizenberg and Jabareen
(2017) suggest that participation justice cannot be accomplished
unless (1) all participants have sufficient material resources to ensure
independence in the participation process, and (2) equal respect is
granted to all participants. Grabowski et al. (2022) note that in the
United States and other countries, Indigenous people continue to be
marginalized in the political process and Indigenous environmental
knowledge is not respected. Writing from the Global South, Álvarez
and Coolsaet (2020) make the same observation and argue that
participation justice does not happen unless non-Western and
Indigenous ways of knowing are honored in planning processes.
McCauley and colleagues (2013) suggest that participation justice
requires government and industry to fully disclose information about
who is receiving what subsidies in ongoing projects. It is not always
clear whether environmental justice scholars are talking about equal
participation or equitable participation. Pellegrini-Masini and
colleagues (2020) suggest that participation should match the
importance of the matter at stake to different groups, noting that
mechanisms should be created to engage the groups most impacted
by environmental problems. Grabowski and colleagues (2022) argue
that Indigenous input should be actively sought, respected, and
supported, given Indigenous knowledge about how natural beings—
human and non-human—can live in reciprocal relationships. One
question that arises in regard to participation justice is how do the
voices of non-human beings get represented in the environmental
discourse?

Given the above discussion, I will attempt a definition of

environmental justice, with full recognition that it probably is not
adequate, has Western and Global North biases, and I might want to
revise it in the near future. Environmental justice involves the
equitable sharing of the benefits and burdens of human interaction
with the physical environment among all demographic groups and
communities, recognizes the history of unequal involvement in
environmental degradation and unequal benefits and burdens for
different groups, and seeks the equitable participation of all groups
and communities in decision-making about environmental policies
and actions. The promotion of ecological and environmental justice
requires an integrated social-racial-economic-ecological justice
perspective. These aspects of justice are completely intertwined in
complex ways and environmental justice cannot be accomplished
without attention to each type of justice. Social justice requires
attention to the opportunities and freedoms afforded different groups
in their interactions with the natural environment and in deliberations
about how to advance ecological and environmental justice. Racial
justice requires a clear-headed consideration of how, from colonial
days, racialized groups have experienced a disproportionate burden
of human-caused environmental destruction. Promotion of racial
justice raises hard questions about the treatment of Indigenous
groups by actors in the Global North and the types of reparations
needed for that treatment. Economic justice requires attention to how
groups of different economic statuses are impacted differently by the
current environmental crisis and also the ways they will be affected by
proposed environmental policies and regulations. And, lastly,
ecological justice requires that consideration of human responsibility
to non-human beings must be centered in all deliberations about how
to move forward on issues of environmental health. Social workers
can use their unique skills and competencies to mobilize local
communities to engage in collective problem-solving in a process of
identifying community problems, community assets, and community
power relationships, with an eye to issues of social, racial, economic,
and ecological justice.

Critical Thinking Questions 7.5

What do you think of Kimmerer’s use of the language of “nonhuman

persons” to recognize non-human natural elements? Do you think the
regular use of such language would change people’s thinking about
nature? What roles do you see for social workers in promoting
ecological and environmental justice? What do you think about the
idea that Indigenous people should have a special role in promoting
ecological and environmental justice? Explain your answers to the
questions.

Implications for Social Work Practice

This discussion of the relationship between human behavior and the

physical environment suggests several practice principles.

In social work assessment, be alert to the meanings that

particular physical environments hold for individuals, families,
small groups, communities, and organizations with which you
work.
Recognize that people have attachments to places as well as to
other people.
In social work assessment, consider any disrupted place
attachments in the groups with which you work.
In social work intervention, advocate for inclusive public places
that do not deny poor people a sense of place.
Assess whether the physical environment of your social service
setting provides adequate privacy and control to the staff and
clients.
Routinely assess the physical environments of clients,
particularly those settings where problem behaviors occur. Check
your evaluation against clients’ perceptions. If you have no
opportunity to see these environments, have clients evaluate
them for you. Provide space on the intake form for assessing the
physical environments of clients.
When assisting people to learn new skills, pay attention to the
discontinuities between the setting where the skills are learned
and the settings where they will be used.
When planning group activities, ensure the best possible fit
between the spatial needs of the activity and the physical
environment where the activity will occur.
Keep the benefits of the natural environment in mind when
planning both prevention and remediation programs. When
 possible, help clients gain access to elements of the natural
environment and, where appropriate, help them plan activities in
the natural environment.
Be alert to any negative experiences clients have had with the
natural environment, including traumatic events with natural
disaster.
Become familiar with the housing situation of individuals and
families with whom you work and advocate for housing stability
where necessary.
When working with unhoused people, assess the proactive ways
they try to navigate the physical environment, create a sense of
place, and gain access to public territories.
When working with unhoused people, advocate for the provision
of basic necessities and access to public spaces.
Working with professional organizations and other professions,
consider how to ensure that the history of race relations,
including race-based housing segregation, is accurately taught in
the public schools.
Assess the uses that clients make of digital technologies,
considering both the benefits and the costs of their use of such
technologies.
Assess whether the physical environment of your social service
setting has design features of healing environments or work with
colleagues to improve the healing nature of the setting.
Know the physical environments of the organizations to which
you refer clients. Assist referral agencies and clients in planning
how to overcome any existing environmental barriers.
Become familiar with technology for adapting environments to
make them more accessible and maximize opportunities for
client input into architectural designs.
Recognize any issues of ecological and environmental justice
impacting the communities where you work, and work with other
stakeholders for social-racial-economic-ecological justice.

Chapter Review

Key Terms
 Behavior settings
Behavior settings theories
Biodiversity
Biophilia
Biophobia
Built environment
Crowding
Ecotherapy
Environmental justice
Healing environment
Human-nature connectedness (HNC)
Natural environment
Natural disasters
Personal space
Place
Place attachment
Place identity
Placemaking
Primary territories
Privacy
Programs
Public territories
Secondary territories
Staffing
Technology
Territoriality

Active Learning

1. Take a walking tour of your neighborhood. What signs do you

see that physical settings are meaningful to people? Are there
places in the neighborhood to which you have a strong
attachment bond? What signs do you see of humans using
structures, natural elements, and spaces to create privacy and
mark their territory? Do you see any behavior settings in which
specific programs are enacted? How well do people seem to be
caring for the natural environment? Are there features of the
 natural environment that seem particularly appealing to you?
How would you evaluate the housing quality of the
neighborhood? Do you see any evidence that unhoused people
have access to facilities in your neighborhood? Do you see
evidence that the neighborhood is integrated by race? Do you
note any of the design features to improve accessibility for
persons with disabilities noted in Exhibit 7.8 ? What effects do
you think the physical environment of the neighborhood might
have on children, adolescents, and older adults?
2. Working alone or with a small group of classmates, make a list of
all the communication technology devices you make use of.
Make another list of the uses you have made of these devices in
the last 2 days. Think about or discuss your relationship to these
devices: how attached you are to them, how big a part of your life
they are, and how you feel when you don’t have access to them?
How do you see these devices making your life better? What, if
any, are their ill effects on your life? Finally, make a list of the
benefits these devices provide to society. Make another list of the
downside of these devices for society. What have you heard
other people say about the benefits and downside of these
technological devices?
3. Working alone or with a small group of classmates, imagine that
Ben Watson (Case Study 7.1) is visiting your community for the
weekend. You would like to take him out to dinner. Working alone
or together, develop a list of questions that you will want to ask of
restaurant managers about their accessibility for Ben to dine
there. Now, each of you get out your cell phone and call one of
your favorite restaurants and go through your list of questions.
What did you learn?
4. Chennai, India, where Shanthi (Case Study 7.2) lives, is known
as a city worth visiting, and yet Shanthi faces many challenges in
her life there. Ranganathan (2022) suggests that the lower
castes and classes are racialized in India. Using concepts from
this chapter, write a paragraph or two about how Shanthi’s
experiences with the physical environment in Chennai are similar
to and different from the experiences of racialized groups in the
United States.
Descriptions of Images and Figures

Back to Figure

The infographic reads as follows.

Contact With Biodiversity:

1. Reduces harms: Reduces heat and air pollution; source of

medicines, food, and clean water.
2. Restores capacities: Restores attention; assists stress recovery.
3. Builds capacities: Encourages physical activity; inspires spiritual
experiences.
4. Causes harm: Increases risk of allergies, infectious diseases,
and harmful microorganisms.

The above four points lead to Human Health & Well-Being, which
comprises of: Improved perceived health, Lower risk of depression,
Lower risk of mortality, Greater risk of allergic rhinitis and vector-
borne diseases.

Back to Figure

The infographic reads as follows.

Concentrated Disease Interactions Intensify Social Inequalities.

Institutional Racism: Residential segregation, school segregation,

occupational segregation, concentrated poverty, highways through
racialized communities, concentration of environmental hazards, no
intergenerational wealth transfer, mass incarceration, weak social
safety net.

Leads to:

Physical and Social Environments: Neighborhood density, poor

housing quality, poor school quality, lack of access to health care,
food insecurity, poor air quality, water insecurity, public transportation,
compromised internet connections, police violence, social stressors.
Which leads to:

Pathways to Disease: Crowding/inability to social distance,

compromised nutrition, obesity, inflammation, physiological
dysregulation, compromised immune system, inaccessible medical
screening, late diagnosis.

Which leads to.

Concentration of Interacting Disease States: Hypertension &

cardiovascular disease, diabetes, cancer, depression, anxiety,
COVID-19 and other contagious diseases.
8 Cultures

Elizabeth D. Hutchison and Linwood Cousins

Learning Objectives

8.1 Analyze one’s own emotional and cognitive reactions to a

case study.
8.2 Outline the elements that make up a comprehensive
definition of culture.
8.3 Compare three theoretical perspectives on culture
(materialist, mentalist, and practice orientation).
8.4 Apply a number of major concepts in the study of culture to a
case study.
8.5 Give examples of how culture and power intersect in the
social categorizations of race, ethnicity, gender, sexuality, social
class, and disability.
8.6 Summarize contemporary thinking about how genes and
culture interact to produce human behavior and the major
processes of cultural change.
8.7 Apply knowledge of human culture to recommend guidelines
for social work engagement, assessment, intervention, and
evaluation.

A Case Study About Cultures

Case Study 8.1: Rubina, Living Across Cultures

Rubina is a 22-year-old Pakistani American female who was

recommended to an outpatient mental health clinic by her primary
care doctor due to possible depression and anxiety. On the referral
the doctor noted that Rubina has chronic headaches, shortness of
breath, and chest pains. The doctor has completed thorough physical
assessments with bloodwork and believes that Rubina’s symptoms
are likely psychosomatic.
At the intake appointment, Rubina is very cooperative and open. She
tells the social worker that she was born in the United States to
parents from Pakistani origins. Her parents moved to the United
States in their 20s, before she was born, for better economic
opportunities. Rubina’s parents currently work in the restaurant
business and have struggled financially as long as she can
remember. Despite their financial problems, her parents have always
emphasized the importance of education and pushed Rubina and her
siblings to excel in school. Rubina graduated high school at the top of
her class and is currently studying business at an Ivy League school.

Rubina tells the social worker that she is doing well at school and that
most of the stress in her life comes from her parents. Rubina lives at
home with her mother, father, and three younger siblings. She reports
that although her parents have been in the United States for over 20
years, they continue to live their day-to-day lives like “back home.”
Rubina clarifies that Pakistan is not home for her—she has only been
there a few times on vacation—but that her parents derive all their
expectations, rules, and norms from that culture. Expectations that
bother Rubina the most include her parents needing to know where
she is at all times and that, as the eldest child in the family, she needs
to take care of her siblings (by helping with homework every day and
driving them around to extracurricular activities). It also really bothers
her that her parents expect her to listen to them unconditionally,
although she is in her last semester of college.

Values of respecting one’s elders, honoring one’s parents, and

helping family members are very strong within the family, and Rubina
feels extremely guilty anytime she tries to put her needs before her
family’s. It’s during these times that Rubina’s unexplained body aches
and pains seem to flare up the most. When Rubina tries to assert
herself, she is met with a lot of resistance and told she is trying to act
“American.” This causes a lot of cognitive dissonance for Rubina, for
she was born in the United States and as a result often feels
American. On some days, however, when Rubina hears about hate
crimes toward people of color in the news she reports feeling more
“Brown” and that perhaps her mother is right that she is not a real
American. Because Rubina doesn’t relate to the Pakistani culture
much, she experiences cultural dysphoria and often feels out of place
wherever she goes.

While trying to navigate through cultural identity issues, Rubina tells

the social worker that she recently started practicing Islam after
joining her university’s Muslim Student Association (MSA). She really
likes how culturally diverse the MSA is and has become friends with
many second-generation immigrants from the Middle East, Africa,
and Asia, like herself, as well as recent North, Central, and South
American converts. Rubina feels that she can relate to her peers in
the MSA about cultural issues and young-adulthood issues in ways
she can’t with her family. Attending MSA lectures and interacting with
other Muslims has helped her explore religion in ways she had not
before. Rubina says that religion gives her a stronger sense of
identity and makes her feel more grounded.

Rubina tells the social worker that her new interest in Islam was not
warmly received at home, although her family identifies themselves
as Muslim. When Rubina started to learn more about religion from
sources outside her family, she came to realize that her parents
misused religion to enforce their cultural values during her childhood.
For example, if Rubina ever disagreed with her parents about an
issue, even respectfully, her mother would tell her that she was
displeasing Allah (God). Rubina doesn’t know if her parents did this
knowingly or out of ignorance but indicates she is resentful of her
parents either way. Rubina has more recently become vocal at the
dinner table about issues important to her, but her parents scoff at her
ideas.

In the past 2 months Rubina began to experiment with the hijab

(Islamic headscarf) for the first time, and this has further exacerbated
conflict at home. Rubina says that when she wears her hijab she
feels closer and more connected to God. Although Rubina’s parents
are considered conservative by most standards, they told her to not
wear the hijab because of the anti-Muslim sentiment within their local
community. Rubina feels that her parents’ views of the hijab only
substantiate her claims that her parents pick and choose standards
that are convenient for them.
Rubina appears to understand that difficult family dynamics are likely
causing her physical ailments, but she tells the social worker she
doesn’t know how to manage her stress in healthy ways. She is
willing to try counseling and expresses some optimism that even if
counseling doesn’t work, at least she will have someone to talk to
who won’t judge her.

Story provided by Najwa Awad

What Is Culture?

Rubina, like many of us, moves back and forth across several
different cultures in her daily life. That is why the title of this chapter is
“Cultures” and not “Culture.” The world has always contained a rich
array of cultures, and history is largely a tale of the conflicts that
occurred when different cultures encountered each other in the same
space. However, in past generations, in what has been called
“traditional culture,” it was not unusual for people to live their lives in
relatively unchanging cultural enclaves with clear norms and values,
with little encounter with people from other cultures with different
norms and values. In many places in the world today, this type of
cultural segregation is no longer the way that humans live. In the
contemporary world, in many but not all places, we come into contact
with a variety of cultures through daily activities but also through the
media, travel, reading, migration, and a global economic system. The
case study indicates several cultures in which Rubina participates,
including “American” culture, university culture, family culture based
on “back home” Pakistani culture, the peer culture of the Muslim
Student Association that includes much cultural diversity, and the
culture of anti-Muslim sentiment in the United States. As her social
worker gets to know Rubina better, she will probably learn of other
cultures in which Rubina participates, perhaps a social media culture
and a culture of business students. What about you? In which
cultures do you participate, and how do the different cultures shape
your identity?
In the contemporary world, cultures interact with and influence each
other. Almost all of us live at the intersection of several different
cultures; sometimes these different cultures reinforce each other,
sometimes they borrow from each other, and sometimes our cross-
cultural experiences are fraught with the kind of conflicts that Rubina
is experiencing. Human behavior must be understood in the context
of multiple interacting cultures.

So, what is culture? Contemporary social scientists suggest that

culture is one of the most elusive social science terms to define
(Mironenko & Sorokin, 2018; Ornelas et al., 2022; Rieger, 2022).
Researchers use many different definitions, reflecting different
theories for understanding culture and focusing on different
phenomena (Gardiner, 2018). More than 50 years ago, two
anthropologists, Alfred Louis Kroeber and Clyde Kluckhohn (1952),
developed a list of 164 definitions of the term culture found in the
social science literature. They divided these definitions into the eight
categories presented in Table 8.1. In a 2006 book Redefining Culture,
Baldwin and colleagues listed 313 definitions from the disciplines of
psychology, sociology, linguistics, anthropology, political science, and
philosophy, among others (Baldwin et al., 2006). Jahoda (2012)
suggests the concept is indispensable, and perhaps it should just be
used without defining it. We agree with Jahoda that any concept used
so broadly across so many disciplines is an important concept. We
disagree, however, that it should be used without a definition.

Table 8.1
Source: Adapted from Culture: A Critical Review of Concepts and
Definitions, by A. Kroeber and C. Kluckhohn, 1952, Peabody
Museum.

Anthropologists trace contemporary definitions of culture back to the

definition offered by anthropologist E. B. Tylor in 1871: “that complex
whole which includes knowledge, belief, art, morals, laws, customs
and any other capabilities and habits acquired by man [sic] as a
member of society” (p. 1). This definition of culture is a broad
definition, and many of the definitions found in the anthropology,
cultural psychology, cultural studies, and sociology literatures that
came after Tylor’s time continued in this broad way of thinking about
culture. Other scholars call for a narrower, more focused definition,
but these scholars have a lot of variation in their thinking about what
the narrower focus should be. Some focus on material culture , which
includes physical objects, resources, and spaces that people use to
define their culture. Examples include homes, places of religious
worship, workspaces, tools, products, and technologies (see P.
Campbell, 2021). Other scholars focus on beliefs and values; some
focus on norms and habits, and others focus on language, symbols,
and meaning making (Dillon, 2020; Inglis, 2016). Several disciplines
are involved in the study of culture, and each discipline includes an
array of definitions. There is no agreed-upon definition of culture and
probably never will be. Table 8.2 provides some definitions of culture
used in the contemporary disciplines of anthropology, cultural
psychology, cultural studies, and sociology.

Table 8.2

In this chapter, culture is defined as a system of knowledge, beliefs,

values, language, symbols, patterns of behavior, material objects,
and institutions that are created, learned, shared, and contested by a
group of people. As you can see, this definition is very similar to the
definition proposed by anthropologist Kenneth J. Guest (see Table
8.2), with some additions. This definition indicates that culture is
“inside our heads” as thoughts, beliefs, perceptions, and emotions
(Cousins, 2015). It is also in the social and material worlds with
patterns of behavior, material objects, and the social institutions we
create to manage social life. It is created over time, shaped by human
interactions. Culture is learned through a process called enculturation
. Some cultural studies scholars are particularly interested in how we
learn culture (Dressler, 2020; Foster, 2018; Pacheco, 2020). The
hallmark of culture is that it is shared by a group of people, but what
we like most about Guest’s definition is that it recognizes that culture
is both shared and contested. This notion that culture is contested as
well as shared is very important to social work. As Ritzer’s definition
of culture (as seen in Table 8.2) points out, shared culture allows both
small and large groups to carry out their collective lives in relative
order and harmony. And yet social workers recognize that order and
harmony too often favor elite participants in a culture while at the
same time harming or oppressing other participants. Besides the
conflicts between cultures, intense internal struggles often erupt over
beliefs, values, symbols, and behaviors.

Consider Rubina’s story. She navigates the conflicts between

“American” culture and “back home” Pakistani culture, as well as the
conflicts between her religious culture and the dominant religious
culture in the United States. But she also lives with an intense internal
struggle about the nature of her family culture. Now, think back to
Amira in Case Study 6.7 in Chapter 6. Amira, like Rubina, is a 22-
year-old Pakistani American. She also struggles with participation in
multiple cultures, but her struggles are not identical to those of
Rubina. This is an important reminder that we must avoid making
assumptions about people based on their ethnicity or any other single
identifier. We must allow people to tell their own stories of cultural
harmony and conflict. Social workers are often called on to intervene
in internal cultural struggles, whether they occur in a family, a small
group, a community, an organization, or even a larger society. In the
United States, political culture often includes “culture wars,” which
can develop over such issues as guns, gender, sexual identity, race,
religion, the environment, who can marry, abortion, and the purposes
of government.

It is important to remember that humans are not the only animals who
create culture (Viciana, 2021; Whitten, 2021). Animal culture has
been the subject of study for a few decades. Viciana (2021) suggests
three traits of animal culture: (1) it is a result of a specific mechanism
of social learning, (2) it is distributed in a population, and (3) it has
some stability or permanence in time. In this chapter, however, our
focus will be on human cultures.

Music is a cultural creation.

©iStockPhoto.com/Lukassek

Theories of Culture
As noted earlier, culture has been studied from a number of
disciplinary perspectives. The two main streams are the humanities
approach and the social science approach. In the humanities
approach, and in common usage, culture is associated with the fine
and performing arts and with “serious” literature. The social science
approach to culture began to be developed during the 19th century
when the new disciplines of anthropology and sociology began to use
the word culture in a different way than traditionally used in the
humanities. In this new way of thinking, culture refers to a society’s
total way of life, and social scientists say, “We are doing culture all the
time.” To begin to think about how we are all doing culture all the
time, consider some of the cultural creations presented in Figure 8.1.
In recent times, cultural scholars from the humanities and social
science approaches have borrowed ideas from each other.
Description

Figure 8.1 Cultural Creations

Over time, social scientists have developed almost as many theories

of culture as definitions of culture. In this section, we use a simple
classification of theories of culture presented by anthropologist
William A. Haviland and colleagues (2017): materialist perspective,
mentalist perspective, and other perspectives. The intent is not to
provide an exhaustive understanding of culture theory but instead to
provide a window on some of the main themes in contemporary
culture theory.

Before beginning that discussion, we call your attention to the

discussion in Chapter 1 of this book about controversies surrounding
assumptions undergirding social science theory, particularly the
competing assumptions about whether human behavior is determined
by forces beyond the control of the person (determinism) or people
are free, proactive agents in the creation of their behavior
(voluntarism). That controversy shows up in theorizing about culture
in the form of questions about human agency in the creation,
maintenance, and changing of cultures. Human agency refers to the
capacity of individuals to act independently and to make their own
free choices. Some theories of culture assume that humans have
agency in creating, maintaining, and changing culture, while other
theories assume little to no human agency in relation to culture.

Materialist Perspective

The materialist perspective places primary emphasis on the role of

the environment, technology, and economy in creating, maintaining,
and changing culture. Ideas, values, beliefs, and cultural products are
seen as adaptations to environmental, technological, and economic
conditions. Still today, the best-known theory in the materialist
perspective is Marxism, which proposes that culture is driven by the
economic organization of a society. Not only material things such as
food, clothing, lodging, and communication technology but also
consciousness—what we are aware of and how we think and feel
about things—are cultural by-products of the economic system. For
example, we might ask if Rubina’s parents’ views of the hijab are
based, in some part, on their struggles in the economic system. In
this perspective, cultural change is the result of growing conflict
between economic classes. As noted in Chapter 2, neo-Marxist
critical theory focuses on the culture industry that mass produces
popular culture products such as movies, music, television shows,
and social media, arguing that products of the culture industry
manipulate humans into passivity (Lash & Lury, 2007; Scannell,
2007). In the view of Marxism and critical theory, human agency is
quite limited.

Whereas Marxism focuses on the economic institution and neo-

Marxist critical theory on the culture industry as the driving force of
culture, cultural ecology focuses on the impact of the physical
environment on culture. Cultural ecologists are interested in how
humans adapt their cultures to the natural environment and how
humans modify nature to suit their needs and desires. They are
particularly interested in the relationship of the physical environment
to the cultures of marginalized and vulnerable groups of people. They
are also concerned about threatened landscapes, and this has led
many cultural ecologists into environmental activism. As you can see,
unlike Marxism and neo-Marxist critical theory, cultural ecology is
interested in human agency and the human capacity to manipulate
the physical environment in the development of culture (Antoinette &
WinklerPrins, 2010; FitzGibbon & Tsioulakis, 2022).

Mentalist Perspective

The mentalist perspective sees humans as creating, maintaining, and

changing culture on the basis of their beliefs, values, language, and
symbolic representations. Culture is understood by understanding
how participants think, feel, and speak. Interpretive anthropology
views humans mostly as “symbolizing, conceptualizing, and meaning-
seeking” creatures (Geertz, 1973, p. 5). Culture should be understood
by peeling back layer upon layer of socially constructed meaning. In
the case of Rubina, what does it mean to her to be Brown, and what
does it mean to others? How did these meanings develop over time?
Also, what does the hijab mean to Rubina, her parents, and the
people she encounters on the street? How did these meanings
develop over time? There is much room for human agency in this
perspective. Culturalism emphasizes the day-to-day aspects of
culture and the active, creative way that people participate in
constructing shared meaning and shared meaningful practices. In this
view, cultural meaning unfolds over time as people interact (Barker &
Jane, 2016). This perspective puts strong emphasis on the role of
human agency in constructing culture. Structuralism examines culture
as a product of the human brain’s mental structure. More specifically,
it proposes that the structure of human cognition leads us to
conceptualize the world in terms of binary opposites (e.g., bad–good,
black–white, day–night, cold–hot, female–male, life–death, us–them).
It suggests that we understand what we are in large part by thinking
about what we are not (Layton, 2006). There is limited room for
human agency from this perspective. Semiotics is the study of
meaning making through signs and symbols. These theoreticians and
researchers study the way language is used as code for values and
ideas, but they also study other types of signs and symbols, such as
war memorials, Internet memes, food, and clothing items such as the
hijab (Barker & Jane, 2016; Chandler, 2022; Layton, 2006). They are
interested in what can be expressed and who can express it, leaving
some room for human agency but more room for some culture
participants than for others.

Poststructuralism and postmodernism developed as critiques of

structuralism but also serve as critiques of Marxism and neo-
Marxism. Poststructuralism rejects the idea of an underlying stable
structure of culture, particularly the idea of meaning making through
fixed binary opposites. For example, it is in agreement with those who
propose gender as a nonbinary attribute. These theorists see
meaning as unstable and in process; attributes like Black identity or
femininity are not fixed attributes but descriptions in language that
have come to count as truth. They are productions of culture that
developed in particular times and places (Barker & Jane, 2016).
Postmodernism, like poststructuralism, argues that truth and meaning
are perspectival; the development of ideas, knowledge, symbols, and
values take place from particular perspectives that come from living in
particular times and places. There are always many possible
conceptual schemes from which judgment of truth and value can be
made. The human condition is fragmented, ambiguous, and uncertain
(Barker & Jane, 2016). Although poststructuralism and
postmodernism seem to leave room for human agency, theorists in
this tradition do not emphasize human agency.

Other Theoretical Perspectives

Some culture scholars (anthropologists, sociologists, psychologists,
political scientists, economists, and social workers) have been
particularly interested in finding a way of thinking about culture that
allows for human agency while also recognizing the constraints that
culture puts on it. They present a practice orientation (Bourdieu,
1977; Giddens, 1979; Ortner, 1989, 1996, 2006) that seeks to explain
what people do as thinking, intentionally acting persons who face the
impact of history and the constraints of structures embedded in
society and culture. It asks how social systems shape, guide, and
direct people’s values, beliefs, and behavior. But it also asks how
people, as human actors or agents, perpetuate or change the
cultures of social systems.

History, social structure, and human agency are key elements in a

practice orientation. History is made by people, but it is made within
the constraints of the social, economic, political, physical, and
biological systems in which people are living. To understand human
diversity, especially as it relates to oppression, exploitation, and
subjugation, we must listen to the memories of both powerful and
marginalized observers. We must listen to clients as much as to
social workers. Colonialism theories of culture argue that to
understand contemporary culture and cultural differences, we must
understand the history of the colonization process that started in the
late 18th century. It is a process by which European nations and the
United States occupied and dominated other nations, constructing
meaning about racial differences and racial hierarchies to control
colonized people and sustain Western privilege and power (Wilson &
Azambuja, 2019). Colonized people were cast as culturally inferior
“others,” and cultural studies were undertaken using Western
knowledge systems to understand “the other.” Colonial conceptions of
race and ethnicity continue to influence cultural understandings today.

Structure refers to the ordered forms and systems of human behavior

existing in public life (e.g., neoliberal capitalism, government, religion,
mass media, family, public education). We carry forth meanings,
values, and beliefs through social, economic, and political practices in
our everyday personal lives and the institutions in which we
participate. Social structure and social institutions are the focus of
Chapter 9 in this book. We reproduce structures when we assume
the rightness of the values, beliefs, and meaning that undergird them
and see no need to change them.

As suggested earlier, human agency recognizes people as capable of

exercising their will to shape their lives. Thus, although racism and
religious bias are structured into society, they are not so completely
dominant over Rubina that she has no room for meaningful self-
expression about issues such as with whom she associates and what
she wears. Human agency is a major source of hope and motivation
for social workers who encounter people, organizations, and systems
that seem unable to break away from the constraints of history and
culture. However, no individual or group is a fully free agent. All are
constrained by biology and by external factors such as the climate,
natural resources, and existing social institutions—although we may
be able to modify some of these constraints through technology.

Critical Thinking Questions 8.1

Of what cultures are you a part? How important is the culture industry
in shaping your values, beliefs, and behaviors? Explain. How much
human agency do you think you have to take charge of your own life?
How much human agency do you think Rubina has? What factors
make a difference in how much human agency people have?

Major Concepts in the Study of Culture

As noted earlier, contemporary understandings of culture include

numerous themes, with different scholars focusing on different
concepts. In this section, we consider some of the major concepts
used in the study of culture across disciplines and theoretical
perspectives. We have already taken a look at material culture, which
includes physical objects, resources, and spaces that people use to
define their culture. Other important concepts in the study of culture
are values, beliefs, symbols, language, norms, subculture and
counterculture, ideal culture versus real culture, and ethnocentrism
and cultural relativism.
Values

Cultures promote and nurture a core set of values , beliefs about

what is important or unimportant, desirable or undesirable, and right
or wrong. They reflect the basic ideals and shared cultural standards
of a group or society. One of the most frequently noted ways to
compare and contrast the values of different cultures at the societal
level is to think in terms of individualist culture versus collectivist
culture. In this view, an individualist culture is made up of people who
are responsible to and for themselves and whose individual
achievement is the overriding goal. The United States and western
European countries are often used as examples of individualist
societies, with the United States often considered to be the most
individualistic society in the world. A collectivist culture is made up of
people who consider the group to be most important, with an
emphasis on traditions, cooperation, and a sharing of common goals.
Societies that are typically noted to be collectivist cultures include
most of Asia, Africa, and South America. Some researchers have
noted that components of both individualist and collectivist values
exist in most cultures, and even within individuals (Gardiner, 2018),
but it is also probably true that most cultures tend to tilt one way or
the other. We can see that Rubina’s parents value a collectivist
approach, at least for the workings of their family, and Rubina, at
least in this phase of her life, has been influenced by the individualist
values of the wider U.S. culture.

Cultural values are not equally shared by all participants, and in any
country in the world looking at a daily newspaper or reading
comments on social media quickly demonstrates struggles over
cultural values. For example, in the United States and around the
world, there is a cultural debate about the proper prioritization of
values of environmental protection versus economic growth. Often,
cultural life includes dualisms of competing values, two things that are
both valued but in competition with each other—perhaps people
value individualism and collectivism or environmental protection and
economic growth. In the United States, we value both privacy and
security, and since September 11, 2011, we have had many debates
about the proper balance of these two values. Policies that were
made to provide security—such as governmental surveillance of
telephone and Internet communications—have been criticized for
their invasion of privacy. Similarly, in social work we value both
individual freedom and the common good. In individual practice
situations, these two values are in competition when one person’s
individual freedom is harmful to another individual or group of
individuals, for example, parents’ right to parent as they choose
versus the rights of a child to be protected from abusive or neglectful
parenting. In the situation of competing values, we always have to
consider how to balance them in specific situations.

Beliefs

Beliefs are cultural conventions about what is true and false, ideas
held and used to explain the world and how things work. Cultural
beliefs are established over time, come from sacred scriptures and
shared experiences, and are passed on by people with authority,
such as parents, teachers, and religious leaders. Beliefs are based
on values and influence the choices we make. “Education is good” is
an example of a belief held in some cultures. Guest (2020) writes
about mental maps of reality as one type of belief system. Mental
maps of reality are cultural classifications of the categories of people
and things that exist and the assignment of meaning to those
classifications. Later in the chapter, we will examine classifications
based on race, ethnicity, sexuality, social class, and disability, and
consider how these classifications have been used to develop
systems of power.

Ideology is akin to values but is used to mean a set of shared beliefs

that explains the social world and guides people’s actions, especially
in relation to economic and political theory and policy. An ideology
consists of cultural beliefs and symbols that support the interests of
specific groups (Scupin, 2021). Here is an example. In the book
American Nations: A History of the Eleven Rival Regional Cultures of
North America, Colin Woodard (2011) argues that the United States
has been a deeply divided country from the days the original colonies
were settled by people from different regions of the British Isles, as
well as from France, the Netherlands, and Spain. He proposes that
this pattern of settlement resulted in 11 different regional cultures:
“Some championed individualism, others utopian social reform. Some
believed themselves guided by divine purpose, others championed
freedom of conscience and inquiry. Some embraced an Anglo-Saxon
Protestant identity, others ethnic and religious pluralism. Some valued
equality and democratic participation, others deference to a traditional
aristocratic order” (p. 2). Over time, some people migrated and new
waves of immigration happened, but Woodard argues that strong
traces of the 11 regional cultures persisted. The 11 cultures have
formed shifting alliances from the Revolutionary War to the Civil War
to the current time, always struggling to gain control of the ideology
and institutions of the federal government.

Woodard proposes that since the Civil War, these 11 regional cultures
have coalesced into two primary competing political ideologies: one
side pushing for a large role for the federal government in securing
social and economic justice at home and opposing military
intervention abroad while the other side pushes for a small role for
federal government in domestic policy and a large military presence
abroad. Other issues get woven into these two ideologies from time
to time, but their basic core has not changed since the Civil War. One
issue woven into political ideologies in recent years is anti-immigrant
and anti-Muslim sentiment. This is an ideology that causes pain to
Rubina, her family, and her peers in the MSA. Woodard’s book
presents incisive analysis of how attitudes toward issues such as
poverty policy, racial injustice, and immigration have been shaped
over time.

Symbols

Cultures include complex systems of symbols, and much of human

behavior involves symbols. A symbol , simply stated, is something
that stands for something else. It can be verbal (language), an artifact
(a gun), or nonverbal behavior (standing for the national anthem). We
are often not aware that we are expressing ourselves symbolically,
because “much symbolic communication is nonverbal, action-based,
and unconscious” (Guest, 2020, p. 41). Let’s consider Rubina’s
recent use of the hijab. She says it symbolizes her relationship with
God, but for her parents it is a symbol of danger. In recent years,
researchers in Muslim countries have studied the meaning of hijab
among Muslim women. Researchers in non-Muslim countries have
studied the meaning of hijab to Muslim women as well as to non-
Muslim residents of the country. What is clear from the research is
that the hijab symbolizes different things to different people but the
socio-political-religious culture also influences the symbolism.

Let’s look first at Muslim countries. The symbolism may differ

depending on whether wearing of hijab is mandatory for women, as it
is in Iran and Afghanistan. While non-Muslims may not recognize
distinctions among different styles of hijabs, such distinctions are
often made in Muslim countries, and research in Muslim countries
recognizes different meanings attached to different styles of hijabs.
Ni’mah (2021) studied the political meaning of different hijab styles of
women political candidates in Indonesia, focusing on three different
styles. The hijab sharia is made from thick, plain cloth and covers all
of the hair, arms, chest, and neck. The hijab modis is a fashionable
headscarf with features such as embroidery and other types of
decorations. The kerudung is a semitransparent cloth that is placed
loosely on the head so that part of the hair and neck can be seen.
Ni’mah found that the women politicians in Indonesia used different
styles of hijab as a symbolic means of communicating with voters
about the type of Muslim they are. In Iran, where wearing hijab is
mandatory for women, women wear hijab in different ways. Some
adhere to strict guidelines to cover their hair and body while others
wear a less modest style of hijab as a form of resistance against the
mandate, a practice known as bad-hijabi (Bayat & Hodges, 2022).
According to the government of Iran, hijab preserves the country’s
moral fiber. The symbolism of the hijab in Iran can only be understood
in the context of mandatory hijab.

In non-Muslim countries, the hijab is sometimes politicized by the

dominant culture. In France, the hijab has been considered a threat to
a secular way of life (Scott, 2009). In the United States and other
Western countries, non-Muslims often see the hijab as a symbol that
Muslim women are sexually, physically, and socially oppressed and in
need of emancipation. The hijab also symbolizes the dangerous
“other” to some non-Muslims (Galonnier, 2015; Karaman & Christian,
2022).

What does the hijab mean to Muslim women in non-Muslim

countries? Karaman and Christian (2022) point out that Muslims in
the United States come from very diverse cultural, racial, and ethnic
backgrounds with 65 countries of origin and suggest that
understanding the meaning of hijab to Muslim women in the United
States requires an intersectional approach. In their study of 34
Muslim women college students in a southern state in the United
States, they identified several different meanings of hijab. A majority
of the hijab-wearing research respondents view the hijab as a
religious requirement and a reminder of God, but two women with this
view of hijab do not wear hijab because of the way it “others” them.
The non-hijab-wearing women report that wearing the hijab does not
make you a better Muslim. For some of the hijab-wearing women,
wearing hijab is a way of expressing identity and a way to deal with
feelings of exclusion. Two of the hijab-wearing women report that
wearing hijab is a feminist strategy, a way to challenge American
beauty standards and to resist consumerism and capitalist society.
McGinty (2014) found that for one woman in her study of five
Palestinian American Muslim women living in Milwaukee, Wisconsin,
wearing the hijab is not a religious practice but a way to symbolize
political solidarity and political protest against Islamophobia. Some
women note a desire to be more visible to let other people know that
“there are Muslims in Milwaukee” (McGinty, 2014, p. 694) and to
diminish the stigma of being Muslim. One of the women chooses not
to wear the hijab because she is highly critical of the local Muslim
community’s pressure to wear it and feels that they stigmatize women
who do not wear it. In a study of 25 Muslim women refugees in
Germany, Paz and Kook (2021) found three themes regarding the
decision to wear the hijab or not: (1) racism, violence, and exclusion;
(2) empowerment and liberation; and (3) identity preservation and
community belonging. These different meanings of hijab to Muslim
women do indicate a need for an intersectional approach to the
question of the symbolization of the hijab to Muslim women.
Language

One important aspect of symbolic culture is language, the system of

words or signs that people use to express thoughts and feelings to
each other. All animals communicate in some fashion. Human
language is found in three primary forms: spoken, written, and
nonverbal. Human brains are wired at birth to learn any spoken
language to which they are exposed, but as brain synapses are
pruned over time to improve brain efficiency the capacity to learn new
languages is diminished. Learning to speak a new language becomes
a major challenge for people migrating across national lines. This is
especially challenging for people who migrate as adults; migrating
adults are usually capable of thinking complexly but not able to
communicate their complex thoughts in their new language. Written
language allows humans to store information and ideas and produce
a cultural history; it also allows communication over wide distances.
Nonverbal language consists of gestures, facial expressions, body
postures, and vocal elements such as rate, volume, and intonation.
One might imagine that even when Rubina does not challenge her
parents’ expectations verbally, she might be communicating her
dissatisfaction with a combination of facial expressions, body
postures, and vocal elements. American Sign Language is an
example of a complex language built entirely on gestures. It allows for
people who are mute or hearing challenged to communicate in face-
to-face interactions; text messaging technologies have also extended
the ability for people who are mute or hearing challenged to
communicate with the written language of their choice.

According to Ballantine and colleagues (2020), there are more than

7,100 spoken languages in the world, with 40% of the world’s
population speaking one of the eight most common languages as
their first language. The five most common first languages in the
world are Chinese (1.3 billion speakers), Spanish (437 million
speakers), English (372 million speakers), Arabic (295 million
speakers), and Hindi (260 million speakers). English is the most
common Internet language around the world, followed by Chinese,
Spanish, and Arabic. Linguistic anthropologists report that tens of
thousands of languages have become extinct throughout history, a
process that occurred as both ancient and recent empires forced
language on conquered people (Guest, 2020, Scupin, 2021). Some
Indigenous groups are working to reclaim their native languages,
sometimes with the assistance of computer technology
(Kaleimamoowahinekapu Galla, 2018; LaFontaine, 2022). Some
linguistic anthropologists recommend bilingualism for Indigenous
people as a way to help perseve their culture (Scupin, 2021). In many
parts of the world, people routinely learn two or more languages to
facilitate communication for different purposes. The United States
and Japan are among the rare monolingual countries (Scupin, 2021).

Linguistic anthropologists have been interested in the connections

between language, thought, and culture (see Guest, 2020; Scupin,
2021). They ask the question, “Do vocabularies and classifictions of
reality embedded in a language affect the way its speakers think and
see the world?” (Guest, 2020, p. 116). Research indicates that
languages are deeply embedded in cultures, and language provides
concepts that influence thinking, social perceptions, and the way we
see the world. Sociolinguists are interested in the ways in which
culture shapes language and language shapes culture in an ongoing
process. Cultures create language and then the language provides
ways of thinking and behaving in relation to aspects of culture. We
saw an example of this in Chapter 7 of this book. Indigenous botanist
Robin Wall Kimmerer (2013) notes that in the English language if you
are a human you are assigned a gendered pronoun, but if you are not
human you are assigned the pronoun “it.” You are either a human or
a thing. Most Indigenous languages do not make that grammatical
distinction between humans and other elements of nature. Kimmerer
suggests that this distinction between humans and things (its)
elevates humans over nature. This is an example of how language
creates a system of power, humans over other natural beings.
Language creates and enforces but also contests and resists
systems of power (Baugh, 2020). We will look at that issue again in
the discussion of gender later in the chapter.

Language, however, is dynamic, flexible, and fluid. New words are

created and added to a culture’s language as the culture evolves and
new cultural products are developed. In September 2022, Merriam-
Webster announced the addition of 370 new words to its English
dictionary. The new words include dumbphone (a cell phone that
does not include advanced software features), greenwash (to make
something appear to be more environmentally friendly, or less
environmentally damaging than it really is), virtue signaling (the act or
practice of conspicuously displaying one’s awareness of and
attentiveness to political issues, matters of social and racial justice,
etc.), dawn chorus (the singing of wild birds that closely precedes and
follows sunrise especially in spring and summer), gift economy (a
system in which goods and services are given freely between people
rather than sold or bartered), and booster dose (a supplementary
dose of a therapeutic agent designed to increase the effectiveness of
one or more previously administered doses) (Merriam-Webster,
2022). Merriam-Webster (2022) also announced that gaslighting
(psychological manipulation of a person usually over an extended
period of time that causes the victim to question the validity of their
own thoughts, perception of reality, or memories) was the English
word of the year.

Norms

Sociologists have been particularly interested in norms , the culturally

defined rules of behavior that guide people in what they are to do or
not to do. Many norms are informal whereas others have been
formalized in laws. The expectation that we stay to the right on the
metro elevator is an informal norm whereas the expectation that we
drive below a certain speed limit is a norm that has been codified into
law. Sociologists make a distinction between norms that are folkways
and norms that are mores. Folkways are norms about desirable
behaviors that are relatively unimportant and not strictly enforced.
Speaking quietly in the library or wearing the latest fashion may be
expected behavior, but the expectations are not usually enforced.
Mores, on the other hand, are considered more important norms,
often hold moral significance in the culture, and may be punished if
violated. Often it is not clear whether particular behaviors are
folkways or mores, and that may vary from setting to setting. For
example, wearing the hijab might be considered a folkway in some
Muslim groups and a more in other Muslim groups. Likewise, some
people in the United States consider standing with hand over heart
when the national anthem is played to be a folkway whereas other
people consider it to be a more.

Norms are reinforced through sanctions—rewards (positive

sanctions) for compliance and punishment (negative sanctions) for
noncompliance. Sanctions can be informal or formal. They can range
from a smile to reinforce compliance or a frown to challenge
noncompliance, withheld allowances, fines for parking violations,
failing grades or expulsion for plagiarism, or imprisonment or even
the death penalty for murder. Families and societies struggle to
identify the most effective sanctions for encouraging compliance with
cultural norms. We know that Rubina’s parents expect her to always
let them know where she is going and to follow their rules
unconditionally. When she challenges these expectations, one way
they try to punish her resistance is to accuse her of trying to act
American, an accusation that is unsettling to her because it reinforces
her confusion about her cultural identity. Another way they try to
punish her is to tell her that she is displeasing Allah. Cultural norms
are often derived from religion, but as Rubina is finding, not all
members of a religious group draw the same norms from the religion.

Studies have found that some cultural groups favor stronger social
norms and stronger punishment for norm violation than other cultural
groups. Cultural tightness-looseness (CTL), an emerging theoretical
framework, proposes that conditions such as resource scarcity, a
history of territorial conflict, and other environment threats can lead to
tight cultures with strong norms and strong punishments for norm
violation, and with a high value for social cohesion and stability.
People living in tight cultures have been found to be more concerned
about norm violation, conformity, and social cohesion than people
living in loose cultures where norms are weaker and there is a high
tolerance for deviant behavior (Lee et al., 2022).

Subcultures and Countercultures

Within most cultures, there are subcultures that involve groups of
people who accept much of the dominant culture but distinguish
themselves by one or more culturally significant characteristics. For
example, the Muslim Student Association (MSA) to which Rubina
belongs is a subculture of the larger culture of the university that she
attends. The MSA members probably share many of the values and
norms of the larger university culture but are distinguished by their
adherence to the religious tenets of Islam and their desire to build a
Muslim religious community on campus. No doubt, Rubina’s
university has many other subcultures, such as other religious
subcultures, a subculture of environmental activists, racial and ethnic
subcultures, subcultures formed around particular music genres, a
theater subculture, subcultures of different athletic activities, perhaps
a Deaf subculture, and many more. In the United States, social class
groups often form subcultures; the super wealthy have networks,
exclusive clubs, and a culture of opulence that differs a great deal
from the cultures of the middle and lower classes. A give-and-take
exists among subcultures and between subcultures and the larger
culture, with subcultures contributing to and influencing each other
and the larger culture. When conflict with the larger culture becomes
serious, a subculture can become a counterculture.

A counterculture not only differs in significant ways from the dominant

culture but also rejects the norms and values of the larger culture. It
may openly act in opposition to the dominant culture, but there are
several ways to do this. Like the Old Order of Amish of Pennsylvania
and Ohio, which reject the dominant U.S. culture definition of
success, countercultures may withdraw and establish their own
cultural conclaves with their own rules. Another way to act in
opposition to dominant culture is to engage in violent sabotage of it.
For example, white supremacist groups reject the larger societal
principles of democratic pluralism and may engage in violent behavior
against it. In the past, they engaged in lynchings, but today they are
more likely to participate in a variety of types of intimidation, including
hanging nooses in prominent and symbolic places or belligerently
challenging an immigrant’s right to live in the United States.
Computer hackers are another contemporary example of a
counterculture. Some hackers are simply having fun developing
technical skills, but others are engaged in hacking for the purpose of
subverting authority, destroying the Internet, or influencing national
elections. Of course, assertive countercultures are not always a
negative force, and some challenge the unfair treatment of groups
that are marginalized and denied power in society. If Rubina’s
university were to develop a strong anti-Muslim culture or policies that
were repressive to Muslim students, it is possible that the MSA would
transition from subculture to counterculture.

Ideal Culture Versus Real Culture

Arlene Skolnick (1997) wrote that “Americans have still not come to
terms with the gap between the way we think our families ought to be
and the complex, often messy realities of our lives” (p. 86). We could
substitute the word culture for families and have a statement that
reflects some of the tensions in cultural life. Sociologists make a
distinction between ideal culture, which consists of the values and
practices that are considered desirable, and real culture, which is
what people actually think and do. For example, a major U.S. value is
democracy, but average voter participation in the United States lags
behind that of many other wealthy countries. There was a surge of
voter turnout in the 2020 general election in the United States, with
62.8% of eligible voters turning out to vote. And still, in a study of
voting paraticpation in 50 mostly high-income countries, the United
States ranked 31st. Voting is compulsory in 24 countries; in many
countries, the national government automatically registers eligible
voters (DeSilver, 2022). Another important U.S. value is equal
opportunity to quality education, and yet, in reality, the inequalities in
our educational institutions are important drivers of growing social
and economic inequalities.

Ethnocentrism and Cultural Relativism

As globalization intensifies, the world’s people are more and more

likely to encounter the diversity of global cultures. How we respond to
these cross-cultural experiences may well determine the survival of
planet Earth. Culture is learned over time from people we care about,
and most people tend to think their culture is the best. Ethnocentrism
is the belief that one’s own cultural way of life is normal, natural, and
even superior to other cultural ways of life; other cultures are judged
by the standards of one’s own culture. Most societies instill some
degree of ethnocentrism in their members as a way to hold the
culture together. Belief in one’s own culture provides a sense of pride
and identity, and it promotes loyalty, unity, and conformity.
Ethnocentrism can also be a barrier to cross-cultural understanding
and lead to misunderstandings between people. It can encourage
hostility, racism, war, and even genocide. Rubina worries about the
anti-Muslim ethnocentrism in the United States and is concerned
about what she reads about hate crimes against Muslims and Brown
people in general.

Social scientists have challenged the strong human tendency toward

ethnocentrism by suggesting an approach of cultural relativism.
Cultural relativism calls for suspending judgment of other people’s
cultural values and practices in order to understand them in their own
cultural context through the eyes of their own members, avoiding
judging one culture by the standards of another culture. Cultural
relativism does not require that we accept or agree with all beliefs
and practices of a particular cultural group, but it allows us to try to
understand beliefs and practices in the social and cultural contexts in
which they developed and are maintained (Muyskens, 2022). It is a
very important approach for social workers to learn to incorporate in
practice at every system level. It requires us to approach our social
work practice with cultural humility , recognizing that culture is an
important part of human behavior, that people live within many
different cultures, and that we will never understand other cultures as
well as the people who live within them. It also requires that we be
self-reflective about our own cultural experiences and interested in
and open to how other people understand their own cultural identities.
Whatever we may think of Muslim women wearing a hijab, we would
want to approach Rubina by trying to understand what it means to her
in her particular social and cultural context. One way to be helpful to
Rubina in her current emotional struggles would be to open
communications to help her and her parents to put each other in
cultural context. Rubina could learn more about what her parents’ life
was like in Pakistan, why they decided to immigrate to the United
States, and how they have tried to adapt to a very different culture
than the one they left. Her parents could learn more about what it is
like to grow up with one culture at home and another in her life
outside the family.

For the past decade, neuroscientists have been studying the neural
basis of prejudice (attitudes and emotional responses to the members
of a social group) and stereotyping (generalized characteristics
ascribed to a social group) (see Amodio, 2014; Cozolino, 2014;
Gorman & Gorman, 2019; Harford, 2020). They have found that both
prejudice and stereotyping are complex cognitive processes that are
supported by a network of neural structures, but different networks
may be involved in these two cognitive processes. The amygdala
appears to be the main brain structure involved in prejudice. The
amygdala is the center for rapid appraisal of stimuli and mobilization
of response to threat. It receives direct information from all sensory
organs, allowing it to respond very rapidly to perceived social threat.
The amygdala is so fast that it responds in advance of a conscious
awareness of danger, and prejudice is mostly an unconscious
process known as implicit bias. Research indicates that the amygdala
is conditioned to respond with fear to members of out-groups (groups
to which we do not belong), especially if there is little or no history of
interaction with those out-groups or if a person’s prior history has
resulted in seeing difference as threatening. Research also indicates
that the amygdala can become conditioned to perceive threat in
situations in which a person is engaged in interaction with members
of out-groups and worries about appearing prejudiced in the eyes of
others (Amodio, 2014). Shame is likely to result in denial and inhibit
motivation to become involved with groups of people who are
different from us (Stevens & Abernethy, 2018). Other neural
structures that have been identified to play a role in prejudice include
the orbital frontal cortex, insula, striatum, medial prefrontal cortex,
cerebellum, and precentral gyrus (Saarinen et al., 2021). The neural
structures found to be involved in stereotyping include the temporal
lobe, medial prefrontal cortex, and lateral prefrontal cortex (Amodio,
2014).
Neuroscientist Robert Sapolsky (2017) cites research that finds that
our brains are especially sensitive to skin color, but there is
tremendous variation in the strength of the reaction. The essence of
this research is that fear conditioning occurs much faster for other-
race faces than for same-race faces. People tend to judge neutral
other-race faces as being angrier than neutral same-race faces. In
addition, people tend to remember same-race faces better than other-
race faces and to show more empathy for same-race than other-race
faces when shown videos of people being poked with needles.
People who show more implicit racial bias on implicit bias tests are
more likely to show more amygdala activation when encountering
other-race people.

Cozolino (2014) suggests that prejudice is an expression of social

phobia, and indeed, xenophobia is a term used to describe fear and
hatred of strangers or foreigners or of anything that is strange or
foreign. Although researchers have had some success in reducing
behavioral and physiological expressions of implicit bias in the
laboratory, implicit bias is very difficult to change in a cultural milieu
that constantly reinforces the bias. For example, it is very difficult to
extinguish racial bias if the culture constantly presents racial
prejudice and stereotypes. It is difficult to extinguish anti-Muslim
sentiment if it is constantly expressed in the media, the family, or the
political institution. Neuroscience research suggests that the best
interventions for reducing prejudice include increasing people’s
awareness of the human tendency for implicit bias, helping them to
identify cues that a threat response is occurring in their cross-cultural
interactions, and helping them to prepare preplanned ways of dealing
with situations where implicit bias is aroused (for example, a plan
such as “I will slow down and respond more carefully”). The idea of
slowing down is important because the amygdala responds about a
half second ahead of the conscious processes of attention and
awareness that can put the brakes on amygdala activation and avoid
what is often called an “amygdala hijack,” a quick reaction that has
negative consequences (Fitzduff, 2021). Over time, activities to get
cognitive control over prejudiced and stereotypical attitudes and
behavior can become habitual. As social workers, we must engage in
an ongoing process of recognizing and examining our implicit biases,
because they can seriously inhibit our effectiveness. We can also
help people recognize their own implicit biases and find ways to
minimize them.

Critical Thinking Questions 8.2

Which cultures are you a part of? What are three important values
and three important norms of each of these cultures? Are there any
conflicts in values and norms across the different cultures in which
you participate? Explain. If you were to be Rubina’s social worker,
what value and norm conflicts might come up in your work with her?

Culture and Power

After many years of ignoring the connections between culture and

power, culture scholars have been interested in how the dynamics of
power are embedded in culture for several decades now (Guest,
2020). Power can be thought of as the ability to act in a chosen way
and to direct or influence the behavior of others. As suggested earlier,
although we often think of culture as composed of similar people who
equally share norms and values, in reality people in a given culture
are usually diverse and their relationships are complicated by power
dynamics within the culture. Some people are able to participate
more fully in culture than other people. Some people are drawn into
the center of the culture and granted resources and privileges. Other
people are ignored or marginalized in the granting of resources and
privileges. Some are even annihilated. The power arrangements of a
culture are supported by cultural values, ideologies, and norms.
Culturally instilled knowledge and attitudes lead people to accept
some power arrangements and reject others.

Cultural understanding of who should be powerful and who should be

powerless has deep historical roots. And history itself is usually told
from the perspective of the people who have the power to construct it.
In recent years, there has been an ongoing struggle in the United
States over content about race, sex, gender, and religion in public
school curricula. School board meetings have become contentious,
with some parents demanding the power to control school curricula
(Talbot, 2021).

Sometimes coercion or physical force is used to ensure compliance

with cultural norms. Most often, however, coercion or force is not
necessary. Instead, cultural power is embedded in the media,
schools, and religion to influence the understanding of what is
natural, normal, and even possible. This creates a cultural condition
called hegemony , the ability of a dominant group to obtain consent
and agreement to cultural values and norms without the use or threat
of force. With this hegemony of values and norms, some thoughts
and actions become unthinkable. People discipline their own behavior
to be in accord with what is considered normal, even when this runs
counter to their own personal interests.

Cultures create social institutions to promote and maintain their core

values. Chapter 9 examines how power is created and maintained in
major social institutions in the United States and globally. In addition,
in every culture, social identity groups get caught up in the dynamics
of cultural power. Those dynamics vary somewhat from culture to
culture, but some of the dynamics are almost universal. In this
section, we take a look at how several social identities are embedded
in cultural dynamics of power, including race, ethnicity, gender,
sexuality, social class, and disability.

Race

Rubina says that when she hears about hate crimes toward people of
color, she feels “Brown.” What does being Brown mean to her, and
why does she associate it with hate crimes toward people of color?
Her reaction is tied up in the concept of race, a category that has
been used for centuries to divide the human population and to stratify
it into superior and inferior groups. As noted in Chapter 2 in this book,
there is a historical relationship between colonialism and the social
construction of race. Race can be defined as a flawed system of
classification, with no biological basis, that uses certain perceived
physical characteristics to divide the human population into
supposedly discrete groups. Although the classification, historically,
was presumed to rest on genetic differences between groups,
contemporary studies of genetics reveal no biologically distinct
human groups. And, indeed, they find that there is more genetic
variation within racial groups than between racial groups (Healey &
Stepnick, 2020). Although other physical features have sometimes
been associated with racial categories, skin color is the prominent
physical attribute used to distinguish race. And yet humans come in
many hues that cannot be divided into discrete groups based on
color. Over time, racial categorizing has used a complex mix of skin
color, national origin, and religion. In regular interactions, humans use
visible cues to make judgements about what they perceive to be
another person’s racial classification.

Racial categorizing happens all over the world, but it takes on

different meanings in different places. Social scientists trace the
origins of contemporary racial classification to the 1400s when people
of western Europe began to travel to Africa, Asia, and eventually
North and South America. As they traveled to, conquered, and
colonized new lands, they became more attentive to the physical
differences they encountered, especially differences in skin color
(Healey & Stepnick, 2020). From the beginning, the European
understanding of race was linked to ideas about inferior (conquered)
and superior (conquering). The western European
conquerors/colonizers were of light hue, and although they
encountered much variation in skin color hue, they thought of race in
binary terms of white (conqueror, superior) and not white (conquered,
inferior).

Although it takes different forms around the world, racialization—

assigning racial character to groups of people—has continued to be a
prominent method of classification in the postcolonial world.
Unrelated people are lumped together based on skin color and other
attributes, in the context of social, economic, and political systems of
inequality left in the wake of colonization. As workers migrate within
and between countries, new forms of racialization occur, but the
white/not white binary way of thinking about race continues to prevail
in the United States and Europe (Guest, 2020).
The U.S. racial system developed in the context of conquest and
seizure of land of an Indigenous people (not white), enslaved people
from Africa (not white), and importation of indentured servants from
Europe (white). An ideology of white supremacy prevailed, a belief
that non-whites were biologically different, intellectually inferior, and
less than human in a spiritual sense (see Smedley, 2011, for a
thorough discussion of the history of race in North America). White
supremacy was more than ideology in the early history of the United
States, however; it was also formalized in the political system.
Anthropologist Pem Buck (2001) documents some of the ways that
white economic elites formalized white privilege in early 1700s in
Virginia, and their motivation for doing so. The elites were confronted
with a situation in which poor landless whites were beginning to join
with African slaves against the European economic elites. To combat
this, the elites introduced a set of legal privileges that were reserved
for whites, such as the right to own a gun, livestock, and land; the
right to obtain freedom at the end of indenture; the right to discipline
Blacks; and eventually the right to vote. The intent of these legal
privileges was to drive a wedge between the European and African
laborers who had much in common.

The rule of hypodescent has been key to maintaining boundaries

between the races in the United States since the time of slavery.
Hypodescent is the tradition of assigning children of mixed-race
unions to the subordinate group. This is sometimes called the “one
drop of blood rule,” meaning that having any ancestor of a
subordinate group (e.g., Black) classifies you as belonging to that
race. The hypodescent rule was enacted into laws in many U.S.
states and even backed by the U.S. Supreme Court as late as 1982
(Guest, 2020). It is no longer enforced by law but is still widely
applied in U.S. culture. A notable contemporary example is the case
of Barack Obama, son of a white woman and Black man from Kenya,
raised by white grandparents, and considered to be the first Black
president of the United States.

Long-established patterns of unequal treatment based on race

persisted in the United States after the legal end of slavery. Jim Crow
segregation laws legally enforced boundaries between whites and
Blacks in the South—in housing, education, property ownership,
voting rights, and public services such as bathrooms, water fountains,
and public transportation. Although much has changed since these
earlier days, the basic outline of Black inequality and white
dominance has persisted, even in the face of resistance, protest, and
political activism. Perhaps no area of race relations is more explosive
than the relationship between the Black community and the criminal
justice system. In numerous studies, Blacks have reported being
treated less fairly and respectfully in their contacts with the police
than whites (see Epp et al., 2014; Voigt et al., 2017). One research
team of linguists used footage of body-worn cameras during routine
traffic stops to investigate that complaint. They found that officers
speak with consistently less respect when speaking with Black
community members during routine traffic stops than when speaking
with White community members (Voigt et al., 2017). This situation
was magnified on May 25, 2020, when George Floyd died when a
Mineapolis police officer kept his knee on Mr. Floyd’s neck for at least
eight minutes and 15 sections. His death sparked global protests and
it became clear that police brutality against people, especially men, of
color is not confined to the United States (Joseph-Salibury et al.,
2021). In their analysis of ethnographic interviews with 50 police
officers during ride-alongs in the western United States, Jones et al.
(2022) conclude that routine policing practices in the United States
serve to maintain spatial separation of white people and people of
color and to protect white space. They found that in white space,
people receive service-oriented policing and in Black space people
receive harsh and aggressive policing.

As groups other than western Europeans began to migrate to the

United States—groups from Asia and from eastern and southern
Europe—new questions were raised about who was white and who
was not. Nativists fought to preserve the racial purity of the nation’s
Anglo-Saxon heritage, and immigration laws were used to this end.
As they first entered the United States, groups as diverse as Chinese,
Irish, Italians, Greeks, and eastern Europeans were considered non-
white. In this way, racial classification began to include nationality as
well as skin color. A 1790 U.S. law limited the right to naturalization
(citizenship) to whites only (Fox, 2019). Religion was important also,
and nativists considered both Catholics and Jews to be non-white. In
recent years, many authors have noted that Muslims have now been
racialized in the United States and other countries. As the
immigration stream to the United States became more diverse, racial
categories continued to be created and contested. When collecting
information on race, the U.S. Census Bureau is required to adhere to
the 1997 Office of Management and Budget (OMB) standards on
race and ethnicity as presented in Table 8.3 . In 2000, for the first
time, individuals were presented with the option to self-identify with
more than one race. As you can see, given this classification system,
Rubina’s family, with Pakistani roots, would be classified as Asian.
The OMB acknowledges that this classification of race is not
scientific.

Table 8.3

Source: About the Topic of Race, U.S. Census Bureau, 2022

(https://www.census.gov/topics/population/race/about.html).
One question that has arisen in recent years is where people from the
Middle East fit. Before September 11, 2011, they were not considered
a separate race in the United States, and under current law, as
reported in Table 8.3, they are considered white. In October 2016,
after pressure from members with that cultural heritage, the OMB
proposed that “Middle Eastern and North African” be added as a new
racial category, but the Trump administration scrapped the plan for
the 2020 census (Eltohamy, 2019). In some news reports, this was
called a new race category, and in other news reports it was called a
new ethnic category. And, indeed, the OMB classification system
muddies the use of the terms race and ethnicity, as we will see in the
discussion of ethnicity in the next section. Just as sometimes
happened with groups from Central and South America in the past,
people of Middle Eastern heritage are now sometimes thought of as
neither Black nor white, but Brown. And Brown is a way that Rubina
—along with other people with South Asian heritage—sometimes
thinks of herself as she sorts out her cultural identity in a world where
white supremacist ideology is still strong.

Racism includes individual thoughts and actions and institutional

patterns and policies that create and maintain unequal access to
power, privilege, resources, and opportunities on the basis of
imagined racial differences. It may be expressed as either individual
or institutional. Individual racism is expressed through personal
prejudiced beliefs and discriminatory actions based on race.
Institutional racism, also called structural racism, includes the
structuring of racial inequality into social institutions, policies, and
systems. Police officers interacting with Black community members
with less respect than that afforded to White community members is
an example of institutional racism. In Chapter 7 The Physical
Environment, we saw how U.S. government bodies at all levels
created, enforced, and perpetuated race-based housing segregation
that persists today. The perpetuation of racial inequality rests on a
long-standing racial ideology that one race (white) is superior to
others.

It is important to note that whiteness is also stratified along class

lines, and not all people of European descent benefit equally from
white privilege. Poor whites are the target of hateful stereotypes,
promulgated by more affluent whites, and are often cut off from
educational and work opportunities. In particular, many have been
hurt by economic globalization, whereas affluent whites have
benefited. Their resentment has helped to fuel populist nationalist
political movements in the United States and Europe. Woodard
(2011) argues that elite whites try to avoid having less affluent whites
protest their lower status by keeping them afraid of non-whites.

Ethnicity

Rubina tells the social worker that she recently started practicing
Islam while navigating through cultural identity issues. When
speaking of cultural identity issues, she seems to be talking about
what is commonly understood as ethnicity. Ethnicity is a word we hear
a lot (e.g., ethnic food, ethnic music, ethnic community, ethnic
conflict), and it can be used to emphasize different aspects of social
life. Ethnicity is a sense of cultural, historical, and sometimes
ancestral connection to a group of people that is considered to be
distinct from people outside the group. In different times and places,
ethnicity may include a common history and ancestors, association
with a particular geographic territory, a shared language, a shared
religion, a sense of shared physical characteristics, and shared
cultural practices such as food, clothing, music, and architecture.
Rubina is currently finding religion to be helpful in navigating through
cultural identity issues. The U.S. Office of Management and Budget
focuses on a combination of language and national origin as the
distinguishing traits of ethnicity. It considers ethnicity to be a separate
identity from race and provides two ethnic categories: “Hispanic or
Latino” and “Not Hispanic or Latino” (U.S. Census Bureau, 2021).
Hispanic refers to coming from a country where Spanish is spoken,
and Latino refers to a person with national origins in Mexico, Central
America, or South America. As with race, the OMB acknowledges
that this is not a scientific way to categorize ethnicity. It seems that
our official ways of defining race and ethnicity are quite muddled at
the moment. Many other countries have a much more expansive list
of ethnic groups.
Ethnic identity is that part of personal identity that derives from one’s
sense of being a part of an ethnic group. Ethnicity is a more pressing
issue in day-to-day life for some people than for others. Research
indicates that in the United States people from ethnic minority and
immigrant backgrounds are more likely to have a strong ethnic
identity than are European American people or people who are from
the third generation of an immigrant family (Tsai & Fuligni, 2012).
(Note: Rubina’s parents are considered first-generation immigrants;
Rubina, who was born in the United States of immigrant parents, is
considered second generation; and any children Rubina might have
would be considered third generation.) Many European Americans
tend to see their ethnicity as the default position and think that it is
only “others” who have ethnicity. Much of the research on ethnic
identity has examined how ethnic identity develops in people from
ethnic minorities, looking at how they navigate between the host
culture and ethnic culture, focusing on a split between “mainstream
identity” and “ethnic identity.” Some researchers have argued in
recent years that this binary way of thinking about ethnic identity is
too simplistic for the world we live in today. A number of researchers
(see Phillimore et al., 2019; Vertovec et al., 2022; Vieytez, 2022)
suggest that many societies today have transitioned from being sites
of diversity to become sites of superdiversity, experiencing a
“diversification of diversity,” noting that “people from more places now
migrate to more places” (van de Vijver et al., 2015; p. 37). In large
cities in Europe and the Americas, many people now live in
neighborhoods that include a majority of people from the host country
along with migrants from many different countries. Social identities
are becoming more complex. And, indeed, many families of the world
have become multiethnic. In recent years, the political conversation in
western Europe and the United States has raised the question of
whether democratic, Western values are compatible with Islam. In a
study of a highly diverse neighborhood in Antwerp, Belgium, one
research team found that strong Muslim ethnic identity and Belgian
identity were not at all incompatible and typically developed hand in
hand (van de Vijver et al., 2015).

So how do societies deal with diversity, let alone superdiversity, of

ethnic cultures? The United States has a complicated history of
dealing with people of different national origins, religions, skin colors,
and ethnic identities. And issues related to cultural diversity continue
to be controversial. From the earliest days, the United States was
ethnically diverse, with the mix that resulted from immigration from
various regions in Europe, forced migration of Africans, and
Indigenous people already living on the land. With new waves of
immigration, the path to incorporation into U.S. society typically
followed color lines. In societies around the world, the approach to
managing ethnic diversity can be divided into two opposing attitudes:
assimilation versus multiculturalism (Ritzer, 2021). In the process of
assimilation , minority groups and new immigrants are expected to
adopt the patterns and norms of the mainstream culture and cease to
exist as a separate group. In the process of multiculturalism ,
nondominant groups and new immigrants and their children
enculturate to the mainstream culture while also retaining their ethnic
culture. Both mainstream identities and ethnic identities are
maintained. Multiculturalism is also called cultural pluralism. There
are long-standing tensions in the United States about which model of
managing ethnic diversity will be dominant, assimilation or
multiculturalism.

Ethnic identity can be a source of belonging and can also be a source

of great conflict within a society. In the 20th and 21st centuries, we
have seen many instances of high-profile ethnic conflict around the
world, such as the Turks and Armenians in Turkey, Nazi Germans
and Jews in Germany, Tutsi and Hutu in Rwanda and Burundi, Arabs
and ethnic Africans in Darfur, and the conflict among various ethnic
groups after the breakup in Yugoslavia. Sometimes religion is a major
part of the ethnic conflict. For example, in Pakistan where Rubina’s
parents grew up, ethnic conflict has included struggles over religion
(Sunni versus Shia), language (Pashto, Sindi, Balochi, Punjabi, Urdu,
and Siraiki), territory, and caste (Majeed, 2013). It would be helpful for
Rubina and her social worker to familiarize themselves with some of
the themes of these struggles and to begin to understand where
Rubina’s parents fit in these systems of ethnic conflict. It is always
helpful for family members to put each other in this kind of historical
and cultural context.
Ethnic cleansing is the term used to describe efforts of one ethnic or
religious group to expel or destroy another group in a particular
geographic area. We have seen ethnic cleansing in the examples of
ethnic conflict noted in the last paragraph, but examples can also be
found in the history of the United States. Much of the Indigenous
population was exterminated by settler colonialists, and U.S. 19th-
century policy forcibly removed Native Americans from their ancestral
homelands in the eastern parts of the country to lands west of the
Mississippi River. During World War II, Japanese American families
living on the West Coast were forced to leave their homes and
relocate to internment camps. Like other countries, the United States
has also used its immigration policies to exclude some ethnic groups.
For example, the Chinese Exclusion Act was passed in 1882 and was
not repealed until 1943, suspending the immigration of Chinese
laborers. In 1888, the Scott Act extended this exclusion to disallow
long-term legal Chinese American residents to reenter the United
States after a visit to China. When Donald Trump became president
in 2017, his administration made great efforts to restrict immigration
of people from many predominantly Muslim countries. The most
extreme form of ethnic conflict is genocide, which involves an active,
systematic attempt to eliminate an entire group of people. In
contemporary times, genocide has occurred in Darfur, Rwanda,
Bosnia and Herzegovina, Cambodia, China, and Germany.

Critical Thinking Questions 8.3

As you think about Rubina’s story, what implicit biases do you think
people might have about her in the classroom, on the street or at the
shopping mall, and at home? What are your reactions to the racial
categories used by the U.S. Census Bureau? What do you think of
the proposal to add a racial category of “Middle Eastern and North
African” to census data? What do you think of the U.S. Census
ethnicity classification that identifies two ethnic groups: Hispanic or
Latino or Not Hispanic or Latino? How important are race and
ethnicity in your own life? Explain.

Gender
Anthropologists consider gender to be a central element in every
facet of human cultures (Guest, 2020). Sociologists consider gender
to be a master status for many people—a social position more
important than other social positions—because of its centrality to a
person’s identity (Ritzer, 2021). Sociologist Judith Lorber (2016)
proposes that gender is one of the major ways that human cultures
organize their day-to-day lives. And yet gender is a highly contested
concept in contemporary times.

Sex and gender are terms that are often used interchangeably, and
their distinctions are often confused. As noted in Chapter 3, sex is a
biological idea. It is typically thought of as a binary designation—
female or male—based on chromosomes (patterns of X and Y);
gonads (testes and ovaries), which produce different hormones; and
genitalia. At birth, individuals are usually proclaimed either male or
female based on genitalia. Gender is a cultural creation, composed of
the expectations about behaviors, attitudes, and personalities that
each culture assigns to people of different sexes.

The evidence is clear that neither sex nor gender is so distinctly

binary as often thought. The characteristics of biological sex do not
always fit into two assumed categories of male and female. Although
the great majority of human bodies fit into two biological sexes,
millions of people around the world are born intersex, with one of
many combinations of male and female genitalia, gonads, and/or
chromosomes. A medical term for intersex is differences of sex
development (DSD) (AIS-DSD Support Group, 2022). In some cases,
intersex traits are obvious at birth, but in other situations, they are not
obvious until puberty. Sex wasn’t always thought of as binary nor has
it always been assigned based on genitals. For example, in 1876
pathologist Theodore Klebs classified anatomical sex into five
categories based on gonads (ovaries, testes, or a mix of ovarian and
testicular tissue) (Dreger et al., 2005). Biologist Fausto-Sterling
(1993, 2000, 2016) suggests that nature offers more than two sexes,
noting that hormonal levels are on a continuum in both females and
males and secondary sex characteristics such as breast size, muscle
size, and hairiness also fall on a continuum. Fausto-Sterling proposes
a middle ground between the absolute categories of female and male
sex.

Although anthropological research has found that some cultures

recognize diversity in biological sex, most Western cultures have
ignored sex that falls outside the binary female and male (Guest,
2020). Birth certificates have required either female or male
designation. Parents and physicians have reponded to intersex
persons with surgery and hormonal treatments to fit the binary
cultural norm. In 2013, Germany became the first European country
to allow parents to register newborns as neither female nor male if
the newborn was born with characteristics of both sexes. In 2018,
German law was changed to provide a “diverse” category (Kraljić &
Drnovšek, 2022). In 2021, the American Medical Association
recommended removing sex from birth certificates, suggesting that
designating newborns as either male or female at birth ignores the
medical spectrum of sex (de la Cretaz, 2021). In 2015, Malta was the
first country to pass a law to prohibit surgery and treatment of sex
characteristics of minors without informed consent (Guilbert, 2015). In
the United States, intersex advocates are working to educate the
public and the medical community about the experiences of intersex
people (Guest, 2020).

Humans are born with biological sex, which is sometimes more

complex than generally understood, and cultures construct gender
based on the understanding of sex. Guest (2020) suggests, “Gender
is taught, learned, performed, and policed” (p. 230). In the United
States and many other countries, gender is taught in a binary way,
based on the assumption that gender flows automatically from
genitalia and reproductive organs and that strong, clear gender
differences exist based on sex. It is grounded in an exaggerated
understanding of biological differences, and it carries biological
differences into spheres where biology is totally irrelevant. There is
nothing biological about which clothes people should wear—who
should wear dresses, who should wear pants, or who should wear
high heels—and, indeed, the norms for clothing vary across place
and time. No biological differences would indicate that women can’t
drive, vote, work outside the home, fight in wars, or hold political
office, and yet these norms have at different times and in different
places been written into laws and carefully policed. Gender
expectations about who can play particular sports, write poems,
nurture children, or do math likewise are not based on biology.
Cultural ideology can be so strong that gender expectations can be
seen as natural and normal. Gender must be examined, however, as
it intersects with race, social class, and sexuality, because different
stereotypes have developed for different groups of males and
females.

In recent times, around the world, people have been contesting two
aspects of gender ideology: that gender is binary and that sex
assigned at birth determines gender. Transgender is a term used to
identify people who have gender identity (internal sense of gender)
and gender expression (external expression of gender) that is
different from their assigned sex at birth. It is also used as an
umbrella term to identify all people who are gender nonconforming,
including people who are gender fluid, identifying sometimes as male
and sometimes as female, as well as people who do not identify with
either of the two culturally dominant genders. There is no single trans
path, and Table 8.4 presents some common definitions of terms used
by people to describe their gender orientation. The list should not be
thought of as exhaustive because we are living in a fluid time when
people are renegotiating the labels they use to describe themselves.
People who are transgender may or may not locate themselves in
culturally established gender categories. They may or may not wish
to use such medical treatments as hormone therapy or sex
reassignment surgery for biological transition.

Table 8.4
Many cultures of the world allow room for gender diversity and, in
some cultures, genders outside the male–female binary have been
revered (Guest, 2020; Scupin, 2021). In a nationally representative
survey of 10,188 U.S. adults in May 2022, researchers at the Pew
Research Center found that adults in the United States hold complex
views on gender variance (Parker et al., 2022). Sixty percent say a
person’s gender is determined by their assigned sex at birth, an
increase from 2021 (56%) and 2017 (54%). About equal proportions
say that society has gone too far in accepting people who are gender
variant (38%) and that society hasn’t gone far enough in accepting
gender variance (36%). About 80% think that transgender people
face at least some discrimination, and a majority (64%) favor laws
that protect transgender and nonbinary people from discrimination in
jobs, housing, and public spaces such as restaurants and stores.
Some states have put laws into place to limit protections for gender
variant individuals, and other states have laws to safeguard the rights
of them. Transgender people in the United States, especially Black
transgender women, face hateful rhetoric, state-sanctioned
discrimination, and violence (Human Rights Watch, 2021; Lenning et
al., 2021). In 2020, Wareham reported that 13 countries specifically
criminalize transgender people, and it is not possible to legally
change your gender in at least 47 other countries.

This is a good place to say something about language and the

cultural creation of binary gender. Linguists have identified three
types of languages in relation to their gendering of nouns and
pronouns. One type includes languages that gender pronouns but not
nouns. Another type includes languages that gender both nouns and
pronouns. And, a third type of language genders neither nouns nor
pronouns (Renström et al., 2022). In English, nouns and most
pronouns (I, we, you, they, etc.) are not gendered. However, the third-
person singular pronoun is binary gendered—masculine he, him, his
or female she, her, hers. English does not provide a pronoun for
someone whose gender is unknown, unclear, nonbinary, or “other.”
Linguist Dennis Baron (2020) presents a detailed history of 200 years
of attempts to create a gender-neutral third-person singular pronoun
and concludes that the best fix is singular they. Many attempts have
been made over the years to create a new word but none of them
have caught on. Singular they was added to U.S. dictionaries in 2019,
to be used when gender is unclear or when a person’s gender identity
does not fit the male–female binary. The American Psychological
Association and National Association of Social Workers recommend
use of singular they when referring to a person whose gender is
unknown or irrelevant to the context or when referring to any person
who uses they as their personal pronoun. That means that social
workers should use they as the default pronoun until they have met
with a client or received paperwork in which the client identifies their
gender and pronoun. The same is recommended when engaging with
colleagues, supervisors, and community members. DeFranza et al.
(2020) suggest that another approach is to follow the lead of
genderless languages and make greater use of nouns, such as a
person’s name or role, rather than pronouns when referring to people
in spoken communication.

Gender is not just a system of classification; it is also a system of

stratification. It has been used to give dominance to men and a
subordinate status to women. It is supported by misogyny, a cultural
belief that “men are better, stronger, more rational, more capable, and
more authoritative than women” (Kurian, 2011, para. 1). It can be
manifested in numerous ways, including gender discrimination,
belittling of women, harassment of women, violence against women,
and sexual objectification of women. There are global differences,
however, in the ways that societies deal with gender and create
gender disparities and inequalities. One research team found that
gender inequality elicits different psychological reactions from women
across cultural groups. Using data from 86 countries, Li et al. (2021)
found that in cultures where equality is valued, gender inequality is
statistically associated with poor psychological well-being among
women. This association is not found in cultures that do not value
equality.

In the 1960s and 1970s, feminists in the United States challenged the
sexism in language use, such as the generic he for third-person
singular pronoun and the use of mankind to refer to all people. They
called attention to how such terms as fireman, policeman, and
mailman promoted assumptions about which jobs were open to which
genders. Today, nongendered terms are used for these occupational
positions, and women are also more likely to be found in those
positions than was true in the 1960s and 1970s. This is an example
of language and culture evolving together (Appelrouth & Edles,
2021).
Anthropologists disagree about how much gender inequality has
existed across time, but most agree that there has been some form of
male dominance in most cultures since the beginning of the
agricultural period of history. Since 2006, the World Economic Forum
has presented an annual global gender gap report that quantifies the
magnitude of gender-based disparities around the world and tracks
their progress over time. Measurement of the gender gap is based on
study of four areas of social life: economic participation and
opportunity, educational attainment, health and survival, and political
empowerment. In 2022, the report indicated that the global gender
gap has closed by 68.1% since 2006 but progress has stalled with
the ongoing pandemic, climate emergency, war, and displacement
(World Economic Forum, 2022). At the current rate of progress, the
report indicates it will take 136 years to reach gender parity globally.
The good news is that 21 countries had reached gender parity in
educational attainment in 2022. No country has reached gender
equality in economic participation and opportunity, health and
survival, and political empowerment.

The gender gap scores are presented as female-to-male ratios. A

score of 1 represents perfect gender equality, which no country has
achieved, and the closer the score is to 1 the greater the gender
equality. Figure 8.2 reports the scores for the 10 countries with the
most gender equality and the 10 countries with the least gender
equality in 2022. Of the 146 countries studied, the United States
ranked 27th in gender equality overall, up from 45th in 2016, with an
overall score of 0.769. It was 22nd in gender equality in terms of
economic participation and opportunity, 51st in educational
attainment, 83rd in health and survival, and 38th in political
empowerment. We should also note that Pakistan is next to the
bottom among 146 countries in overall gender equality, and 135th in
educational attainment. You probably are familiar with the riveting
story of Malala Yousafzai, who was shot for going to school in
Pakistan. And yet Rubina’s family has always encouraged Rubina to
excel in school here in the United States. Perhaps her social worker
could encourage her to explore with her parents what their
experiences were with girls and schooling in Pakistan and how they
came to put such high value on the education of their children,
including their female children, here in the United States.

Description
Figure 8.2 Ten Countries With the Highest and Lowest Gender
Equality

Source: Based on Global Gender Gap Report 2022, World Economic

Forum, 2022
(https://www3.weforum.org/docs/WEF_GGGR_2022.pdf?
_gl=1*53gsz9*_up*MQ.
.&gclid=EAIaIQobChMI75vilfzK_AIVegStBh1JZASiEAAYAiAAEgJ_6f
D_BwE).

Sexuality

Sexuality is both a physiological process and a cultural construction.

Physiologically, it involves a range of desires and behaviors related to
erotic physical contact. Culturally, it involves debates about which
kinds of physical desires and behaviors are moral, appropriate, and
natural. In this chapter, we focus on those cultural debates and how
they relate to power. All societies have cultural rules to regulate
sexual relations—rules about the why, how, when, where, and with
whom of sexuality, about who is allowed to do what with whom.
People in all societies are enculturated to channel sexual desires into
a limited number of acceptable sexual behaviors. Cultural norms
regarding sexuality vary across time and place, and social scientists
agree that, at least in Western cultures, cultural norms of sexuality
are currently in flux.

There are cultural debates about the “when” of sexuality, but the
biggest cultural debates about sexuality have centered on the “why”
and “with whom” questions. In terms of “when,” all cultures have
values and norms about the appropriate age for the sexual debut.
There is growing international agreement that children should not be
engaged in sexual interaction other than exploration of their own
bodies, but child brides are still common in many parts of the world.
Research in Ethiopia and the United States indicates that child brides
are at higher risk of intimate partner violence and are often unable to
negotiate safe sex (Abera et al., 2020; McFarlane et al., 2016). There
is less agreement about sexuality during adolescence than about
childhood sexuality, as seen in the debate about how much of the
U.S. sex education curriculum should focus on abstinence.

The biggest “why” debate is whether procreation or pleasure is the

purpose of sexuality. Anthropologists agree that in the social
organization of early humans, sexual activity was basically oriented
toward reproduction. They also agree, however, that sexuality began
to lose its exclusive reproductive meaning early in human evolution.
Religion has been a major force in the debate about the purpose of
sexuality. Revolutions in reproductive technology have spurred new
religious controversies about sexuality for pleasure. There are
divisions within each of the three Abrahamic religious traditions—
Christianity, Islam, and Judaism—on this question. In Christianity, the
Catholic leadership has condemned sexual intercourse that occurs
without the possible “natural” outcome of conception. Natural family
planning but not use of artificial contraceptives is considered
acceptable. Some Protestant groups share the Catholic view, but
many Protestant denominations favor the use of contraceptives, with
some arguing that sexual pleasure facilitates interpersonal bonding
and that contraceptives are needed to prevent overpopulation
(Benagiano & Mori, 2009). There are similar divisions on the issue of
contraception within both Islam and Judaism (Adedini et al., 2018).
The use of contraception does not appear to be a major ethical issue
in Hinduism, Sikhism, and Buddhism (Srikanthan & Reid, 2008).

Cultures have had a lot to say about with whom it is appropriate and
moral to have sexual relations, but the answers have not been the
same across time and place. Here are some examples. Cultures
have varied over time about the acceptability of having sexual
relations with anyone to whom you are not married. About 15% of
countries today have rules requiring that sexual involvement only
happens in marriage (Haviland et al., 2017), but many countries have
very lax standards about this issue. Adultery has been criminalized in
many societies, and some states in the United States continue to
have laws against adultery. In the United States and many other
countries, it is illegal to have sexual relations with a child, although
the age of consent varies from country to country, and even state to
state in the United States. There are incest taboos in all cultures,
prohibiting sexual relations among certain close relatives, but the
definition of close varies. During European colonization, white men
were allowed to have sexual relations with non-white women, but sex
was vehemently prohibited between white women and non-white men
(Stoler, 2010). In the United States, antimiscegenation state laws
were passed in the 18th century, outlawing marriage between
members of different races and often including the criminalization of
cohabitation and sex between whites and non-whites. These laws
were ruled unconstitutional in the 1967 Loving v. Virginia Supreme
Court ruling. In 1949, South Africa passed the Prohibition of Mixed
Marriages Act that prohibited sexual relationships between white
people and people of other race groups, a law that was not repealed
until 1985 (Beningfield, 2006). Sodomy laws have existed for
hundreds of years, originating from religious prohibitions against
nonprocreative sexual acts. Sodomy has been defined in different
ways, narrowly to prohibit anal sex between two men, but more
broadly to include any sexual penetration other than vaginal
intercourse, including oral and anal sex. Sodomy laws were declared
unconstitutional in the United States in 2003 in the Lawrence v. Texas
case, but sodomy remains technically illegal in the military, and 16
states still have laws making sodomy illegal (Wakefield, 2020).
Sodomy laws are still operative in some places in the world and are
even punishable by death.

In the dominant Western model, sexuality is binary: heterosexuality

and homosexuality (straight and gay). But this binary approach is a
relatively recent invention, typically traced to the late 19th century,
and some societies of the world still lack terms to distinguish sexuality
this way (Haviland et al., 2017). In many times and places, sexuality
is understood as a behavior, not a permanent, stable, fixed identity,
and sexuality is recognized as fluid (Guest, 2020). Recently, in
Western cultures, the heterosexual–homosexual binary has been
supplemented with other categories, including bisexual (attraction to
people of more than one gender), pansexual (attraction to any
person, regardless of the person’s gender, sex, or sexuality), and
asexual (little or no sexual attraction to people of any gender).
Research indicates that human sexuality does not fit so neatly into a
binary system. Researchers have found diversity, flexibility, and
fluidity along a continuum of sexual desire and sexual behavior. In the
United States, people under 30 years of age have been found to be
more likely than others to identify as neither heterosexual nor
gay/lesbian: 29% for this age group, compared to 24% in the 30–44
age group, and 8% in the 45–60 age group (Oswalt et al., 2016). As
researchers are recognizing that sexual orientation is more complex
than once thought, people are developing new terms to describe their
sexual desires and behaviors. Social workers should avoid making
assumptions about how people think about and enact their sexuality.

And what is the intersection of sexuality and power? Let’s begin with
the changing status of what has come to be called the LGBTQ+
community, a community that is a mix of people who vary by gender
and sexuality. The legal rights of this community have changed
substantially in the United States and other Western countries since
the first edition of this book was published in 1999. Although there
has been a recent wave of acceptance for same-gender couples in
many Western countries, they are still a very vulnerable group in
many parts of the world. In 2022, same-gender sex was illegal in 67
countries and same-gender marriage was legal in 32 countries
(Human Rights Campaign, 2022; Human Rights Watch, 2022). Where
same-gender sex is illegal, punishment varies from fines to corporal
punishment, imprisonment, or the death penalty. The United States
has some of the most advanced LGBTQ+ rights in the world, but civil
protections for this group still vary from jurisdiction to jurisdiction. A
June 26, 2015, Supreme Court ruling, Obergefell v. Hodges,
recognized the marriages of same-gender couples nationwide. As
this chapter is written in January 2022, however, fewer than half of
U.S. states offer protection against discrimination based on sexual
orientation and gender identity. In many states, employers may fire or
refuse to hire a person based on sexual orientation or gender identity,
and LGBTQ+ people have no protection against discrimination in
public accommodations or housing. LGBTQ+ youth continue to
encounter harassment and bullying in school, and LGBTQ+ youth
and adults are frequent victims of violent hate crimes (Freedom for All
Americans, 2023).
Sexual assault, a sexual act in which a person is coerced or
physically forced to engage against their will, is a clear example of
sexuality interacting with power. It is difficult to measure, largely
because it often goes unreported. RAINN (Rape, Abuse & Incest
National Network) is the largest anti–sexual violence organization in
the United States. They estimate that someone in the United States is
sexually assaulted every 68 seconds, 1 of every 6 U.S. women and 1
in 33 U.S. men has been the victim of an attempted or completed
rape in their lifetime. Ages 12–34 are the highest risk years for rape
and sexual assault. Transgender students are at slightly higher risk
for sexual violence than cisgender students (21% compared to 18%).
Sexual violence is pervasive on college campuses; 13% of all
graduate and undergraduate students experience rape or sexual
assault but many do not report that assault. Native Americans are at
greater risk of sexual violence than members of other races. It is
estimated that each year 80,600 prison inmates are sexually
assaulted, and the U.S. Department of Defense estimates that 6.2%
of active duty women experienced sexual assault in 2018 (RAINN,
2023). Rape culture is a term that has been used to describe the
cultural norms that develop in some settings that allow rape and
sexual assault to be “excused, legitimized and viewed as inevitable”
(Dodge, 2016, p. 67). Alexa Dodge (2016) writes about how social
media are used to extend rape culture when photographic images of
acts of sexual violence are disseminated online. Kessel (2022)
argues for an intersectional analysis of rape culture, suggesting that it
must understood in the context of several dimensions of power,
including patriarchy, white supremacy, heteronormativity, and
capitalist exploitation. Kessel concludes that sexual violence is used
to protect systems of power.

Sex trafficking, also called commercial sexual exploitation, refers to

the sexual exploitation of human bodies for the social, political,
economic, and/or sexual benefits of others. Victims of sex trafficking
are often brutalized with physical, emotional, and sexual violence.
Worldwide, it is estimated that 4.8 million people are victims of sex
trafficking each year (Ecker, 2022), and in the United States, sex
trafficking has been reported in every state and the average age of
entry into sex trade is 15 years (Guardian Group, 2021). Godoy and
colleagues (2016) suggest that cultural expectations, norms, and
values that support the sexual objectification of women, children, and
adolescents contribute to sex trafficking. In the United States,
women, children, members of the LGBTQ+ community, persons with
mental and physical disabilities, Indigenous persons, and migrants
are the people most vulnerable to sex trafficking. There is evidence,
however, that sexually exploited boys and young men are less likely
to be identified than sexually exploited girls and women (Godoy et al.,
2016).

Social Class

Social class is a system of power based on wealth, income, and

social position that produces unequal access to society’s resources.
Inequality exists in every contemporary culture, but it is organized in
different ways in different places. That raises two questions: (1) Is
inequality a natural part of human culture? and (2) Is inequality based
on culture or social structure? In this section, we briefly consider the
relationship of social class to culture, and Chapter 9 focuses more
completely on how inequality is created and maintained in major
societal institutions.

Anthropologists report that until the development of agriculture about

10,000 years ago, human economic and social structures were
organized around hunting and gathering, also known as food foraging
(Guest, 2020; Valentino & Vaisey, 2022). There are still some hunting
and gathering societies in the world today. It is thought that these
societies were and are egalitarian in nature (called egalitarian
societies), sharing resources to ensure the success of the group.
Food foraging societies are highly mobile, especially when on food-
getting expeditions. Therefore, it makes little sense in these societies
to accumulate luxuries or surplus goods, and this lack of
accumulation serves to limit status differentials (Haviland et al.,
2017). Valentino and Vaisey (2022) argue that modern humans have
spent nearly all of their 300,000-year history in egalitarian groups,
and cultural evolution played a major role in humans developing such
extreme levels of inequality in such a short period of time (10,000 of
300,000 years). Cultural innovations of new tools led to a food
surplus, which raised issues of the allocation of surplus (Sterelny,
2021), and categories of division of labor evolved over time and
produced status distinctions (O’Connor, 2019).

Trump (2020) notes that cultures develop rules about fair allocation of
resources and when inequality is fair and unfair. Tump further notes
that, currently, the United States is experiencing historically high rates
of economic inequality without experiencing historically high levels of
resistance to it. Available information, self-interest, and group-interest
often interfere with the implementation of cultural values about
inequality, and strategies for redistribution are hotly contested.
Anthropologists characterize social class in the United States and
many other countries today as a system of social status based on
conspicuous consumption and the accumulation of surplus (Haviland
et al., 2017). In the global capitalist economy, people who live in
technologically wired parts of the world buy and sell anything and
everything without having face-to-face contact. This changes the
culture of exchange and moves it away from earlier values of
reciprocity.

To understand the role of culture in inequality, Valentino and Vaisey

(2022) recommend Charles Tilly’s model of inequality presented in
the book Durable Inequality (Tilly, 1998). Tilly proposes four cognitive
processes and cultural concepts that drive inequality: exploitation,
opportunity hoarding, emulation, and adaptation. In discussing
exploitation, Tilly notes that some well-connected groups exploit the
labor and other resources of other groups whom they exclude from
reaping the full value of rewards involved. Valentino and Vaisey
(2022) note that the exploiters make justification for their actions
using or creating cultural stories, values, beliefs, ideologies, and
norms about what is fair. Meritocracy is one commonly used
justification, using individual-based explanations for group
differences. Opportunity hoarding involves retaining access to
valuable resources by closing opportunities to exploited groups.
Valentino and Vaisey (2022) suggest that opportunity hoarders use
cultural classification and categorization systems to create
boundaries around who is deserving and undeserving. Examples
include higher education admission standards and credentials for
hiring that explicitly or implicitly exclude some categories of people.
Emulation involves the copying of established cultural practices from
setting to setting. For example, an entire occupational sector, such as
law or medicine, copies the practice of gender-based hiring from one
setting to another. Valentino and Vaisey (2022) suggest that third-
order beliefs (what someone thinks most people think) are often
involved in emulation. Adapatation occurs when individuals become
invested in particular strategies and goals to adjust to unequal
circumstances. Both those with and without power adapt and their
adaptations reproduce inequality. For example, individuals from lower
class backgrounds engage in collective support, sharing their limited
resources, while individuals from higher class backgrounds focus on
individual achievement (Valentino & Vaisey, 2022). Valentino and
Vaisey (2022) propose that interventions are needed to inform people
about existing inequalities and to shift cultural narratives about why
they exist.

Perhaps that is what happened in Sweden and other Nordic countries

during the 20th century. Erik Bengtsson (2019) notes that during the
20th century, Sweden became known for its “middle way” between
capitalism and socialism, with a high degree of economic equality, a
generous welfare state, and a strong social democracy. It is often
assumed that Sweden has a long history of egalitarianism. With
careful historical analysis. Bengtsson (2019) demonstrates that the
story of a long history of egalitarianism is a cultural myth. In the
period 1850–1920, Sweden was severely unequal. In 1900, it had the
most restricted suffrage and unequal wealth among the western
European countries, even more inequality than the United States.
From 1920 to 1980, however, a rapid transition occurred, and
Sweden and other Nordic countries became the countries with the
highest levels of economic equality. Bengtsson attributes that major
cultural shift to ideological flexibility and to popular social movements,
especially the labor movement, in the decades after 1870. Cultural
change occurred over several decades. The role of social movements
in cultural change will be the topic of Chapter 14, Social Movements,
in this book.
Disability

In Chapters 6 and 7 in this book, we read about four models of

disability: moral, medical, social, and human rights models. These
models of disability are cultural products based on values, beliefs,
and mental maps of reality. In contemporary times, disability has been
constructed as a medical bodymind binary category, either you are
disabled or you are not. Most definitions of disability focus on bodily
differences or impairments, and disability has become a broader
category over time. The Convention on the Rights of Persons with
Disabilities (CRDP; United Nations, 2006, art. 1, p. 4) defines
disabled people as “those who have long-term physical, mental,
intellectual, or sensory impairments, which in interaction with various
barriers may hinder their full and effective participation in society on
an equal basis with others.” That definition has been interpreted to
include all people with chronic illnesses (Branco et al., 2019). This
kind of categorization includes a very wide range of embodiments.
Bogart and Dunn (2019) suggest that social construction is involved
in the disabled/non-disabled binary categorization and prefer this
definition of disability: “anyone who is identified (correctly or
incorrectly) by others or who self-identifies as having a disability” (p.
652).

In Chapter 7, we looked at the role that the built environment can play
in disabling people. Here we look at how the sociocultural
environment disempowers and disables people with bodily
differences and impairments. The discipline of disability studies
identifies ableism as a cultural mental map that disempowers
disabled people and privileges non-disabled people (Bogart & Dunn,
2019; Moral et al., 2022; van der Horst & Vickerstaff, 2022). The
literature contains a number of definitions of ableism , but the most
common one is some version of this: a set of beliefs and practices
that recognizes a particular kind of body as the perfect, fully human
body. Being disabled is understood as being in a “diminished state of
being” (F. Campbell, 2001, p. 44). Another often presented definition
of ableism is “stereotyping, prejudice, discrimination, and social
oppression toward people with disabilities” (Bogart & Dunn, 2019).
Negative biases about people with disabilities may be either explicit
or implicit. Research with occupational and physical therapy
assistants, people whose daily work involves contact with disabled
people, found that these professionals were low in explicit disability
bias but still high in implicit disability bias (Vanpuymbrouck et al.,
2022). Social workers must examine their own beliefs and attitudes
about disability.

Researchers examining the ways that ableism is manifested in

encounters between disabled and non-disabled people have
developed classifications of types of ableist behaviors. They have
identified hostile, benevolent, and ambivalent ableism (Nario-
Redmond et al., 2019). Hostile ableism involves shaming language,
avoidance, and physical aggression. Benevolent ableism includes
pity, paternalistic protection, infantilization, patronization, and offering
unwanted help. One form of benevolent ableism has been called
“inspiration porn,” portrayals which objectify disabled people as
sources of wonder and amazement to serve as inspirations for non-
disabled people to try harder (Nario-Redmond et al., 2019).
Ambivalent ableism occurs when non-disabled people hold a
combination of positive and negative biases about disabled people
and shift their behaviors depending on the situation. For example,
benevolent ableism such as patronization may shift to hostile ableism
if the disabled person fails to respond in a stereotypical manner or
challenges disability biases. In an international sample of disabled
people, Nario-Redmond et al. (2019) found that most respondents
reported experiences with nearly every form of ableism. The most
commonly reported form of ableism was paternalistic or
condescending ableism, experienced as unwanted help,
infantilization, general pity, and overprotective families. Verbal abuse
and ridicule were more commonly reported than physical or sexual
assault. Physical invasions of privacy were also commonly reported.

Researchers in New Zealand did in-depth interviews with youth who

are Deaf or blind or have vision, hearing, or mobility impairments.
Their parents were also interviewed. The respondents with readily
visible bodily difference and disabilities reported high levels of
intrusive staring, which one young person referred to as conveying
“what the hell are you?” (Calder-Daw et al., 2020, p. 141). The
researchers interpreted those stares as diagnostic stares, part of a
medicalization process. The diagnostic stare frequently gave way to
invasive questions and comments such as “what’s wrong with you?”
(p. 142). Research participants also noted receiving offers of prayers,
advice, treatments, and cures. Calder-Daw et al. (2020) found that
ableism appeared in different forms for people with mariginally visible
or invisible disabilities and differences. While these young people
were free from the intrusive stares, they were the recipients of
disability skepticism and sometimes overt hostility. One young
woman, Gemma, reported that a misunderstanding developed at her
part-time job when she reported to a customer that she was not able
to roll paper the way the customer wanted it rolled. The customer
discounted her lack of ability and insisted Gemma roll the paper.
When it became clear that Gemma could not roll the paper, the
customer told her she should wear something that identifies her
disability so that people would know. Nario-Redmond et al. (2019)
also found that people with invisible disabilities were much more likely
than people with visible disabilities to receive hostile and
delegitimizing reactions. In the Calder-Daw et al. (2020) study, youth
with invisible disabilities and their families reported “proofing
practices” that require them to produce medical documentation in
order to receive needed accommodations.

With a medical model of disability, the focus is on finding a way to fix,

treat, or cure the disability. The medical model also produced the
eugenics movement, forced sterilization, and even euthanization. In
2022, the National Women’s Law Center, reported that 31 states plus
Washington, DC, have laws explicitly allowing the forced sterilization
of disabled people, with two such state laws passed as recently as
2019. Seventeen states allow forced sterilizations of disabled
children. Zwick (2019) reports that disabled people were the first
victims of the Nazi holocaust and the last to be memorialized.
Between August 1938 and May 1945, starting before World War II
began, approximately 300,000 people labeled disabled were
“deliberately starved, lethally injected, gassed, or otherwise
euphemistically ‘given the good death’” (p. 47). In August 1939, Hitler
authorized a program to exterminate children labeled as physically or
mentally weak. Earlier, in 1933, German legislation mandated
sterilization of people with specific physical and psychiatric conditions
including “feeble-mindedness”; hereditary blindness, deafness, and
epilepsy; schizophrenia and manic depression; severe physical
deformity; and chronic alcoholism. A memorial to disabled victims of
the holocaust was unveiled in 2014, after earlier memorials to Jewish,
homosexual, and Roma and Sinti victims were constructed. Some
disability rights activists argue that the current use of genetic testing
and selective abortion is a perpetuation of eugenics.

Ableism presents disabled people as asexual, not as people capable

of love, sexual expression, and sensuality. In the recent attention to
the rights for people with disabilities, little attention has been paid to
the constraints on and possibilities for sexual desire and sexual
behavior among people with disabilities. Anthropologists Don Kulick
and Jens Rydstrom (2015) explored how state power intersects with
sexuality for people with disabilities living in group homes in Denmark
and Sweden. These two countries are both liberal welfare states with
similar cultural histories; they are both considered to be sexually
progressive and have been at the forefront of disability rights.
However, they take very different approaches to the sexuality of
people with severe disabilities. In Sweden, like most countries of the
world, the sexual lives of people with severe disabilities are denied
and repressed. The staff in group homes are trained to discourage
any signs of sexual desire. In contrast, Denmark supports the rights
of people with severe disabilities to express their sexuality. Group
homes for people with disabilities are supported by a network of
advocates, sexual advisors, social workers, medical professionals,
counselors, and educators who are committed to recognizing and
facilitating the sexual desires of people with disabilities. Sexual
advisors undergo an 18-month training course and work under an
elaborate set of national guidelines. People with severe disabilities
are supported to engage in such sexual activities as masturbation,
having sex with a partner, or purchasing sexual services from a sex
worker. Kulick and Rydstrom consider this to be a social justice issue
that extends the rights of people with disabilities. Anthea Skinner
(2018) writes about an international disability music scene that
presents themes of romance and sexuality among disabled people, in
an attempt to promote cultural change related to disability and
sexuality.

Critical Thinking Questions 8.4

What do you think about the changing ideas about the binary nature
of gender and sexuality? What examples have you seen of this
cultural change? How important are gender and sexuality labels in
your own life? Explain. How important has social class been in your
own life in the past 2 days? Explain. What role does ability and
disability play in your life? What factors can make a difference in how
important gender, sexuality, social class, and disability are in people’s
lives?

Genes, Culture, and Cultural Change

These days, the common answer to the old question of whether it is

nature or nurture that drives human behavior goes like this: Human
behavior is influenced by an evolutionary process involving the
interaction of genes and culture over long periods of time. Scholars
across such diverse disciplines as anthropology, biology, economics,
genetics, and psychology agree that humans have two inheritance
systems—genetic inheritance and cultural inheritance—occupying the
same physical body. Genetic inheritance occurs through processes of
selection, mutation, drift, migration, and recombination (Markov &
Markov, 2021). In general, organisms that are better adapted to their
cultural and physical environments are more likely to survive and
pass on their genes to a new generation. Gene traits that are
adaptive to particular environments thrive and replicate over time
(Lee et al., 2022). The primary mechanism of cultural inheritance is
social learning through socially communicated language, beliefs,
norms, actions, institutions, and technology (Waring & Wood, 2021).
Social learning often happens by observation, modeling, and
imitation; in the digital age, the cultural models may live close by or at
a great distance. Cultural inheritance is influenced by many more
ancestors than occurs with genetic inheritance. Although there are
still disagreements about which came first in human history, biological
change or cultural change, there is general agreement that the history
of human behavior involves extensive gene–culture coevolution.

Coevolution of Genes, Culture, and Behavior

Gene–culture coevolutionary theory (GCT) is a branch of theoretical

population genetics that explores how cultural and genetic processes
interact over evolutionary time to affect behavior and produce human
diversity (Lee et al., 2022; Waring & Wood, 2021). Many animals
display culture, but human culture evolves more quickly and is
cumulative (O’Brien & Bentley, 2020). Social learning operates faster
than biological evolution, allowing cultural innovations to spread more
quickly than genetic mutations. As humans modify their physical and
cultural environments, they modify the selection pressure on human
genes as well as on the genes of other organisms living in the same
physical environments. The novel cultural environments that are
created may stimulate gene change. Human cultural adaptations
such as medical science allow culture to extend and even override
genetic capacity. Scientific knowledge about nutrition and other
healthy habits has extended human longevity, and medical
interventions such as the caesarean section procedure and
gestational surrogacy make human reproduction possible where it
would otherwise be impossible (Waring & Wood, 2021).
Unfortunately, human cultural adaptations have also led to species
loss for some non-human beings and created harsh environments
that challenge the genetic capacity of some humans.

It is generally agreed that the coevolution of genes and cultures

creates faster and stronger human evolution than either inheritance
system working alone could create. Azumagakito et al. (2018) report
that the rate of genomic evolution during the last 40,000 years has
occurred at a rate 100 times that of earlier human evolution, and that
is probably due in large part to an increasing rate of cultural change
putting pressure on genes to adapt. Brain volume has increased
threefold during the last million years of human evolution, providing
more capacity for social learning. There are questions, however,
about the relative strength of genes and cultures in human evolution.
Some theorists and researchers propose that genes “hold culture on
a leash” (E. O. Wilson, 1978, p. 167), meaning that culture cannot
change beyond the genetic limits of physical, cognitive, and
psychological abilities. One offered example is that genetic limitations
on human bite configuration may have limited language evolution
(Blasi et al., 2019). Waring and Wood (2021) argue, however, that
although there is some evidence that genes constrained cultural
development during the stone age, this limitation gave way and gene
limitation on culture has been decreasing over the long term as the
pace of cultural adaptations has accelerated. By organizing
themselves into groups, humans can draw on the genetic capacity of
a large number of people to create and revise culture rather than
being limited by the genetic inheritance of any one group member. In
addition, humans continue to find new ways to collect, store, and
disseminate new cultural knowledge. Aguilar and Akcay (2018) found
that altruistic behaviors can evolve through cultural evolution even
when opposed by genetic selection. In a study of language evolution,
Azumagakito et al. (2018) found that on a short-term scale, cultural
evolution outstrips biological evolution, but cultural evolution
fluctuates more than biological evolution; on a long-term scale,
biological and cultural coevolution produce more rapid biological
evolution.

Gene–culture coevolution is not easy to study, and the early evidence

came from research on the evolution of physical traits. Here are some
examples of that research. Fisher and Ridley (2013) provide three
examples. The gene mutation that allowed humans to remain lactase-
persistent into adulthood, meaning that, unlike other species, they
continue to have the enzyme to digest the lactose in milk after
weaning, occurred in response to dairy consumption associated with
agricultural developments. The higher alcohol tolerance of Europeans
in comparison to Asians was the consequence of greater alcohol
consumption in Europe. The invention of fire and cooking 2 million
years ago altered the human gut size. Economist Herbert Gintis
(2011) provides another example, suggesting that as humans
developed cultures that involved living near other humans, they
began to develop the abilities for cooperating and empathic
communication. This led to genetic changes that encoded the
capacity for cooperation and empathy into the human genome and
sharpened the capacity.

More recently, researchers are studying the gene–culture coevolution

of culture-driven behavioral traits. A pioneering study by Chiao and
Blizinsky (2010) found a strong statistical association between a
serotonin transporter gene and the cultural value for individualism
versus collectivism across the globe. More recently, Lee et al. (2022)
found a correlation between the oxytocin receptor gene and cultural
tightness. Levy et al. (2016) found that culturally conveyed negative
stereotypes about aging predicted later biomarkers of Alzheimer’s
disease (reduced hippocampal volume and increased amyloid plaque
development).

The human genome provides a large brain, capable of cultural

adaptation and innovation, always entangled with ongoing genetic
evolution. Genetic phenotype plasticity and cultural adaptation and
innovation interact to contribute to human evolution. A person’s
genotype is their unique set of genes; phenotype is the obvservable
characteristics created by the interaction of genotype and the
environment. Phenotype plasticity refers to the ability of individual
genotypes to produce different phenotypes under different
environmental conditions.

Cultural Change

If cultural change plays such a big role in human evolution, it is

important to consider how cultures change. Culture generally works
to maintain stability, but environmental, demographic, economic,
technological, political, and other changes challenge cultures to
adapt. Sometimes cultural change is quite voluntary, with people
welcoming new ideas, tools, and methods. Often, however, cultural
change is forced on people by outsiders. In this discussion, we will
look first at voluntary cultural change. In recent times, some cultures
have been changing faster than others, and in those cultures the
pace of cultural change seems to have intensified. Anthropologists
ask the question whether recent developments in information and
communication technology are causing as monumental a cultural
revolution as that created by the industrial revolution.

Anthropologists identify innovation, modification, recombination,

diffusion, and cultural loss as some of the most important
mechanisms of voluntary cultural change (Haviland et al., 2017;
O’Brien & Bentley, 2020). Innovation is any new idea, tool, or method.
A primary innovation is the creation, invention, or chance discovery of
an entirely new idea, tool, or method. A secondary innovation is a
new application or modification of an existing idea, tool, or method.
Secondary innovation also happens when ideas, tools, or methods
are recombined in a novel way. Force of habit tends to block ready
acceptance of the new and unfamiliar, but cultural beliefs may
encourage some innovations more than others. Religious or other
forms of ideology can be a major force against cultural innovation, as
happened when Galileo was tried for heresy for declaring that the
Earth revolves around the sun, an idea that ran counter to Roman
Catholic dogma at the time.

Ideas, tools, and methods also spread from one culture to another, a
process of cultural change known as diffusion. Cultural beliefs and
norms are diffused through observation, modeling, and imitation. The
rapid spread of information and communication technologies is a
recent example of the diffusion of cultural tools, and these cultural
tools allow rapid diffusion of new cultural ideas, tools and methods.
Anthropologists suggest that cultural borrowing accounts for a very
large part of any culture’s content (Haviland et al., 2017). But cultures
are selective about what they borrow, and they use new cultural
ideas, tools, and methods in a way consistent with other features of
the local culture.

Sometimes acceptance of a new innovation results in cultural loss,

when an existing idea, tool, or method is abandoned. Plant and
animal extinctions as a result of human action on the natural
environment is one example of cultural loss. Loss of knowledge of
nature in highly urbanized cultures is another example. Library card
catalogs, floppy disks, overhead projectors, carbon paper, paper
phone books, typewriters, and audio cassettes are examples of tools
that we once used in our teaching and writing that have been
abandoned. Another example of cultural loss is the disappearance
over time of words or phrases in a language. For example, we have
not heard the Old English word cockalorum used lately to describe a
boastful and self-important person (but some have suggested
bringing the word back).

Among those who have the power to drive and direct cultural change
in their own favor, change is seen as progress, but change is not
usually seen as progress by people who do not benefit from it.
Globalization is a good example. For those who have the power to
manipulate global markets to amass great wealth, globalization is
seen as progress, but, increasingly, globalization is seen as the
enemy to people who have lost ground as profits are maximized at
the expense of workplace safety, worker compensation, and
environmental conservation. Repressive change was the hallmark of
colonialism when both acculturation and ethnocide were used to
develop cultural dominance. Acculturation is the massive cultural
change that occurs in a society when it experiences intensive contact
with a more powerful society. Ethnocide occurs when one cultural
group sets out to destroy another cultural group’s cultural heritage.
Ethnocide involves forbidding the use of an ancestral language,
criminalizing traditional customs, destroying spiritual practices and
sacred places, and removing people from their homeland—stopping
short of physical exterminantion. In many places of the world,
including the United States, both ethnocide and extermination were
practiced against Indigenous people during the colonial era, and the
aftermath of ethnocide continues. In many societies today, immigrant
or other subordinated groups are directed to learn and accept the
dominant culture’s cultural beliefs and practices, to assimilate and
abandon their cultural uniqueness.

Rubina will face assimilation pressure to forgo wearing the hijab, but
she seems prepared to resist that pressure. She is engaging in
accommodation , the process of partial or selective cultural change.
In the accommodation process, nondominant groups follow the
norms, rules, and standards of the dominant culture only in specific
circumstances and contexts. Rubina follows the university rules and
shares most of the norms of the dominant U.S. culture, but she will
not remove her hijab, and her family does not live by many U.S.
cultural standards at home. Sometimes syncretism occurs as
members of nondominant groups find creative ways to blend old
culture with new culture into new cultural forms. Examples include
blending traditional healing practices with Western scientific medicine
or blending spiritual/religious practices from two cultures. Tetreault
(2019) studied how French-speaking adolescents of North African
background blend French and Arabic languages in their daily lives in
a French neighborhood. Tetreault found that while the adolescents
spoke French in school and on the streets, when they are on the
streets they appropriate the Arabic word Hashek, which their parents
use as a polite word, but they use it to tease and insult their peers.

There are a number of ways to resist attempts at cultural destruction.

When the scale of discontent reaches a certain level, rebellion and
revolution may occur. Although rebellion and revolution are
sometimes waged against internal leaders, they are often waged
against political rule from outside. Today, many Indigenous groups
whose cultures were attacked by colonizers are using different ways
to resist cultural destruction. They are involved in emancipatory
processes and revitalization movements to reclaim their knowledge,
rituals, and languages (Jimenez-Luque, 2021; Kambon & Songsore,
2022). This is nowhere more evident than in their leadership in the
global environmental movement.

All of her life, Rubina has been engaged in a bicultural socialization

process in which members of nondominant groups master both the
dominant culture and their own. It is necessary for people like Rubina,
who are the children of first-generation immigrants. Rubina seems to
have mastered both cultures well enough to move back and forth
between school and home during childhood and adolescence, but in
her current life stage, she struggles to resolve the conflict between
the culture of her parents and the culture of her peers regarding
young-adult independence. The struggle has been so great that it is
now affecting her health. Depending on how large the differences are
between two cultures, bicultural people may see their bicultural
identities as incompatible or as relatively conflict-free (Repke &
Benet-Martínez, 2017).

The United States is a pluralistic society, where different cultural

groups can maintain their distinctive cultural identities, values, and
practices while participating in the wider society with its set of norms
and laws. Anthropologists have found that pluralistic societies are
vulnerable to fragmentation along language, ethnic, and religious
lines (Haviland et al., 2017). We can certainly see evidence of such
fragmentation in the United States, and social workers have a role to
play in supporting societal respect for cultural pluralism and working
to heal the wounds of past cultural imperialism. Social workers who
conduct multidimensional cultural analyses should seek to
understand the processes by which culture is being maintained,
adapted, and changed in the lives of the individuals, families, groups,
and communities with whom they work. We must also be alert to the
ways in which the process of cultural change is not voluntary. We
must pay attention to the political, social, and economic practices that
undergird institutional norms and values. If these processes are
harmful and oppressive for some people, we have a professional
obligation, through our code of ethics, to facilitate change. And we
have a role to play in helping families like Rubina’s to negotiate
cultural conflicts within the family.

Critical Thinking Questions 8.5

How do you see genes and culture interacting in the production of

your own behavior? How do you see information and communication
technologies contributing to cultural change? Do you see those
cultural changes as good or bad in your own life? What one cultural
change would you most like to see? What do you see as the forces
that might support that cultural change? What do you see as the
forces that would oppose such a cultural change?

Implications for Social Work Practice

As a social worker, you will want to recognize the powerful role that
culture plays in the lives of the individuals, families, small groups,
organizations, communities, and social movements with which you
come in contact. Here are a few principles to guide your social work
assessment and intervention.

Engage in an ongoing process of identifying and examining your

own implicit biases and the impact they have on your
professional activities.
In social work engagement and assessment, recognize the
multiple interacting cultures involved in the stories you hear.
Pay attention to material culture in the communities in which you
work.
Assist individuals, groups, organizations, communities, and
social movements to exercise human agency in the ongoing
creation, maintenance, and change of the cultures in which they
participate.
Recognize how culture has been created, maintained, and
changed over time in the families, small groups, organizations,
communities, and social movements with which you work.
Assist client systems to examine cultural values, ideology,
symbols, language, and norms—and any conflicts about those—
involved in their situations.
Recognize how power and culture interact to create privilege and
disadvantage for client systems, particularly as they relate to
major identities such as race, ethnicity, gender, sexuality, social
class, and disability.
Support individuals and collectivities who resist cultural
marginalization, recognizing their strengths, creativity, and hope
as well as their pain.
Advocate for social work interventions and policy practices that
improve the life chances for identity groups who have been
marginalized by cultural ideology and norms.
Work to ensure that nondominant groups have a significant say
in how cultural change proceeds.

Chapter Review
Key Terms

Ableism
Accommodation (cultural)
Assimilation (cultural)
Beliefs
Bicultural socialization
Cultural humility
Cultural relativism
Culture
Enculturation
Ethnic identity
Ethnicity
Ethnocentrism
Gender
Hegemony
Material culture
Materialist perspective (culture)
Mentalist perspective (culture)
Multiculturalism
Norms
Power
Practice orientation (culture)
Race
Racism
Symbol
Values
Xenophobia

Active Learning

1. Compare the cultural experiences that Rubina is having as a

young adult with your own young-adult experiences, considering
the following themes: cultural values, cultural beliefs, cultural
symbols, language, cultural norms, subcultures, and
countercultures. Now imagine that you and Rubina change
places for a day. How do you think you might react to the values,
 symbols, and norms of Rubina’s life situation? How do you think
she might react to the values, symbols, and norms of your life
situation?
2. Consider where you fit in the social categories related to race,
ethnicity, gender, sexuality, social class, and disability. For each
category, consider whether you carry cultural privilege or cultural
disadvantage. Sociologists describe master identities as those
that are most important for our sense of self. Of the social
categories of race, ethnicity, gender, sexuality, social class, and
disability, would you consider your identity in any of these social
categories to be your master identity? If so, which one or ones,
and for what reasons? If not, is there another social category that
would constitute a master identity for you?
3. Think about a cultural change that you have seen in your lifetime.
Perhaps it is a technological innovation, a fashion change, a
change in political culture, a change in the cultural attitudes
about gender, sexuality, race, religion, or some other type of
cultural change. What do you think were the forces behind the
cultural change? How has that cultural change affected your own
life? What are the advantages and disadvantages of that cultural
change for society as a whole? For your family? For you
personally?

Descriptions of Images and Figures

Back to Figure

The chart reads as follows.

Ask yourself what judgments you make and meanings you attribute in
the following areas:

Music: Classical versus jazz, Rhythm and blues versus bluegrass,

Celtic versus rock and roll.

Food: Hamburger versus eel, Ants versus hot dogs, Kangaroo tail
versus squid, Pigs' feet versus horse.
Household/Domestic Activities: Parents and children sleeping in
separate beds and/or separate rooms versus sleeping in the open,
Sexual intercourse in private versus public, Bathing in private versus
public, Breastfeeding in private versus public, Families living, eating,
and sleeping in one large room versus separate rooms, Eating with
fingers and hands versus forks, spoons, and knives.

Back to Figure

In both graphs, the x axis shows the index scores from 0 to 1 in

increments of 0.1, and the y axis shows the country’s rank.

The first graph shows the ten countries with the highest gender
equality.

Rank 1: Iceland: 0.908.

Rank 2: Finland: 0.860.

Rank 3: Norway: 0.845.

Rank 4: New Zealand: 0.841.

Rank 5: Sweden: 0.820.

Rank 6: Rwanda. 0.811.

Rank 7: Nicaragua: 0.81

Rank 8: Namibia: 0.807.

Rank 9: Ireland: 0.804.

Rank 10: Germany: 0.801.

The second graph shows the ten countries with the lowest gender
equality.

Rank 137: Qatar: 0.617.

Rank 138: Benin: 0.612.

Rank 139: Oman: 0.609.

Rank 140: Algeria: 0.602.

Rank 141: Mali: 0.601.

Rank 142: Chad: 0.579.

Rank 143: Islamic Republic of Iran: 0.576.

Rank 144: Democratic Republic of Congo: 0.575.

Rank 145: Pakistan: 0.564.

Rank 146: Afghanistan: 0.435.

9 Social Structure and Social Institutions: Global and National

Elizabeth D. Hutchison

Learning Objectives

9.1 Analyze one’s own emotional and cognitive reactions to a case

study.
9.2 Analyze how social structure and social institutions give order and
stability to social life and why they must also change.
9.3 Summarize patterns in global and national inequality.
9.4 Give examples of global and national trends in eight major social
institutions (government and political, economic, education, health,
mass media, social welfare, religious, and family and kinship).
9.5 Advocate for diversity, equity, and inclusion in eight major social
institutions (government and political, economic, education, health,
mass media, social welfare, religious, and family and kinship).
9.6 Apply knowledge of social structure and social institutions to
recommend guidelines for social work engagement, assessment,
intervention, and evaluation.

A Case Study About Social Structure and Social Institutions

Case Study 9.1: Osvaldo Jimenez, Finding His Way as an Undocumented Student in the United States

“Osvaldo Jimenez” (not his real name) is a 29-year-old man who is

pursuing a PhD in an agricultural field at the University of Nevada, Reno
(UNR). Unlike young people who come to study at U.S. universities on
educational visas, he spent his late teen years and his entire adulthood
navigating obstacles as an undocumented immigrant. Osvaldo is paving
his path to his chosen profession, sometimes with the aid of U.S. social
institutions, sometimes despite them.

Osvaldo is from Gómez Palacio, Mexico. With a population of over

300,000 and a metropolitan area with about 4 times that many residents, it
is one of the most populated areas in Mexico. In the Mexican state of
Coahuila, Gómez Palacio is located about 250 miles due south of the
U.S.–Mexican border at Big Bend National Park in Texas. The region
balances a traditional economy of ranching with an industrial core of
textile, clothing, and metal processing. With his parents and two younger
siblings in Gómez Palacio, Osvaldo had a close-knit family life as a child
and teen. Both his mother’s and father’s families had been in ranching,
but with the 1994 Northern American Free Trade Agreement (NAFTA)
compromising their profits and the value of their land, the families moved
off and closed the ranches sometime before his birth. Both of his parents
graduated from the nation’s flagship university (National Autonomous
University of Mexico, UNAM), soon thereafter starting careers and family.

Osvaldo attended private school and was bilingual in Spanish and

English. From a young age, he had dreams of getting a college education
and perhaps becoming a veterinarian. Although Coahuila had some
limited options for him, he hoped to one day study and work in the United
States. Part of that dream was due to the many U.S. customs that were
part of his life. Crisis, however, forced migration on him and his family
when drug cartels started tearing apart his hometown. By the time he was
17 years old, he and his brothers had to stop their schooling and his
parents made quick plans to move southward to Mexico City. Not sure that
the Mexico City schools would serve his needs, Osvaldo decided to leave
for the United States and finish high school there. Under such pressure,
Osvaldo did not have time to pursue a travel or educational visa, thus he
entered the United States as an undocumented immigrant.

Osvaldo traveled first to the San Francisco Bay Area. His aunt agreed that
if he was enrolled in school, he could sleep under her roof. Despite the
delays due to his travels and enrollment difficulties, Osvaldo’s strong
English skills and perseverance meant that he could still finish high school
in the Bay Area that same academic year. His path forward was not clear
from there. He had applied to and been accepted to several California
universities, but he still could not secure an educational immigrant visa.
Because he had not arrived in the United States before age 16, he did not
qualify for Deferred Action for Childhood Arrivals (DACA), a renewable 2-
year deferment of deportation program created in 2012. DACA would
have allowed him, as a graduate of a U.S. high school, to have work
authorization and a promise of no deportation if he kept his record clean
and renewed his DACA status every 2 years. He would not have any
assistance for higher education at the state level either, even though
California had recently passed an assembly bill (AB 540) for “tuition
equity,” which allows state universities and colleges to charge
undocumented immigrants as in-state students if they could document 2
years of attendance and graduation from a California high school (among
other things).

He returned to Mexico somewhat defeated but determined to pursue

higher education in the United States, even if it meant living there again
as an undocumented immigrant. He went back to the Bay Area and
enrolled in community college. The college charged him as an out-of-state
student and he soon found himself holding down three jobs, including
ranch labor alongside other undocumented immigrants, so that he could
pay his school bills. Due to his immigration status, these jobs were paid
“under the table” and thus his employers could and did pay him less than
minimum wage (for several years, he earned $6 per hour when the state
minimum wage was $8 per hour). Because Osvaldo was raised to respect
his employers and because he knew that his immigration status made him
potentially disposable to his employers, he never complained about the
reduced rate of pay. Luckily, his employers never reported Osvaldo to
immigration officials, and he was able to avoid apprehension by the latter
during occasional raids in the countryside and at the local markets. Life in
California, then, was never easy with the threat of deportation always
hanging over him, long hours of manual work, and a demanding study
schedule. Troubling interactions with people sometimes punctuated his
already challenging situation. At one point, for example, a community
college administrator dropped him from a class due to his immigration
status, but with the aid of a more informed dean, he regained his
enrollment.

After 2 years of three jobs and full-time community college, at age 23,
Osvaldo moved to Reno to finish his BS at the University of Nevada, Reno
(UNR). Despite a preference for attending a California university, he
enrolled at UNR because, unlike the universities in California, it offered
him an out-of-state tuition rate that was comparable to what he had paid
for community college. Still, to pay his tuition, he had to continue with
ranch labor. For more than a year, with a rickety old car, he engaged in a
200-mile commute between work on the ranches in the Bay Area and
school in Reno. The ranch employers had offered to double his hourly rate
and advance him the funds for his tuition if he promised to work long
weekends. To balance his obligations and to economize, Osvaldo often
slept in his car or on couches while working 40-hour weekends. Over his
first year in Reno, he dedicated himself to his courses, sacrificing
opportunities to socialize and fully participate in intramural sports. At UNR,
though he had some struggles with people making xenophobic statements
about undocumented populations and thus being unsure whether to
mention his immigration status to new people, his biggest challenge was
continuing to live without health insurance. Like most undocumented
immigrants, he did not have employers who paid for health insurance; he
could not afford to pay for an individual plan, and due to his immigration
status he did not qualify for Medicaid or reduced-fee plans through the
Affordable Care Act. Consequently, on two occasions—when he broke his
hand and back—he could not work or study sufficiently. His only source of
medical assistance was community medical clinics that charged on sliding
scales for limited types of care. Though his family helped financially as
they could, it was only during these health crises that Osvaldo turned to
his local religious institution, Catholic Charities, for material and emotional
assistance. Unfortunately, he now has chronic aches and pains in his
hands and back from injuries and his extended work hours.

In recent years, life has grown a little easier for Osvaldo. Most importantly,
his brothers eventually came to California—one with a prized educational
visa. The brothers are resources to each other socially, emotionally, and
financially. The brother with the educational visa will have more
opportunities than Osvaldo and an easier time applying for work visas
later. And if that brother becomes a Legal Permanent Resident (LPR),
he’ll be able to travel to Mexico to visit the family that Osvaldo has not
seen for more than a decade. Reno has turned out to be a good home as
well, because he soon found a room to rent and, once he shared his story
with the owner, she offered him a significantly reduced rate. Across the
city, he has made friends through participation in intramural soccer, and
he often witnesses minds opening in the city. With a scholarship in his
senior year, he left the long work commutes behind and participated in
soccer tournaments as well as undergraduate lab research.

After completing BS and MS programs, Osvaldo is now pursuing a second

MS in computer science as well as a PhD in an agricultural area. He is
participating in research in sustainable agricultural practices and cultures,
and he hopes that his work can extend to pastoral communities like
Gómez Palacio that are trying to subsist despite the domination of global
big agribusiness. After 6 years, he was finally able to qualify for in-state
tuition in Nevada. As a student, he has also benefitted from mentoring
from faculty members who have advocated for him as an undocumented
student who cannot legally work and thus is in need of scholarships. The
university has also provided a social worker dedicated to undocumented
and DACA students who has connected him to many services, such as
immigration lawyers, free medical clinics, and food pantries.

Osvaldo wants to “pay it forward” for other undocumented students in the

Reno area. As a graduate student, he has attended political gatherings
and meetings with state university officials and participated in efforts with
student movements. He hopes that in sharing stories about being
undocumented he might counter the negative stereotypes about
immigrants so prevalent in the mass media. He also hopes to convince
the university to hire more than one social worker for undocumented
students.

Osvaldo is sure he will achieve his professional goals, but he is not so

sure if he’ll be able to achieve anything like the American Dream, since he
does not know if he can stay in the United States long after finishing his
studies. Because he crossed the border without authorization, no future
employer in the United States would be able to sponsor him for a work
visa unless he stayed out of the country for 10 years beforehand. If the
U.S. Congress passes some form of a DREAM Act, providing a pathway
to citizenship to young people, this would not likely include him. Osvaldo
would need an amnesty program that would have a wider net for people
who have been in the United States for many years and who came after
age 16. Despite all that he has achieved and despite being a posterchild
for the “good” immigrant, Osvaldo currently has only one real option for
getting documentation in the United States: to marry a U.S. LPR or
citizen. For Osvaldo, even that is not actually an option, since he is
engaged to a woman who also is undocumented.

Story provided by Jennifer Cullison

Patterns of Social Life

Although Osvaldo Jimenez is happy for his story to be shared with

readers of this book, his name and some aspects of his story have been
changed to provide anonymity to him. As you read his story, you are
probably aware of both the people and the environments involved. A
number of people are involved in the story, and you may be observing
their interactions with each other and what each person contributes to
Osvaldo’s current situation. Although you do not want to lose sight of the
personal dimensions of Osvaldo’s story, in this chapter we consider the
broad patterns of social life that he has encountered and continues to
encounter. Notice the connections between his personal troubles and
successes and the broader societal conditions in Mexico and the United
States.

A good way to begin to think about broad patterns of social life is to

imagine that you and 100 other people have made a space journey to a
new planet that has recently, thanks to technological breakthroughs,
become inhabitable by humans. You are committed to beginning a new
society on this new frontier. How will you work together to be successful in
this endeavor? What will you need to do to ensure the survival of this new
community? Now imagine that your community of 100 has grown to
include more than 8 billion people, spread across six continents, with
news and ideas being carried around the globe instantly through multiple
media outlets, billions of dollars moving across continents electronically,
and products being manufactured and services being provided by a
dispersed global labor force. How would you suggest that people work
together to ensure the survival of this global society? One way to think
about Osvaldo Jimenez’s story is to think of it as a globalization story. In
Chapter 1, we defined globalization as a process by which the world’s
people are becoming more interconnected economically, politically,
environmentally, and culturally.

Sociologists and anthropologists have given much thought to how people

work together to try to ensure the survival of a society. They have
identified two concepts—social structure and social institutions—as
central to understanding those endeavors. In the broadest sense, social
structure is another term for society, or simply an acknowledgment that
social life is patterned, not random. It provides the framework within which
individual and group behavior is played out in daily life. Social structure is
a set of interrelated social institutions developed by humans to allow them
to survive, interact, and live together. Recently, immigration laws in the
government and political institution are one attempt to bring stability and
order to life, but they are hotly contested in the United States and many
other countries.

Our understanding of social institutions is complicated by the casual,

everyday use of the term institution to cover a variety of meanings. In this
book, however, we use the definition of social institution as a relatively
stable, organized, patterned set of social roles and social norms that
provides a basis for behavior in a particular area of social life and helps
society meet basic survival needs (Ballantine et al., 2020; Esposito, 2022;
Newman, 2017). Social institutions manage conflict and attempt to hold
opposing interests together (Esposito, 2022). As societies became more
complex over time, more functions were removed from the family and
community, and new social institutions emerged to manage particular
areas of life. In large, complex societies, an intricate interrelated set of
social institutions must work together to ensure the survival of the society.
What happens in one institution affects other social institutions.

Sociological treatment of social structure and social institutions

emphasizes the ways in which they persist and contribute to social
stability. But often they persist despite unintended consequences and
evidence that they are ineffective. Currently, immigration policies around
the world are creating as much instability as stability. Although social
institutions are relatively stable, they also change—whether by accident,
by evolution, or by design (McMichael & Weber, 2021; Scott, 2014). Scott
(2014) suggests three types of processes that contribute to the stability of
social institutions: regulatory processes, normative processes, and
cultural-cognitive processes. Different types of processes are at work in
different social institutions. Regulatory processes involve rules,
monitoring, and enforcement through rewards and punishment. Normative
processes involve values and norms about how things should be done.
Cultural-cognitive processes involve beliefs about the world and how to
behave in it.

Social institutions are relatively stable, but they must also change and
adapt when faced with new situations, especially crisis situations, if they
are to meet their basic tasks of holding societies together and allowing
them to survive. The COVID-19 pandemic presented such a crisis
situation for societies around the world. There has been much criticism of
the inadequacies and failures of social institutions during this public health
emergency, and yet we have to ask how we would have weathered the
pandemic without social institutions. There were many controversies
about how to manage the pandemic, and social institutions were accused
of doing too much by some and too little by others. Esposito (2022)
suggests that these controversies are a reminder that conflict is an
expected and necessary part of social systems, and social institutions
must be able to respond to competing needs such as freedom and the
protection of human lives that became controversial during the pandemic.

Eight interrelated social institutions are discussed in this chapter: the

government and political institution, economic institution, educational
institution, health institution, mass media institution, social welfare
institution, religious institution, and family and kinship institution. We will
take a look at the functions of each of these institutions, the ways in which
they create or maintain social inequality, their trends, and how they were
affected by and affected the course of the COVID-19 pandemic. We can
see how important each of these institutions is in Osvaldo Jimenez’s life.

Patterns of Inequality in Social Life

Perhaps the most important and troubling pattern in contemporary life is

the continued extremely high level of social inequality, both between
nations and within nation-states. Although globalization has brought some
improvements in literacy, health, and living standards for many, we pay
particular attention to trends in social inequality because the profession of
social work has historically made a commitment to persons and groups
that are disadvantaged in the distribution of institutional resources. To
carry out this commitment, we must have a way of understanding social
inequality and its influence on human behavior. Throughout this chapter,
we explore how social inequality is created and maintained in eight major
interrelated social institutions. But first we take a closer look at inequality
globally and in the United States.

There are many debates about whether globalization is leading to

increased or decreased global inequality, and the answer depends on how
the question is asked. In a study of global inequality in income between
1970 and 2018, Hammar and Waldenström (2020) found that between-
country inequality (henceforth reported as global inequality) fell during that
period, but within-country inequality grew. In a longer term and more
comprehensive study, Chancel and Piketty (2021) report similar but more
complex findings about trends in global and within-country income
inequality in the two-century period 1820–2020. They report that since the
early 19th century, global income inequality has always been very large
because of a highly hierarchical world economic system. Global inequality
increased between 1820 and 1910 in a period of Western colonial
capitalism and stabilized at a very high level between 1920 and 2020.
Within-country inequality also grew between 1820 and 1910 but dropped
between 1920 and 1980 during a period of rising social protection
spending and progressive taxation in high-income countries. Within-
country inequality has been rising since 1980, and global inequality has
begun to decline. Chancel and Piketty (2021) report that the recent
decline in global inequality is due, in large part, to a growing middle class
in countries such as India, Indonesia, Vietnam, and a number (but not all)
of sub-Saharan African countries. Both global and within-country
inequality remain at extremely high levels. To put that in perspective,
Chancel and Piketty (2021) report that in 2020 the top 0.1% of the world’s
income earners had the same share of the world’s income as the bottom
50%, about 8%. McMichael and Weber (2021) point out that the people at
the top of the world’s income and wealth structure are engaged in high
consumption and resource-grabbing, and the richest 10% are responsible
for almost half of the world’s carbon dioxide emissions. In all the regions
of the world, some groups are more deprived than other groups in income
and other resources. These groups include women and girls, ethnic
minorities, Indigenous peoples, people with disabilities, people living in
rural areas, and migrants (McMichael & Weber, 2021).

Let’s look at the trend in income inequality in the United States. In the
period from 1947 to 1973, income inequality in the United States declined
slightly. Since 1974, however, income inequality has grown substantially.
The most commonly used measure of income inequality is the Gini index ,
which measures the extent to which the distribution of income within a
country deviates from a perfectly equal distribution. Gini index scores
range from 0 (perfect equality) to 100 (perfect inequality). As Figure 9.1
shows, the Gini index in the United States grew from 39.4 in 1970 to 49.4
in 2021. Semega and Kollar (2022) report that the increase in U.S.
inequality in 2021 was driven by declines in income at the bottom during
the COVID-19 pandemic. Looking at wealth instead of income, Saez and
Zucman (2020) report extraordinary wealth accumulation among rich
people in the United States between 1980 and 2020, with wealth
inequality growing much faster than income inequality. In 1980, on
average, people in the top 1% owned wealth that was worth 60 years of
the average U.S. income. In 2020, they owned 200 years of the average
U.S. income (Saez & Zucman, 2020). After a period of gains in Black and
Hispanic wealth between 1983 and 2007, the Great Recession of 2007–
2008 exacerbated wealth disparities between whites and members of
racialized groups (Modi & Sewell, 2022; Wolff, 2021).
Description

Figure 9.1 Gini Index of Inequality in the United States, 1970–2021

Sources: DeNavas-Walt et al., 2006; DeNavas-Walt et al., 2013; Semega

& Kollar, 2022.

The United States has the highest level of inequality of the high-income
countries. Figure 9.2 shows the income inequality ranking of 18 high-
income Global North countries in the period 2018–2020, based on the
Gini index, moving from the country with the least inequality at the bottom
(Belgium, Gini index 27.2) to the country with the greatest inequality at the
top (United States, Gini index of 41.7). (Note: The Gini index listed for the
United States in this World Bank database is below that listed in other
databases, most likely due to different methods of calculation regarding
taxes and transfers.) The 18 countries presented in Figure 9.2 are used
throughout this chapter to make comparisons between the United States
and other Global North high-income countries. I call these countries the
peer countries. Of course, the United States does not have more
inequality than all countries in the world. The rate of inequality is lower in
the United States than in many low- to middle-income countries. Overall,
the highest rates of inequality can be found in some formerly colonized
African and Latin American countries, but the rate of inequality is not
consistent within these regions.
Description

Figure 9.2 Ranking of Social Inequality in 18 Global North High-Income

Countries 2018–2020

Source: World Bank, 2021.

Some social and economic analysts argue that social inequality is the
price of economic growth (Carneiro et al., 2022), but a comparison of the
United States with other high-income countries suggests that societal
health is best maintained when economic growth is balanced with
attention to social equality. Let’s look at three social indicators for the 18
peer countries in Figure 9.2 : childhood mortality (probability of dying
before age 5), life expectancy, and secondary school enrollment. In 1960,
the United States had an infant mortality rate lower than 10 of the peer
countries listed in Figure 9.2 , but the United States has had the highest
child mortality rate of the 18 countries since the 1980s (Thakrar et al.,
2018). In 2021, the infant mortality rate in the United States (5 deaths per
1,000 live births) was 2.5 times that of Finland, Italy, Japan, Norway, and
Sweden, who each had 2 deaths per 1,000 live births (World Bank,
2022a). All the peer countries also have longer life expectancies than the
United States does, with Japan (84.8 years) as the country with the
highest life expectancy, having a life expectancy almost 7 years longer
than the life expectancy in the United States (78.1 years) (World
Population Review, 2023). The United States does better in terms of
educational attainment, with secondary education completion rates higher
than 15 of the peer countries (OECD Data, 2022). These data suggest
that education does not reduce economic inequality as much as
sometimes suggested, at least not in the United States.

There is growing support for the idea that economic inequality is

associated with a number of social ills, including increased physical and
mental health difficulties (Wilkinson & Pickett, 2009); reduced trust,
cooperation, and social cohesion (Van de Werfhorst & Salverda, 2012);
increased violence and social unrest (Ezcurra & Palacios, 2016); lower
political participation (Solt, 2008); reduced support for democracy
(Andersen, 2012); decreased trust in government (Chi & Kwon, 2016);
stronger support for authoritarian beliefs (Solt, 2012); increased anti-
immigrant sentiment (Colantone & Stanig, 2019); and increased domestic
terrorism (Krieger & Meierrieks, 2021). Inequality penetrates every social
institution and undermines social ties. Higher levels of inequality have
been found to be associated with people being more negative toward
members of other groups, enhanced stereotyping, desire for a strong
leader, and embrace of conspiracy theories (Jetten et al., 2021).

Poverty is one measure of social inequality, but there are different

approaches to measuring poverty across the world. The available
evidence indicates that before industrialization only a small elite enjoyed
living conditions that would not, today, be described as extreme poverty.
For 3 decades, the percentage of the world’s people living in extreme
poverty was declining, but the trend was broken in 2020 by the COVID-19
pandemic. During the first wave of the pandemic, the world’s poorest
people suffered the steepest income losses and faced setbacks in health
and education (World Bank, 2022b). In 2021, an estimated 9% of the
global population was living in extreme poverty, defined as living on less
than US$1.90 per person per day. Over one-fifth of the global population
live below the poverty line of US$3.20 per day, and over two-fifths lives
with less than US$5.50 per day. China and India had the largest
reductions of people living in extreme poverty between 2010 and 2021,
but in 26 countries in sub-Saharan Africa the number of people living in
extreme poverty increased between 2010 and 2020 (Development
Initiatives, 2021). There is general agreement that extreme poverty cannot
be eliminated without decreasing global inequality (see Wolff, 2021).

Poverty rates in the United States demonstrate that social inequality is

related to race and ethnicity, age, gender, and disability. In 2021, the
overall poverty rate in the United States was 11.6%. The white poverty
rate was 8.1%, compared to a 17.1% Hispanic poverty rate, 19.5% African
American poverty rate, and 24.3% Native American poverty rate. The
child poverty rate was 15.3%, the poverty rate for people with disabilities
was 24.9%, and the poverty rate for women (12.6%) was slightly higher
than the overall poverty rate (Center for American Progress, 2022).

Contemporary Trends in Global and U.S. Social Institutions

As suggested, social institutions are relatively stable, but they also

change. They are created and modified over time as people interact in
various social configurations. They have undergone great changes over
time, yet they often seem so resistant to change. Usually the pace of
institutional change is slow, but there are also times of transition when the
pace of institutional change is quite rapid, for example, the period at the
beginning of the industrial revolution. Contemporary futurists suggest that
we have entered a time when the pace of technological change will
continue to accelerate rapidly, and we might expect that continued rapid
technological change will produce change, sometimes rapid change, in
most if not all major social institutions.

Writing about global social structure and social institutions at the

beginning of the 21st century, Anthony Giddens (2000), a British social
scientist, suggested that the recent pace and scope of change has
produced a “runaway world.” Some social scientists posit that the pace
and scope of change in the past few decades has produced several crises
for global as well as U.S. social institutions, for example, an inequality
crisis, a financial volatility crisis, an energy crisis, a climate crisis, a
security crisis, and a legitimacy crisis. They propose that these combined
crises are leading to a quest for new ways of organizing the global social
structure and that we may now be at a turning point transitioning to yet
unclear new ways of organizing social life (see McMichael & Weber,
2021). The contributing authors and I have worked on this seventh edition
of this book in the context of an ongoing public health crisis (COVID-19),
intensified global awareness of racial injustice and the long-term impact of
colonialism, a climate and environmental crisis, challenges to electoral
systems at the heart of democracies, and growing economic inequality. I
cannot predict future trends in social structure and social institutions, but I
believe it is important for social workers to think about their work in the
context of contemporary trends and to imagine the possibilities for how
they might help to shape future trends in such a way that they bend
toward social, racial, economic, and environmental justice.

It is increasingly difficult to understand the changes in our own society

without recognizing the global context of those changes. Globalization is
affecting all aspects of social life around the world. Indeed, the process of
globalization has been stimulating changes in the major social institutions
for several decades, but in a pronounced way for the past few decades.
The discussion that follows positions trends in U.S. social institutions
within a global context. Doing so illuminates how U.S. society is both
different from and the same as other societies, and it aids critical thinking
about the question of why we do things the way we do. McMichael and
Weber (2021) suggest that we are at a crossroads, and the long arc of
human history is “now bending toward recognition of the importance of
cultural diversity, racial justice, and biodiversity for human and planetary
sustainability” (p. xv).

We turn now to analysis of trends in eight major social institutions, both

globally and in the United States: the government and political institution,
the economic institution, the educational institution, the health institution,
the mass media institution, the social welfare institution, the religious
institution, and the family and kinship institution. Table 9.1 presents these
social institutions and the major functions they perform for society.
Table 9.1

Critical Thinking Questions 9.1

Do you agree with Anthony Giddens that we live in a “runaway world?

Explain your answer. Do you agree with social scientists who suggest that
recent developments in social institutions have produced an inequality
crisis, financial volatility crisis, energy crisis, climate crisis, security crisis,
and legitimacy crisis? What evidence have you seen in your own life of
the presence or absence of these crises? What evidence do you see in
the case study of Osvaldo Jimenez?

Trends in the Government and Political Institution

Osvaldo Jimenez’s family left ranching in Mexico after the North American
Free Trade Agreement (NAFTA) between Mexico, Canada, and the United
States compromised profits and the value of their land. Osvaldo has lived
in fear of agents of the government, particularly immigration agents.
Osvaldo would like to stay in the United States after he completes his
education, but he has no confidence that the government would pass
legislation that would allow him to do that. The government and political
institution is responsible for how decisions get made and enforced for
society as a whole. It is expected to resolve both internal and external
conflicts and mobilize collective resources to meet societal goals. The
government and political institution facilitates human cooperation and
coexistence in a defined geographical area but also creates and must
manage conflict (Haviland et al., 2017). Our day-to-day lives are
influenced by government in a multitude of ways. Governments are
constantly made and remade by political campaigns, elections, court
rulings, executive orders, war and insurrection, economic circumstances,
and so forth; they are “quite fluid, contested, and even fragile” (Guest,
2020, p. 515).

Political systems around the world vary widely, from authoritarian to

democratic. Authoritarian systems may have a hereditary monarchy or a
dictator who seized power; sometimes democratically elected leaders
become dictators. Leaders in democratic systems are elected by their
citizens and are accountable to them; they must govern in the context of
laws and written documents (Ballantine et al., 2020). Evidence suggests
that the government institution is in transition globally, including in the
United States. There is much complexity in global trends in government
and politics, but the following historical factors are supremely important for
beginning to understand current complexities.

1. Colonialism. The contemporary global political landscape must be

understood in the historical context of colonialism , a process of
dominant and powerful nations going beyond their borders, creating
empires, and occupying and dominating other nations, sometimes by
administrative rule from a distance and sometimes by establishing
permanent settlements in colonized countries (Guest, 2020;
McMichael & Weber, 2021). Eight European countries (Belgium,
Britain, France, Germany, Italy, the Netherlands, Portugal, and Spain)
and Japan and the United States deployed economic, political, and
military force over several centuries to set up colonial empires, which
allowed them to strengthen their own economies by exploiting the raw
materials and labors of the colonized countries. Colonial governments
 took power away from local governance and prevented the localities
from establishing stable political systems. Most of these empires
came to a rather abrupt end after World War II, but they left a
disorganized political legacy in their wake in much of Africa, Central
and South America, and parts of Asia and the Middle East. After the
colonized countries established their independence, the United
States and other Western powers advanced a new institutional
framework that called for free trade and transformation of the formerly
colonized countries into democracies. This new institutional
framework, sometimes referred to as neocolonialism , involves
dominant and powerful nations going beyond their boundaries to
exert influence over formerly colonized and otherwise marginalized
nations and impose their culture, laws, economic system, and
language on them. It is promoted by such international organizations
as the World Bank, the International Monetary Fund (IMF), and the
World Trade Organization (WTO). These organizations, which are led
by the United States and western Europe, regulate relations between
countries, and this role carries much power over political and
economic institutions (Guest, 2020). The United States and western
Europe also played a major role in coercing former colonies to
organize into nation-states with imposed national boundaries that
were inconsistent with age-old ethnic divisions. This has resulted in
ongoing ethnic clashes throughout the former colonies (McMichael &
Weber, 2021). Most of the existing nation-states of the world were
created after World War II, and new nation-states continue to develop
in Europe, Asia, and Africa (Ballantine et al., 2020; Guest, 2020).
2. International power struggles. Across time, groups have tried to
assert their will over other groups, and the struggle for power over
people, ideas, and natural resources is very much a part of the
contemporary geopolitical scene. As nation-states develop, many
become militarized. Guest (2020) suggests that the current era is
marked by continuous war which now involves extraordinary tools
and weaponry. Global networks of individuals, associations,
governments, and industries provide the weapons and finances to
start and maintain wars. Wars are fought between nation-states and
within nation-states. They are fought over territorial boundaries,
natural resources, governing ideology, culture, and religion.
Sometimes nations or transnational organizations use the hard power
of military force to gain power. Other times, they use the soft power of
persuasion and inducement through international aid.
3. Economic globalization. Changes in the government institution are
intertwined with changes in the economic institution, and these
changes taken together are playing a large role in global inequality
(Ballantine et al., 2020; Ritzer, 2021). Beginning in the 1970s,
economic globalization started to present serious challenges to
nationally based democracies. New information and transportation
technologies made possible the development of transnational
corporations (TNCs) , which carry on production and distribution
activities in many nations. TNCs cross national lines to take
advantage of cheap labor pools, lax environmental regulations,
beneficial tax laws, and new consumer markets. It is hard for any
nation-state to monitor or get control over TNCs, and no international
government exists (Sernau, 2020). Under these circumstances,
around 1970, governments began to retrench in their efforts to
monitor and control the economic institution. A neoliberal philosophy
that governments should keep their hands off the economic institution
took hold, perhaps nowhere more than in the United States.
Neoliberalism justifies economic free markets as the organizing
principle of societies. McMichael and Weber (2021) argue that the
neoliberal philosophy seriously limits the ability of political and
government institutions to focus on the common good.
4. Transnational centers of power. Although no international government
exists, the United States played a leadership role in the development
of several transnational political and economic organizations and
policies at the end of World War II. The United Nations (UN) was
developed to ensure international peace and security. The North
Atlantic Treaty Organization (NATO) was formed as a security
alliance between Europe and the United States, stating that an armed
attack against one member state was an attack against all member
states. The World Bank was developed to promote reconstruction in
war-torn nations but has, in recent years, taken on a concern for
poverty. The World Bank president is appointed by the U.S. president.
The International Monetary Fund (IMF) was developed to promote
international monetary cooperation and a fair balance of trade. The
managing director of the IMF is appointed by the United Kingdom,
France, and Germany. The General Agreement on Tariffs and Trade
(GATT) was designed to provide an international forum for developing
freer trade across national boundaries; the World Trade Organization
(WTO) was developed under GATT to regulate the global economy
according to principles of free trade. More recently, the United States,
Canada, and Mexico signed the North American Free Trade
Agreement (NAFTA). European nations joined together as the
European Union (EU), adopting a common currency, a set of common
legal and economic structures, and other joint endeavors. Similar
organizations are in various stages of development in Latin America,
Asia, and Africa. The World Bank, IMF, and WTO, all governed by
unelected officials, have become very powerful in dictating how
nation-states should govern. For example, when making loans, the
World Bank requires that borrowing nations follow the principles of
neoliberalism, including reducing their social welfare programs,
privatizing their public services, and becoming more open to imports.
In 2000, the WTO developed a General Agreement on Trade in
Services (GATS) that compels governments to provide unlimited
market access to foreign service providers. Among other things,
GATS imposes severe constraints on national governments’ ability to
protect the environment. The IMF has enforced these principles,
sometimes overriding decisions made at the national level. The
deliberations of the WTO are secret; members can lodge complaints,
but the decision of the WTO’s dispute settlement program is binding
unless every member of the WTO votes to reverse it. There is much
evidence that the decisions of the World Bank, IMF, and WTO have
been more favorable to Global North nations than to Global South
nations and play a role in continuing global inequality (McMichael &
Weber, 2021). A wave of nationalism, best exemplified by Britain’s
vote to leave the EU and the election of U.S. president Donald Trump
in 2016, is a recent response to the bureaucracies of globalization.
State, local, and federal governments are social institutions responsible
for making and enforcing societal rules. Here we see the state capitol
building of New York, USA.

© Tom Brakefield/Stockbyte/Thinkstock

The future of the neoliberal philosophy is not clear. For a number of

decades, it served wealthy nations and wealthy individuals well. However,
the 2008 global economic crisis called its principles into question and
began to chip away at its primary premise that the market has its own
wisdom and should not be interfered with. For some time now, poor
nations and social justice advocates have engaged in growing resistance
to the neoliberal philosophy and its implementation by the World Bank,
IMF, and WTO. There has been much concern about the unfair advantage
given to Global North wealthy nations and the exploitation of labor and
natural resources in poorer Global South nations. There is also much
concern about the damage done to the environment caused by placing
the chase for wealth and economic growth above any other value and by
the World Bank’s emphasis on energy and export agriculture rather than
on social investments such as education, health services, housing, and
water and sanitation systems. However, there is also much resolve by rich
and powerful individuals and societies to hold on to neoliberal principles
(McMichael & Weber, 2021).

Although not valued in all types of governments around the world,

freedom and liberty are highly valued in democracies. Freedom House, a
nonprofit, majority U.S. government–funded organization in Washington,
DC, provides annual ratings of people’s access to political rights and civil
liberties in 210 countries and territories using a consistent set of criteria.
They report that the COVID-19 pandemic contributed to a weakening of
democracy in 80 countries of the world, with governments responding with
abuses of power, silencing of critics, and undermining systems of
accountability (Freedom House, 2022a). Figure 9.3 shows the 2021
Freedom House (2022b) rankings for the 18 Global North democracies
used as peer countries in this chapter. The higher the score, the greater
the freedom. As you can see in Figure 9.3 , all of the peer countries were
rated to have relatively high freedom in 2021, but the United States had
the lowest score, 83, with Finland, Norway, and Sweden receiving a
perfect score of 100. Freedom House (2022c) suggests that democracy
has suffered erosion in the United States in the past few years, with “rising
political polarization and extremism, partisan pressure on the electoral
process, bias and dysfunction in the criminal justice system, harmful
policies on immigration and asylum seekers, and growing disparities in
wealth, economic opportunity, and political influence” (p. 2). Key U.S.
developments reported for 2021 include the threatened transfer of
presidential power, going so far as insurrection; 19 states passing
electoral laws that make voting more difficult, some even allowing partisan
interference in election management, vote counting, and certification;
criminal cases involving publicized police killings of Black persons; and
deep political divides about the management of the COVID-19 pandemic.
In the following paragraphs, we look briefly at three important
governmental issues: immigration, the COVID-19 pandemic, and
economic disparities.
Description

Figure 9.3 Rankings of Freedom in 18 Global North Democracies

Source: Freedom House, 2022b.

A confluence of economic globalization, war, political strife, and climate
disasters has produced mass cross-national migration. Most of this
migration has occurred within regions; but there is also a trend of
migration from low-wage to high-wage countries (McMichael & Weber,
2021). This has led to considerable political attention to immigration
issues around the globe. In the United States and Europe, immigration
issues are the source of intense political debate. As we think about the
trials of Osvaldo Jimenez, we are reminded of this increased attention to
immigration issues. The U.S. Congress has not been able to agree on
comprehensive immigration policy, and immigration issues are often used
as wedge issues during elections. The Trump administration succeeded in
reducing the number of legal immigrants, refugees, and asylum seekers
entering the United States, and the Biden administration has reversed
some of those policies but kept others in place. Legal challenges argue
that asylum seekers’ basic due process rights are violated, and human
rights groups criticize the poor conditions in immigration detention facilities
(Freedom House, 2022b). With the lack of clear federal guidelines, local
and state governments have become ground zero for the country’s volatile
immigration politics (Nicholls & de Wilde, 2023).

Governments must be able to gain the trust and cooperation of the

populace. That is crucial when a society faces a major and novel crisis
like the COVID-19 pandemic. Researchers have engaged in cross-
national study of how governments responded to the pandemic. Some
researchers point out that countries like China, Singapore, and South
Korea developed strict containment measures such as lockdown early in
the pandemic while liberal democracies like the United States, the United
Kingdom, and France took more lenient approaches (Chen et al., 2021).
Chen et al. (2021) suggest that it is harder for liberal democracies to limit
human actions, noting that in Sweden freedom of movement is
constitutionally protected. In a study of four North Atlantic countries—
Canada, Ireland, the United Kingdom, and the United States—Unruh et al.
(2022) found that gaining the cooperation of the public was aided by
consistent messaging (a challenge with a novel virus) and alignment
between the health experts and political leadership. All four of the
countries under study had pandemic plans in place prior to COVID, but
the plan was not activated in the United States. Public health agencies
were not independent from the government in any of the four countries,
but in the United States the executive branch interfered with public health
decisions, communications, and guidelines, going so far as rewriting
scientific guidelines. The United States, Canada, and the United Kingdom
took a more decentralized approach than Ireland, and this had both
positive and negative consequences. On the positive side in the United
States, state and local governments were able to take a more scientific
approach than what was being proposed by the executive branch of the
federal government. On the negative side, some states took a less
scientific approach than what was available. It is important to note that
rapid, robust federal fiscal policy responses to the pandemic in the United
States aided economic recovery, but political polarization about the
implemented containment measures linger (Center on Budget and Policy
Priorities, 2022).

Two important political issues play a large role in the level of economic
inequality in a society: tax policy and minimum wage policy. European
governments tax their wealthier citizens at a much higher rate than the
United States does and set higher minimum wages. The COVID relief
effort and American Rescue Plan in the United States made a number of
changes to antipoverty polices, and poverty fell by the largest amount in 5
decades, demonstrating that governmental policy makes a difference in
economic inequality.

Actions of the government impact what social workers can and cannot do
to promote individual and collective well-being. Social workers cannot
afford to ignore processes and trends in the political arena. In the United
States, social workers must be attuned to the important role money plays
in providing access to government and politics, to continuing
underrepresentation of women, people of color, and members of other
marginalized groups among elected officials, and to existing and proposed
barriers to access to the electoral process. They must also be aware of
the possibilities of what can be accomplished by collective action, the
subject of Chapter 14 in this book.

Trends in the Economic Institution

Osvaldo Jimenez worked at three jobs while attending community college

in the United States. Because of his immigration status, he was paid
“under the table,” at a rate even lower than the minimum wage in
California. When he transferred his studies to Reno, Nevada, he worked
long weekends to receive a higher pay rate, and often slept in his car or
on couches to economize. The economic institution has primary
responsibility for regulating the production, distribution, and consumption
of goods and services. The nature of the economy has been ever
changing since premodern times, but the rate of change has accelerated
wildly since the beginning of the industrial revolution, particularly in recent
decades under neoliberalism and economic globalization.

Economic life can be organized in many ways, and a great variety of ways
have been used over time. In recent times, different approaches to
organizing the economic institution around the world fall on a continuum,
with market capitalism at one end and a centralized or planned economy
at the other end. In market capitalism, the economy operates by voluntary
exchange in a free market and is not planned or controlled by a central
authority. The goods and services produced by human labor are
exchanged in the market and not produced for consumption by the
laborer. The means of production are privately owned by one group, and
another group, the workers hired through a labor market, own little
besides their capacity to work. No governmental interference is thought to
be needed because “the invisible hand of the market” will ensure fair
production and distribution, including fair profit for some and not for
others. Investment is privately controlled. In a centralized or planned
economy, the government plans and controls production and distribution
of goods and services. The means of production are collectively rather
than privately owned, and the terms of labor are regulated by the
government rather than by the market. In such economies, there is deep
distrust of the exploitation of labor thought to occur in a market run by a
financial elite in pursuit of their own self-interests (Ballantine et al., 2020;
Guest, 2020; Ritzer, 2021).

In reality, no country in the world today practices either pure market

capitalism or a pure planned centralized economy. The U.S. economy is
thought to be a special case of capitalism in the world today, coming the
closest to pure market capitalism. And yet there are a number of ways in
which national and state governments in the United States interfere with
market-based production and distribution of goods and services, including
labor regulations; farm, oil, housing, automobile, and health care
subsidies; public education; and unemployment insurance, Social
Security, Medicare, and Medicaid (Ballantine et al., 2020; Subsidy
Tracker, 2022). A number of countries have mixed economies, where the
good of the whole society is considered paramount and private profit is
less important than in pure capitalism. In these countries, collective
planning is engaged in an attempt to balance societal needs with
individual economic freedom. Northern European countries are the best
examples of mixed economies. The former Soviet Union was once
considered to be the best example of a planned economy, but since its fall
in 1991, the region no longer holds that distinction. China is often thought
to be the current best example of a pure planned economy today but, in
fact, is becoming a dominant capitalist force while holding on to its highly
centralized government (McMichael & Weber, 2021). There is much
agreement that economic globalization is pushing all countries toward
some embrace of market capitalism.

Before further discussion, some clarity is needed about what we mean by

economic globalization , whose primary ingredients are a global
production system, a global labor force, and global consumers organized
through a global market. Much of what we wear, eat, and use has global
origins, involving commodity chains located in a number of countries. If
you look around your room, you will see many examples of economic
globalization, but much of the global process will be invisible to you. The
globalization of commodity medical supply chains became the focus of
much attention in the early days of the COVID-19 pandemic, and other
supply chains were disrupted for months as well (Mahajan & Tomar, 2020;
Pitschner, 2022).
Walmart is a growing symbol of economic globalization.
© Teh Eng Koon/AFP/Getty Images

The global economy is driven by corporate desire for the bigger profits
that come from cheap raw materials and cheap labor and by consumer
desire for inexpensive and novel products. Corporations are constantly
seeking cheaper labor sites to stay competitive. Much of the global
economy is controlled by TNCs. TNCs have become very powerful over
the past several decades; in fact, UN data indicate that TNCs account for
two-thirds of world trade and hold most product patents (cited in
McMichael & Weber, 2021).

Proponents of economic globalization argue that in time it will bring

modernity and prosperity to all regions of the world. Critics argue that it is
just an unsustainable pyramid scheme that must end because prosperity
of victors is always paid for by the losses of latecomers and because the
physical environment can no longer sustain the economic activities
(Sernau, 2020). This is a good place to point out that not all peoples of the
world put a high value on consumerism and chasing economic growth,
values that are central to globalization. Unfortunately, however, policies of
the World Bank, IMF, and WTO have made it impossible to make a living
on subsistence farms and small-craft enterprises. A number of
globalization scholars argue that economic globalization as we have
known it is not sustainable because of the social disruption and
environmental degradation it has wrought and that we may be seeing the
beginning of a transition to a different form of capitalism that puts greater
emphasis on sustainability (see Banerjee & Duflo, 2019; McMichael &
Weber, 2021). The future of globalization is not certain, but several trends
can be identified at its current stage of development.

1. Slowed economic growth. For about 30 years following World War II,
rapid economic growth occurred in Western Europe, the United
States, and Canada, but this rate of growth came to a halt in 1973.
Economists have many theories about why this happened, but
Banerjee and Duflo’s (2019) review of the research indicates that it is
not at all clear. It appears that economic growth slows as countries
get to a certain level of per capital income. The United States and
some other countries have responded to slowed economic growth by
lowering taxes on the wealthy and asking poor people to tighten their
belts, based on the theory that the benefits to the wealthy will trickle
down and stimulate a more rapid pace of economic growth. The
 research does not support this theory, and even the IMF now
recognizes that it is bad policy to try to promote growth on the backs
of poor members of society.
2. Regional disparities. Rich nations have been getting richer, a few
nations have made impressive gains, most poor nations have made
few gains, and the poorest nations have lost ground. Current
economic arrangements are also creating regional disparities in the
United States, with some regions being at risk of being permanently
left behind (Banerjee & Duflo, 2019).
3. Labor force bifurcation. As globalization progressed, wage labor
began to bifurcate , or divide into two branches. One branch is the
core of relatively stable, skilled, well-paid labor. The other branch is
the periphery of periodic or seasonal (often referred to as casual) low-
wage labor. People involved in casual labor suffered the greatest
economic loss during the COVID-19 pandemic. In the new global
division of labor, the upper tier of jobs is found disproportionately in
the wealthy Global North countries, and the lower tier of jobs is found
disproportionately in the previously colonized countries. Recently,
however, bifurcation of labor has occurred all over the world, in
wealthy Global North societies as well as in poor, newly industrializing
societies in the Global South (Banerjee & Duflo, 2019; McMichael &
Weber, 2021). In the United States, a few firms have captured
particular economic sectors, and huge wage and benefit differentials
have developed between the giant firms and other firms in the sector.
The current period of labor force bifurcation has also been
accompanied by a precipitous increase in chief executive officer
(CEO) salaries and stagnation in wages of other workers (Banerjee &
Duflo, 2019). The CEO-to-worker compensation ratio in the United
States is much higher than in most other countries, and this is an
important contributor to growing inequality in the United States.
4. Displacement. Since the 1980s, automation and outsourcing of work
have produced left-behind workers and left-behind regions in many
countries (Banerjee & Duflo, 2019). In the United States, workers
without a college education have increasingly been displaced from
mid-skill jobs, such as clerical and administrative jobs, and pushed
into lower-skilled roles such as cleaning and security. Many European
countries have invested more than the United States in stabilizing the
employment opportunities for displaced workers, providing longer
term unemployment insurance and job transition programs.
5. Labor exportation. Migration for the purpose of finding work is not a
new phenomenon, but it has become an important part of economic
globalization. As many formerly colonized countries struggled to
repay debt incurred during the 1980s, exporting workers became a
way for countries to gain access to foreign currency. Remittance flows
from exported laborers working in wealthy countries to their families
in low-income countries bolstered the economies in some low-income
countries, and remittance-dependent regions were negatively
impacted by COVID-19 when many casual laboring migrants became
unemployed (Gupta et al., 2021). A majority of labor migrants are
women and children, and both women and children are vulnerable to
human trafficking. Human trafficking , or the trade in humans, has
received increasing global attention in the recent years. Human
trafficking is one of the most lucrative international criminal activities.
Van Buren et al. (2021) report that the outsourcing and
subcontracting business supply chain model creates incentives for
and enables human trafficking. Labor trafficking occurs in a wide
range of labor sectors, including domestic work, hospitality services,
agriculture, fishing, mining, forestry, clothing manufacturing,
construction, electronics manufacturing, transportation, and
warehousing.

6. Limited protection by organized labor. Since the beginning of

industrial capitalism, labor unions have been the force behind
governmental protection of workers’ rights, fighting successfully for
such protections as workplace safety, a minimum wage, a reduced
workweek, and pensions. Economic globalization has seriously
weakened the bargaining power of nationally based labor unions
because companies can always threaten to take their business
somewhere else. In the United States, the rate of union membership,
or the percentage of all workers who are union members, decreased
from 26% in 1945 to 10.1% in 2022 (Bureau of Labor Statistics, 2023;
Wikimedia Commons, 2020). However, labor unions are still strong in
some countries. Figure 9.4 shows data on the rate of union
membership in the 18 Global North peer countries in the period
2018–2020 (International Labor Organization, 2023). You might
notice that the five countries with the highest rate of union
membership are among the six countries with the lowest rates of
inequality. In the United States, the union membership rate of public-
sector workers (31.1%) is more than 5 times that of private-sector
 workers (6.9%) (Bureau of Labor Statistics, 2023). In 2022, U.S.
union workers had median weekly earnings of $1,216 compared to
$1,029 for nonunion workers (Bureau of Labor Statistics, 2023).

Description

Figure 9.4 Percentage of Employees in Unions in 18 Global North

Countries 2018–2020

Source: International Labor Organization, 2023.

It is too early to know the long-term impact of the COVID-19 pandemic on

the economic institution, but governmental policies in many countries,
including the United States, reduced the economic impact of the
pandemic. In the early phase of the pandemic, many lower-wage workers
lost their jobs and other lower-wage workers were considered essential
workers and could not follow social-distancing guidelines. For higher-
wage workers there was a sudden large increase in people teleworking
from home, and some analysts predict that working from home will
continue to occur at higher than pre-COVID levels (Jain et al., 2022).
Shopping for all kinds of products had been moving online for some time,
but the pandemic greatly increased that trend.

Social workers who participate in policy development must be informed

about the serious challenges to job security in the contemporary era. They
are also called on to deal with many of the social problems arising out of
job insecurity in the economic institution—problems such as displaced
workers, inadequate resources for family caregiving, domestic violence,
substance abuse, depression, and anxiety.

Critical Thinking Questions 9.2

What impact, if any, do you think the neoliberal philosophy in the

government and political institution is having on diversity, equity, and
inclusion in societies around the world? What have you heard about the
benefits of economic globalization? What have you heard about harms
from economic globalization? What do you make of the controversy about
whether economic globalization is a good or bad thing? How is economic
globalization affecting the government institution? How is economic
globalization affecting Osvaldo Jimenez?

Trends in the Educational Institution

Receiving an education has been the driving force of Osvaldo Jimenez’s

life since he was 17 years old and had to stop schooling in Mexico due to
the violence by drug cartels. In the United States, he has faced many
struggles to get access to and complete undergraduate and graduate
education. His pursuit of education has been both thwarted and supported
by college and university administrative staff and faculty. Traditionally, the
primary purpose of the educational institution has been to pass along
formal knowledge from one generation to the next—a function that was
largely performed by the family, with some help from the religious
institution, until the 19th century. Formal education , schooling that
includes a predetermined curriculum, has expanded dramatically around
the world in the past several decades, and yet there are parts of the world
where formal education is minimal.

In 2015, several international organizations worked together to organize

the World Education Forum 2015 in Incheon, Republic of Korea. The
participants adopted the Incheon Declaration for Education 2030, which
presents a vison for world education by 2030. The goal is to “ensure
inclusive and equitable quality education and promote lifelong learning
opportunities for all” (UNESCO, 2015). Guidelines for meeting this goal
include the following (it is important to note that these guidelines assume
a gender binary rather than using the more inclusive language of “all
people”):

1. Ensure that all girls and boys complete free, equitable, and quality
primary and secondary education.
2. Ensure that all girls and boys have access to quality early childhood
development, care, and preprimary education so that they are ready
for primary school education.
3. Ensure equal access for all women and men to affordable and quality
technical, vocational, and tertiary education, including university.
4. Substantially increase the number of youth and adults who have
relevant skills, including technical and vocational skills, for
employment, decent jobs, and entrepreneurship.
5. Eliminate gender disparities in education and ensure equal access to
all levels of education and vocation training for the vulnerable,
including persons with disabilities, Indigenous peoples, and children
in vulnerable situations.
6. Ensure that all youth and a substantial proportion of adults, both men
and women, achieve literacy and numeracy.
7. Ensure that all learners acquire the knowledge and skills needed to
promote sustainable development.

The last guideline related to sustainable development is a new guideline

not previously included in goals for international education, consistent with
growing international concern about the global climate crisis.

In an era of a knowledge-based global economy, there continue to be

large global gaps in opportunities for education, as reflected in UNESCO’s
2020 Global Education Monitoring Report (UNESCO, 2022). There is
much evidence of long-term benefits of quality early childhood education,
and globally 75% of children attended preprimary education in 2020, but
that was true of only 43% of children in low-income countries. Gender
parity in education has been achieved at the global level, but not in all
countries.

Nations around the world structure their educational systems in different

ways, and we have heard a lot in this era of intensified global competition
about how educational outcomes in the United States stack up against
those in other high-income countries. Across the political spectrum and in
the media, there has been much commentary in the late 20th and early
21st centuries to suggest that public education in the United States is
broken. Education historian Diane Ravitch (2010, 2013, 2020) has found
that in almost every decade of the 20th century, critics loudly proclaimed
that the public education system was in crisis. The nature of the proposed
crisis shifted over time: sometimes the schools were considered too
academic and not sufficiently tied to the needs of the industrial economy,
and other times the schools were attacked for their lack of academic rigor.
More recently, the proposed crisis in the educational institution has
focused on the achievement gap between children of different racial,
ethnic, and class groups, but contemporary criticisms also emphasize the
poor performance of U.S. students on international tests. Just as the
nature of the proposed crisis has shifted over time, so has the nature of
the proposed solutions, with each generation of policymakers assuming
they have found the silver bullet to fix the educational institution.

The story told by the U.S. mass media is often one of decline in the
educational institution. For example, a 2010 Newsweek story indicated
that “once upon a time, American students tested better than any other
students in the world. Now, ranked against European schoolchildren,
America does about as well as Lithuania, behind at least 10 other nations”
(Thomas et al., 2010, p. 24). Long-term data suggest, however, that there
has never been a time when U.S. students were first on international
tests. When the first international tests were administered in the mid-
1960s, U.S. students ranked at or the near the bottom of all students
tested. In the 1970s, 1980s, and 1990s, U.S. students typically scored in
the bottom quartile or near the international average (Ravitch, 2010).

For over two decades, billionaire philanthropists (such as the Walmart

Walton family, DeVos family, Koch brothers, Michael Bloomberg, and Bill
Gates) joined with Republican and Democratic politicians in the United
States to promote a range of solutions to the false story of educational
decline. They have attempted to privatize public schools, break teachers’
unions, and attack teacher professionalism. Billions of dollars have been
poured into privatized charter schools often run by corporate chains and
voucher programs to allow families to use public education money to
attend private schools of their choice. In the drive to improve international
testing scores, annual testing in Grades 3–8 was introduced, a common
core curriculum was adopted, low performance schools were closed, and
teacher pay was tied to student test scores. None of these experiments
were field tested before being implemented on national and state levels,
but improved test scores were the proposed measure of their success
(Ravitch, 2020).

If improved test scores are the sign of an improved educational institution,

these experiments failed (see Ravitch, 2020; Stecher et al., 2018). As I
write this, I am looking at the most recent performance (2018) of U.S. 15-
year-old students on testing by the Program for International Student
Assessment (PISA). The results for the three literacy areas—
mathematics, science, and reading—are summarized in Table 9.2 , along
with a comparison of U.S. student scores with scores of students from 77
other countries, including all of the 17 Global North peer countries used in
other sections of this chapter. Overall, 24 education systems had higher
average scores than the United States did, including 12 of the Global
North peer countries. The highest overall average score was for students
from China (Beijing, Shanghai, Jiangsu, Zhejiang). Their average score
was 578.8, and the average score for the United States was 495.0. The
average scores of U.S. students was above the international average on
reading, average in science, and below the international average in
mathematics. The mean U.S. student performance in reading,
mathematics, and science has remained about the same since 2006, with
no significant improvement nor decline (Schleicher, 2019). The story told
by these data is that U.S. students do not stand out on international tests
and are not faring better after over 2 decades of ongoing national policy
experiments.

Table 9.2
Source: Based on Schleicher, 2019.

Another story of crisis in the U.S. educational institution—a story of

disparity of educational outcomes—is a long-standing problem. The crisis
has been explained as an achievement gap between white students and
students of color, but recent research indicates that it is a gap created at
the intersection of race and economic class (Guerrero, 2021; Hung et al.,
2020; Paschall et al., 2018). Educational disparities have been measured
by national and international test scores, school grades, and school
completion. In a study of 2 decades of educational disparities, Paschall et
al. (2018) found the gaps are wide for both race/ethnicity and economic
class, with a growing gap between poor white students and poor Black
and Hispanic students. Greater time spent in poverty is associated with
poorer educational outcomes. Guerrero (2021) also found a large gap in
mathematics scores between wealthy Black and white students, with
wealthy white students scoring higher than wealthy Black students. Barton
and Coley (2010), of the Educational Testing Service, examined the
white–Black gap in educational achievement from the beginning of the
20th century to 2010. They found a large reduction in the gap in the 1970s
and 1980s, when Black students made greater gains than white students.
They also found that improvement in reducing the gap stagnated in the
1990s, and progress has continued to slow since that time. The gap
remains large. In a 20-year study of the period 1986–2005, Paschall and
colleagues (2018) found no evidence of national progress on racial and
class educational disparities. The 2018 PISA test scores indicate that
socioeconomically advantaged students in the United States outscored
socioeconomically disadvantaged students by 99 points in reading
(Schleicher, 2019). No attempt to “fix” schools will “fix” gross economic
inequality and a long history of racial discrimination in a number of social
institutions.
Some students of the world attend well-resourced schools while these
students in southern Ethiopia face a very different situation of educational
resources.

© AP Photo/Michael Sohn

In the height of the COVID-19 pandemic in March 2020, more than 190
countries closed schools and made an emergency shift to remote learning
(Aurini & Davies, 2021). School administrators, teachers, and students
had to make a quick adaptation to this new method of schooling. Equity
issues were paramount, with concerns about equitable access to
electronic devices, wireless connectivity, and home spaces for remote
school participation. Food insecurity was a concern for students eligible
for free and reduced-price lunch, and accommodating students with
special educational needs was another challenge (Ashta et al., 2022;
Gothwal et al., 2022). The challenge was experienced at every level of
education, and there is evidence of an emotional toll on many
administrators, teachers, and students (Ashta et al., 2022; Casacchia et
al., 2021; Cormier et al., 2022; Far Abid Hossain et al., 2020; Nurunnabi
et al., 2020). Administrators and teachers were concerned that the
COVID-19 shutdown would exacerbate race and class disparities in
educational outcomes. It is too early to know what the long-term impact is,
but preliminary findings from the Netherlands and the United States
suggest that may have happened in the short term. In the Netherlands,
which had only an 8-week school shutdown, learning loss from the
shutdown was found to be 60% higher among students from homes with
less-educated parents (Engzell et al., 2021). In the United States,
students had recovered from learning loss in reading by November 2020,
but mathematics learning loss continued for high school students into the
2021–2022 school year. The largest negative impacts were for students in
urban Title 1 schools serving high numbers of low-income students and
Black or African American, Hispanic or Latino, and American Indian or
Alaska Native students (Kuhfeld et al., 2020; Renaissance Learning,
2022).

In 2022, organized parent groups and state legislatures in the United

States challenged curriculum content on race, racism, gender identity, and
sexual orientation in K–12 schools. State lawmakers proposed 137 bills
restricting classroom discussion and staff training about these topics, a
250% increase from 2021. By the spring of 2022, 17 states had passed
policies to restrict how teachers can address issues related to race,
gender, and “divisive concepts.” Bills to restrict freedoms of LGBTQ+
students have increased greatly over the past few years (Pendharkar,
2022). A January 2023 report by the Rand Corporation, Walking on
Eggshells, found that one-quarter of teachers indicate that these policies
are influencing their choice of curriculum materials and instructional
practices; other teachers resist (Woo et al., 2023). A Washington Post
analysis found that 28% of these laws explicitly limit instruction on race
and racism, and 23% explicitly limit instruction on gender identity,
sexuality, and LGBTQ+ issues (Natanson, 2023). Other laws are vague,
referring to anything that could be controversial or potentially offensive.
Many teachers report that these laws and restrictions are making them
fearful of any discussion about race, gender, and sexuality (Woo et al.,
2023), and they most likely are also making for a fearful environment for
LGBTQ+ and racialized students.

Around the world, the public and leaders are concerned about whether
their educational institution is responding well to globalization and the
rapid pace of change in other institutions (Ballantine et al., 2020).
Certainly, there is a need for improvement in the U.S. educational
institution, and it makes sense to look for ideas from the countries that
have successful educational institutions based on two criteria: First, their
students score well on international testing, and second, their students’
socioeconomic status and race or ethnicity do not have a large impact on
learning outcomes. Evidence suggests that the best educational
outcomes occur in countries where there are universal early childhood
education programs; where the teachers are well-trained, experienced,
well-paid, highly respected, and given professional autonomy; where the
curriculum is broad-based and rigorous; and where there are resources to
address the needs of students in every school (Ravitch, 2013, 2020).
Ravitch (2020) suggests a number of evidence-based interventions that
could have had a greater positive impact on educational achievement
than recent U.S. educational policies have had. Here are just a few of
them: Ensuring that all parents and children have access to regular
medical checkups; ensuring that all students have nutritious meals;
providing good after-school programs where children get exercise, play,
and tutoring; ensuring all schools provide art supplies, dramatics,
marching bands, jazz bands, orchestras, and choral groups; reducing
class sizes; and providing teaching assistants, social workers, librarians,
nurses, counselors, books, and other supplies.
Social workers can help schools and parents become more comfortable
with each other. Social workers should also become active partners in
efforts at educational reform, particularly those that equalize educational
opportunities, but to be effective in these efforts, we need to be informed
about trends in the educational institution. By the time you read this, the
public conversation about the educational institution and ways to improve
it may have shifted again. We must carefully evaluate whether what we
see and hear in the mass media about circumstances in the educational
institution is supported by available evidence.

Trends in the Health Institution

Osvaldo Jimenez’s employers have not provided health insurance, and he

cannot afford an individual insurance plan. Due to his immigration status,
he does not qualify for Medicaid or reduced-fee plans through the
Affordable Care Act. When he suffered injuries to his hand and back, he
was able to receive limited care from a community health clinic that
charged on a sliding scale. The health institution is the primary one for
promoting the general health of a society. At one time, health was
addressed primarily in the home, by families. Today, in wealthy countries,
health is a major social institution, and health care organizations are major
employers (Ballantine et al., 2020). The preamble to the constitution of the
World Health Organization (WHO) defines health as a “state of complete
physical, mental and social well-being and not merely the absence of
disease or infirmity” (World Health Organization, 2023, para. 1).
Unfortunately, there is much disparity in global health. One commonly
used measure of a society’s health is the average life expectancy at birth.
WHO (2022) reports that the average life expectancy at birth in 2019
ranged from 50.7 years in Lesotho to 84.3 in Japan.

Societies around the world have developed widely different approaches

for achieving and sustaining health. Not all societies apply a Western
scientific understanding of health and healing, but increasingly Western
societies are integrating some non-Western practices with Western
medicine and non-Western societies are integrating some Western
medicine with non-Western practices (Guest, 2020). Global health
organizations such as the World Health Organization, the Red Cross, and
Doctors without Borders provide preventive health services, such as
immunizations, and humanitarian medical aid to low-income Global South
countries, using Western scientific medicine, and must find ways to
coordinate with the cultures and belief systems of the countries served. In
a study conducted in rural West Bengal, India, Dutta (2020) found that
Indigenous people in the region prefer a bottom-up, community-led
approach to building health infrastructure. They would like to be able to
contact institutions external to the community for resources and/or
suggestions while maintaining control over the developing infrastructure.

In Global North countries, there are two health systems in the health
institution, a preventive health system and a curative health system
(Jacques & Noël, 2022). The preventive health system, otherwise known
as the public health system , focuses on protecting and improving the
health of people and their communities, the health of the whole
population. This effort includes promoting healthy lifestyles; researching
and disseminating knowledge about disease and injury prevention; and
preventing, detecting, and responding to infectious diseases. The curative
health system, also known as therapeutic care , focuses on diagnosing
and providing treatments for illness or injury of individual patients.
Jacques and Noël (2022) found that people in Global North countries are
more likely to support funding for therapeutic care for individuals than for
public health. They also found that in times of austerity, Global North
countries make cuts in funding for public health, which is what happened
after the global 2008 recession. The COVID-19 pandemic highlighted the
importance of strong public health systems. Some health providers in the
Global South countries where the health institution infrastructure is
underdeveloped argue for greater emphasis on public health than curative
health (Babatunde et al., 2021; Ofoli et al., 2020).

Different societies organize their health systems in different ways, with

Western Global North societies developing large bureaucracies to
manage health promotion and health care delivery. Most governments in
Europe made a decision in the late 1800s and early 1900s to support
health care as a human right and put some form of national health care
system into place. Some countries (Nordic countries, Southern European
countries, the United Kingdom, Australia, and Canada) have state
regulated and financed therapeutic health systems, and other countries
(German-speaking countries, France, Japan, and Eastern European
countries) have shared financing and regulation between the federal
government and social partners (Jacques & Noël, 2022). The United
States is unique among Global North countries in its highly fragmented
multi-payer therapeutic care system, with a mix of publicly financed
programs and private insurers (Ballantine et al., 2020; McClellan et al.,
2022). This system developed in piecemeal over time, with medical
practitioners, facilities, and insurance and drug companies establishing
themselves and resisting government involvement (Ballantine et al.,
2020). The U.S. health institution is known for its quality of care in some
specialty areas, its facilities, medical education, and advanced medical
technology, but its critics suggest it is a social problem itself. The United
States spends more per person on health care than any country in the
world, and yet it lags behind all other Global North countries in life
expectancy. It also has higher suicide rates, higher chronic disease
burden, and higher hospitalizations for preventable causes than other
Global North countries. The United States has also struggled with
misdiagnosis and medical errors leading to preventable deaths and
enduring race and class health disparities (Isasi et al., 2022).

The Organization for Economic Co-operation and Development (OECD),

an intergovernmental organization of 38 countries, does an annual report
of health indicators in all 38 countries, including the 18 countries used in
this chapter as peer countries. In 2021, they found that 13 of the peer
countries had universal (100%) health care coverage, over 90% of the
population were eligible for paid health care in 4 other countries, and the
United States had health care coverage for 89.8% of the population.
Figure 9.5 presents two graphs based on data from the most recent
OECD report, showing data for 2019 (OECD, 2021). The top graph shows
health spending per capita. The United States spent more per person on
health care than any of the peer countries; at $10,948 per capita, it spent
3 times the amount spent in the country with the least per person
expenditure, Spain at $3,600. The graph on the bottom shows that the
United States had the lowest average life expectancy of all the peer
countries in 2019, and since that time, the average life expectancy in all
the peer countries has been increasing while it has been declining in the
United States (Isasi et al., 2022; OECD, 2021). The OECD also reports
data on avoidable mortality per 100,000 deaths. In 2021, the United
States (265 per 100,000 deaths) had more avoidable mortality than any of
the peer countries, twice the number of Switzerland, the country with the
lowest avoidable mortality (122 per 100,000 deaths) (OECD, 2021).
Description
Figure 9.5 Health Spending Per Capita and Life Expectancy at Birth for 18
Global North Countries, 2019

Source: OECD, 2021.

COVID-19 put stress on health institutions around the world, both the
public health systems and the curative health systems, and the pandemic
illuminated both the strengths and the fragilities of health institutions. In
the United States, the National Academy of Medicine (2022) engaged in a
comprehensive study to examine how the U.S. health institution fared
during the COVID-19 pandemic, highlighting the weaknesses in the health
institution that existed prior to the pandemic and the opportunities to
strengthen and transform the institution. The report found the following
weaknesses in the health institution prior to the pandemic (Isasi et al.,
2022; Madara et al., 2022; McClellan et al., 2022):

Underinvestment in the public health infrastructure, resulting in

understaffing and outdated technology for both preventive and
emergency public health services
Lack of coordination between public health and therapeutic health
systems
Lack of access to therapeutic services for millions of people (14.5%
of population lacked health insurance, 23% of Medicare beneficiaries
were underinsured)
Uneven distribution of providers across geographic areas, with 80%
of the rural population medically underserved
Longstanding disparities in population health for marginalized groups
Institutional racism
High stress levels among health care workers (35–45% reported
occupational distress)
Disconnected and gaps in digital health systems
High cost of health care, with premiums and deductibles outpacing
the growth of median household incomes

The National Academy of Medicine (2022) report declared the U.S.

response to the COVID-19 pandemic devastating, even though
individuals, families, and communities were resilient (Isasi et al., 2022). In
his book The Premonition: A Pandemic Story, Michael Lewis (2021) tells
an engaging but sad story about how the U.S. public health system came
to be so unprepared for the pandemic. The morbidity and mortality rates in
the first wave of the pandemic disproportionately affected populations by
age, income, geographic location, education, race, ethnicity, gender and
sexual orientation, and immigration status (Garcia et al., 2021; Isasi et al.,
2022; Lopez et al., 2021). Essential employees, including health care
providers, were more likely than the general population to be exposed to
COVID-19. Medical supply chain problems disrupted treatment. There
was a shortage of behavioral/mental health providers, more so in some
geographic areas than others. Marginalized populations had less access
to testing, tracing, treatment, and vaccination (Isasi et al., 2022). There
were challenges in receiving routine preventive care and screening, as
well as disruptions in chronic disease management. Many home- and
community-based care providers lacked access to personal protective
equipment (PPE). And, finally, the pandemic was politicized, and the
public health system came under attack, creating confusion and conflict in
the public. During 2020 and 2021, the United States had the fourth
highest number of COVID-19 deaths per million population among the
peer countries used in this chapter (behind the United Kingdom, Belgium,
and Italy), and the most COVID-19 cases per million population (OECD,
2021).

Based on their analysis of the pre-pandemic state of the U.S. health

institution and its performance during the pandemic, the Academy of
Medicine (2022) report also proposed guidelines for improvements to the
U.S. health institution, summarized below (Abernethy et al., 2022).

Center action on individuals, families, and communities, not just on

individuals.
Commit to equity as a core health system performance measure.
Seek input from marginalized communities to improve equity.
Secure the public health infrastructure for 21st-century health
challenges, including pandemics and other emergencies.
Build a strong and integrated digital health and data-sharing
infrastructure.
Integrate telehealth into payment and delivery systems.
Invest in workforce capacity and readiness.
Streamline pathways for biomedical research.
Strengthen the stewardship of the health product supply chain.
Restructure health care payments to focus on outcomes and
population health.
 Foster communication and collaboration across sectors and
stakeholders.
Integrate medical and behavioral health.
Coordinate delivery of both health and social services with community
organizations.

Social workers should seek to have a strong voice in working toward

several of these guidelines, but especially these three: seeking input of
marginalized communities to improve equity, integrating medical and
behavioral health, and coordinating delivery of both health and social
services with community organizations.

Trends in the Mass Media Institution

Osvaldo Jimenez is aware of the negative stereotypes about immigrants

that are prevalent in the mass media., and in settings that feel safe he
tells his immigration story to counter the stereotypes. The mass media
institution is the primary institution for managing the flow of information,
images, and ideas among all members of society. Mass media serves an
entertainment role for society, but it also influences how we understand
ourselves and the world. Mass media technology is the engine of
globalization, giving people worldwide immediate access to other cultures
and other markets. Rapid advances in electronic communication
technology since the 1950s have resulted in widespread access to
multiple forms of mass communication—traditional media such as
newspapers, magazines, books, radio, television, and film and Internet-
based media such as digital television and radio, social media, digital
videos, electronic documents, video games, and websites. Increasingly,
traditional media are integrated with Internet-based media, blurring the
lines between them. Electronic media now allow two-way as well as one-
way communication, and they can store and manipulate vast amounts of
information (Hanson, 2022).

The mass media are thoroughly embedded in our daily lives, so much so
that Croteau and colleagues (2022) suggest that the mass media
institution is the dominant social institution in contemporary life in the
United States and many other countries. It is estimated that in 2022, U.S.
adults spent an average of 13 hours and 11 minutes per day using a
variety of media, including smartphones, desktops/laptops, social
networks, YouTube, TV, radio, digital video, and digital audio (Cramer-
Flood, 2022). This estimate does not include print media. During the
COVID-19 pandemic, mass media played an even more important role in
the daily lives of most people. In March 2020, during the early days of the
pandemic, the time people in the United States spent online via mobile
devices doubled compared to the previous year (Nielsen, 2020).
Government and politics, economic, education, health, social welfare,
religious, and family functions were conducted using electronic
technology.

There are great disparities around the globe in Internet availability,

affordability, and quality of service, a situation known as the digital divide.
In 2020, the UN’s Broadband Commission for Sustainable Development
(International Telecommunication Union and United Nations Educational,
Scientific and Cultural Organization, 2020) estimated that nearly 3.6 billion
people in the world remained totally unconnected to the Internet, with
about 53.6% of the global population online. Internet access is about twice
as high in urban areas as in rural areas around the world, and
economically marginalized and disabled people around the world have
less Internet access than the general population (Johansson et al., 2021).
The digital divide deepens other inequalities such as access to health
care, economic opportunity, and educational opportunity.
Mass media technology is the engine of globalization, and people around
the world are saturated with images from multiple media forms.

© JOSEP LAGO/Getty Images

Sociologists who study the mass media institution suggest that when
considering trends in mass media, four elements of media should be
considered: media content, media technology, media industry, and media
users (Croteau et al., 2022; Hodkinson, 2017). Figure 9.6 presents a
model of these four elements of the mass media institution. Double-
headed arrows represent the potential relationships among the four
elements and the two-way relationships between the elements and the
social world. The shading indicates that the social world (social,
economic, political, and cultural contexts of mass media) is both the
center of the model and surrounds it; the social world affects and is
affected by elements of the mass media institution. There are important
trends in each of the four elements.

Description

Figure 9.6 Four Elements of the Mass Media Institution

Source: Based on Croteau et al. (2022), Media Society, p. 12, Figure

1.5A.
1. Trends in media technologies. When the United States was founded,
there was only one form of mass media: print. For much of the latter
half of the 20th century, U.S. households had access to three
television channels, but now there are hundreds of cable and satellite
channels (Hanson, 2022). Growth of digital and Internet technology
has transformed mass media. New media products have been
coming at a very fast clip, giving us new mobile devices (for example,
smartphones, tablets, game consoles, e-readers) and new Internet-
based outlets (for example, Hulu, Sling TV, Disney+, Amazon Prime,
Peacock, Netflix, YouTube, Facebook, Twitter, Instagram, Snapchat,
WhatsApp, Siri, Alexa, Zoom). Smartphones and tablets are
handheld mobile computers bringing together several functions,
serving as a telephone, a camera, a personal music player, a portable
games machine, a video player, a diary, a data search machine, an
app store, and lots more. All of this can be accomplished wherever
we can access Wi-Fi or a high-speed cellular data network.
Researchers have found that many people around the world believe
they are over-using their smartphones (Olson et al., 2022), but
smartphones served many useful purposes during the COVID-19
pandemic. For example, smartphone applications were developed for
health management for older adults (Ha et al., 2021).
2. Trends in media content. Increasingly, digital media allow individuals
to choose and control the content to which they are exposed. This
means that many of us live in “bubbles” of like-minded people
receiving information about the world from the same sources while
remaining totally unaware of what content people in other bubbles are
receiving from different sources. International concern has arisen
about how this is leading to increasing political and cultural
fragmentation and polarization (Einav et al., 2022). International
concern has also arisen about the accuracy (or inaccuracy) of
information that spreads rapidly across social media, which has
become a primary medium for manipulating public opinion. Both
misinformation and disinformation are disseminated. Misinformation
is unintentional inaccurate information, and disinformation involves a
message that intends to deceive, mislead, or confuse (Giachanou et
al., 2022). Fake accounts are created on social media platforms to
reach large audiences. These fake accounts may be fully or partially
automated ( bots ), or they may be human driven ( trolls ). Some
governments have been found to create state-backed trolls to cross
national boundaries, as happened with the Russian Internet
 Research Agency trolls during the U.S. 2016 presidential election
(Mazza et al., 2022). Politics and health have been frequent targets of
intentional disinformation campaigns, and social media
misinformation and disinformation disrupted both the treatment and
vaccination rates for COVID-19 (Loomba et al., 2021). Fact checkers
are at work and automatic detection systems are being developed to
uncover disinformation on social media, but the work is hampered by
the diversity of topics and multiple languages supported on media
platforms. Disinformation is spread using written words but also by
images and video clips (Giachanou et al., 2022). Many people see
this as a major threat to contemporary societies.
3. Trends in the media industry. It is not accurate to speak of a single
media industry. Instead, there are distinct sectors of media, such as
publishing, advertising, radio, television, music, and social media.
However, these sectors are becoming blurry as media sectors merge,
with the same owners owning print news, book publishing, and film
and other entertainment businesses. Contemporary media markets
are overwhelmingly dominated by a small number of powerful, often
transnational, companies. There have been many mergers, but
mergers have not always been successful, and splits have occurred,
sometimes to merge again (Croteau et al., 2022; Hanson, 2022). In
the United States, there is a tradition of private ownership of media
industries, but in some parts of the world media companies are
publicly owned. Media companies are increasingly targeting a global
market to sell products. Some critics suggest that the global reach of
media companies based in North America and Europe, particularly in
the United States, is a form of cultural imperialism through which
Western cultural values are spread around the world (Croteau et al.,
2022).
4. Trends in media users. In the early days of the Internet, users formed
an audience to read or watch content online. Certainly, we still use
the Internet in this way, but now we can also have conversations and
create content to share with others (Croteau et al., 2022; Hodkinson,
2017). Here are some examples: writing a review of a product on
Amazon, updating our Facebook page or downloading material to
share with our friends, creating a video for YouTube, posting photos
on Instagram, posting a blog entry, producing a podcast, or sending a
brief message on X (formerly known as Twitter). Research indicates,
however, that a relatively small number of people generate most of
the content on social media (Croteau et al., 2022). Active users make
 choices about how and why to use media, and they interpret media in
diverse ways.

In totalitarian societies, the flow of information, images, and ideas is

controlled by the government. Democracies have a long tradition of
freedom of the press—a belief that the media must be free to serve as a
public watchdog. Traditionally, the emphasis has been on the watchdog
role in relation to the government and political institution—in other words,
a press that is not controlled by the government. In the current era of
media mergers and acquisitions, concerns have centered on media
censorship by the economic institution. Critics suggest that powerful
multinational media corporations censor the coverage of news to protect
their economic or political interests. Organizations that analyze freedom of
the press report that media freedom has been deteriorating around the
world for over a decade, in both democracies as well as authoritarian
states (Repucci, 2020). In a study of 180 countries, Reporters Without
Borders (2022) rated the United States as 42nd in freedom of the press
worldwide in 2022, down from 32nd in 2013 and 21st in 2009. In 2022, the
United States ranked behind 15 of the peer countries used as
comparisons in this chapter. The highest marks went to the northern
European countries Norway, Denmark, Sweden, Estonia, and Finland
(Reporters Without Borders, 2022).

In recent years, there is considerable concern about how the media

abuses citizen privacy. There is concern about how social networking
sites violate users’ privacy. There is concern about how commercial sites
engage in information gathering, profiling, and data mining on “free” online
platforms in order to market their products (Croteau et al., 2022). There is
concern about how media companies hack phones to gather information
for news stories. There is also concern about the possibility that media
companies might be cooperating with government surveillance of
individuals.

Mass media critics suggest that control of the media by political and
economic elites results in control of cultural meanings to benefit elites and
silence dissident views. The mass media in the United States has
historically been controlled by white, middle- and upper-class men, who
have presented their worldviews. Mass media owners are interested in
attracting affluent consumers and choose content with this aim in mind
(Croteau et al., 2022). Women, people of color, low-income people,
LGBTQ+ people, and people with disabilities have been underrepresented
in media presentations, and when represented, the images have often
been unflattering. There has been improvement in this situation in the past
2 decades, but there is still a long way to go. Historically, nondominant
groups have developed alternative media to compensate for their absence
or poor treatment in the dominant media. That is still the case today and is
becoming a much easier task with the new Internet-based media.

Social workers should be aware of how national and local media

represent nondominant groups in their communities and collaborate with
others to develop fairer representations.

Critical Thinking Questions 9.3

What stories have you seen about the educational and health institutions
in the mass media recently? How is what you have seen in the mass
media about these social institutions similar to and different from what is
reported in this chapter? How do you understand the strengths and
limitations of the health and educational institutions in the United States,
as compared with their counterparts in other wealthy countries? What do
you think about the Academy of Medicine’s recommendation that medical
and behavioral health services should be integrated? What would life be
like without the mass media? How would you find out about national and
global events? Do you consider misinformation and disinformation on the
Internet a problem in contemporary social life? Explain your answer.

Trends in the Social Welfare Institution

Osvaldo Jimenez has often been in need of material and social support
during his time studying in the United States. He has not been eligible for
public social protections because of his immigration status, but he has
benefited from services at Catholic Charities and from a university social
worker who connected him to many services, such as immigration
lawyers, free medical clinics, and food pantries. The social welfare
institution is concerned with the well-being of society’s vulnerable
populations and with the social health of the society. These institutions
developed in all industrialized countries in the 19th and 20th centuries as
these nations tried to cope with the alienation and disruption caused by
social inequalities of industrial market capitalism (Teeple, 2000). It was an
expression of altruism toward the people who did not fare well in this
economic arrangement, but it also was an expression of concern that the
inequalities inherent in the system could destabilize a society and
undermine its social health. Increasingly, the international community uses
the language of social protection, rather than social welfare, language that
was first adopted in European countries (see Gerard et al., 2020; Loewe &
Schüring, 2021; Mestrum, 2020). Social protection refers to the policies
and programs designed to reduce poverty, vulnerability to risks, and social
exclusion. Social protection programs are also thought to promote social
cohesion and the stability of society. Some policy advocates use the term
social investments to refer to policies and programs that seek to promote
both individual and societal well-being (Fleckenstein & Lee, 2020).
Increasingly, social protection is looked at through a rights-based
perspective.

In 2016, the World Bank and the International Labour Organization

worked together to initiate the Global Partnership for Universal Social
Protection (2023). Social protection is becoming an important policy issue
in many countries around the world, but it is reported that over half of the
world’s population has no access to social protection programs (Loewe &
Schüring, 2021). Low-income and middle-income countries are still
building social protection systems. Nongovernmental organizations
(NGOs), usually not affiliated with any government, are crossing national
lines to provide services, advocate for social protection policies and
programs, and challenge the principles of neoliberalism (Levitt et al.,
2023). There are large differences in the protection systems where they
have been developed, and some of these differences occur because of
differences in thinking about the primary goal of social protection. Some of
the proposed primary goals include reduction of people’s vulnerability to
risk, fighting poverty, promoting social inclusion, contributing to social
cohesion, stimulating investment and economic growth, stabilizing
societies, and boosting human capital (Loewe & Schüring, 2021).

In an examination of global social protection policies and programs,

Loewe and Schüring (2021) identify four philosophical approaches to
social protection. Residualism focuses on poverty alleviation, targeting the
“deserving poor, and serving only as last resort. Cash transfers and
educational and health vouchers are some of the programs offered. The
United States, Ireland, and Australia are considered to follow a chiefly
residualism approach. Selectivism recommends a preventive function,
focusing on risk reduction for all people, not just those who are poor.
Social insurance is an example of an offered program. Countries
considered to follow a selectivist philosophy include France, Belgium,
Germany, and many countries in Latin America. Productivism
recommends a promotive function of mobilizing resources to assist people
to be economically productive, focusing on economic development among
low-income people. Job training would be a primary program. Loewe and
Schüring (2021) indicate that no country currently takes a chiefly
productivism approach, and research by Fleckenstein and Lee (2020)
suggests that although the productivism approach is promoted by some
advocates, it is a generally neglected area of social protection.
Universalism serves a transformative function, focusing on social equity,
social inclusion, empowerment, and universal rights. It is a more
comprehensive, institutionalized approach that emphasizes redistribution
and universal benefits rather than targeting poverty reduction and
assigning individual responsibility for managing risk. Universalist
programs include rights-based social pensions, child benefits, paid
parental leave, universal childcare, and a free health system. Sweden and
Norway are considered the best examples of universalism.

Some programs try to prevent risk, some try to limit the impact of risks,
and others try to assist people to cope with risk. Provision of social
services such as psychotherapy, case management, and drug
rehabilitation are examples of programs to assist people to cope with risk.
Fleckenstein and Lee (2020) report that while countries in Europe and
East Asia are increasing family support policies, they are retrenching their
labor market policies such as unemployment benefits, helping people find
new jobs, and job training and retraining. This retrenchment of labor
market programs has been happening as employment has become less
stable in a globalized economy. Emergency unemployment measures
were taken by many countries during the first wave of the COVID-19
pandemic (Béland et al., 2020).

Although there are many controversies regarding social protection, Loewe

and Schüring (2021) report that there is an emerging international
consensus among scholars, policymakers, and practitioners about what
social protection is. Here are four main themes of that agreement:

Movement toward universal social protection. Social protection

should not be just a quick patch-up for society’s poorest members but
 should, instead, provide a more systematic approach to social
inclusion and human rights.
Common standards but no blueprints. All countries and territories
should abide by international standards but there should be
variability, recognizing different political cultures and socioeconomic
conditions of countries. Areas of agreement include minimum levels
of protection for “maternity care, income security for children, persons
in active age who don’t earn sufficient income, and persons in old
age” (Loewe & Schüring, 2021, p. 23).
A systems approach to social protection. Different components of the
social protection system should be integrated and synchronized, with
communication across policies and programs.
The social contract as the analytical framework for social protection.
Social protection should be based on explicit and implicit agreements
about rights and obligations between groups of people and the
government.

The emerging consensus indicates that social protection systems should

be synchronized, inclusive and equitable, transparent and accountable,
and have the nation-state playing the central role (Loewe & Schüring,
2021).

The social welfare institution, like any other social institution, reflects the
culture of the society. Figure 9.7 demonstrates that public expenditure for
social purposes as a percentage of GDP varies among the Global North
countries used as peer countries in this chapter. Public expenditures for
social purposes include cash benefits, direct in-kind delivery of goods and
services, and tax breaks targeting low-income households, older adults,
disabled, sick, unemployed adults, and young persons. Figure 9.7 also
demonstrates that public expenditures for social purposes increased in
most peer countries from 1990 to 2019.
Description

Figure 9.7 Public Expenditures for Social Purposes as a Percentage of

GDP in 1990 and 2019 for 18 Global North Countries

Source: OECD, 2022.

Around the world, social welfare institutions were challenged to respond

quickly and adequately to the COVID-19 pandemic to prevent disastrous
financial and health outcomes for both low- and middle-income individuals
and families. The pandemic exposed the vulnerability of inadequate social
protection systems and the people who live with inadequate social
protection. It is important to note that the data shown in Figure 9.7 are
pre-pandemic data and do not reflect emergency social protection
expenditures. Camilletti and Nesbitt-Ahmed (2022) report that between
March 20, 2020, and May 14, 2021, a total of 3,333 pandemic-specific
social protection measures were developed in 222 countries or territories.
Social protection measures were taken in almost every low-, middle-, and
high-income country of the world (Razavi et al., 2020). Many types of
protection measures were used to respond to the particular needs of the
country or territory, including public health measures, income support
measures, unemployment support measures, relaxed eligibility measures,
and family leave measures (Razavi et al., 2020). The social protection
responses to the pandemic exceeded responses to earlier crises but were
temporary in nature. In earlier global crises, including the recession of
2008, nations increased social protections during the crisis but retrenched
the social protection system in the aftermath of the crisis, leaving the
system weakened for the next crisis. It is too early to know if that has
happened in the aftermath of the COVID-19 pandemic. When public
spending on children increased in the United States during the first 2
years of the pandemic, the child poverty rate reached its lowest recorded
level, but it began to rise again as the temporary relief funding spent down
(Lou et al., 2022; Mackey & Cohen, 2022). Countries with the strongest
social protection systems in place at the start of the pandemic were able
to respond more rapidly and more boldly to the first phase of the
pandemic. Béland et al. (2020) found that Canada, which had some
universal policies in place prior to the pandemic, was able to respond
more quickly and more adequately than the response in the United States.

Social welfare policy in the United States, as in any society, varies with
who holds political power at any given time and has shifted over time.
From the 1930s to the 1970s, beginning with the presidency of Franklin
Delano Roosevelt, the general policy direction was for the federal
government to play a strong role in the social welfare institution. The
Social Security Act of 1935 began a process of government protections
that was expanded during the 1960s and 1970s, with the passage of
Medicare, Medicaid, the Food Stamp Program (now Supplemental
Nutrition Assistance Program), and Head Start, among other programs. In
the late 1970s, the traditional liberal belief in a federally based social
welfare system began to lose favor. There was a diminishing sense of
public responsibility and an increasing emphasis on individual
responsibility for the social well-being of the nation. Neoliberal philosophy,
under the democratic administration of Bill Clinton in the 1990s, led to
welfare reform that greatly curtailed supports to poor children and their
families. Since the 1980s, a conservative philosophy has been in
ascendancy with ongoing attempts to privatize social security
(unsuccessful to date) and to otherwise limit the role of the federal
government in the social welfare institution. At the same time, however,
cultural conservatives have called for an increased role for the federal
government in issues such as abortion and medical care for transgender
people. With a huge federal debt caused by tax cuts, wars, financial crisis,
and the pandemic, the philosophy of social welfare remains highly
contested in the United States.

The data cited in Figure 9.7 indicate that 11 of the 17 peer countries used
as comparison in this chapter devote a greater percentage of their GDP to
public social welfare expenditures than the United States. We must be
careful in interpreting the data, however. Given ambivalence about
government and a strong belief in the market, the United States has
developed a mixed social welfare system made up of federal, state, and
local governmental programs; private nonprofit social welfare
organizations; and a growing number of private for-profit organizations. It
is hard to compare this system with the European model in terms of
expenditures, but it is safe to say that the welfare institution in the United
States is more fragmented than the European model, and its family
support policies, such as family leave, family allowances, and early
childhood education and care, are much less comprehensive. Indeed, the
European countries are not alone in providing more generous public
support to families than is offered in the United States. Parental leave
policies are a good example. In the United States, parents are offered 12
weeks of unpaid leave under the Family and Medical Leave Act, which
exempts companies with fewer than 50 paid employees. All wealthy peer
countries used in this chapter, as well as many low- and middle-income
countries provide paid parental leave, some at 100% of pay rate and
some at a lesser rate. For example, Estonia offers mothers 82.1 weeks
paid leave at full pay. A number of other countries—Austria, Czech
Republic, Lithuania, Poland, Croatia, and Romania—offer a year or more
worth of leave at more than 75% of pay. Although most countries offer
more leave for mothers than for fathers, at least 34 countries provide
some leave for fathers (OECD Family Database, 2022). In most countries
with paid family leave, a social security–type system is used to fund the
paid leave. Although the United States does not have a national paid
leave policy, a few states and some corporations provide paid leave.
According to a survey of private-industry employees by the Bureau of
Labor Statistics, 23% of private-industry employees had access to some
form of paid family leave in March 2021 (cited in Donovan, 2022). These
benefits were most prevalent among people in professional and technical
occupations. In addition, 11 states and the District of Columbia had
enacted legislation to develop paid family leave programs by May 2022
(Donovan, 2022).

In Chapters 13 and 14 of this book, we will consider the ways that the
neoliberal policy is pushing social work toward individual solutions for
societal problems and away from social reform. Social workers cannot be
active participants in moving that balance back to social reform unless
they clearly understand trends in the interrelated social institutions
discussed in this chapter.

Trends in the Religious Institution

We do not know whether Osvaldo Jimenez has frequent contact with

religious organizations, but we do know that he sought out assistance
from Catholic Charities when he faced health challenges. The religious
institution is a primary one for providing meaning, purpose, belonging, and
moral standards. It also serves important socialization, social control, and
mutual support functions. Sociologists study several main components of
the institution: belief systems, worldviews, practices, symbols, rituals, and
organizational structures that provide networks of support as well as roles
and statuses (Roberts & Yamane, 2021).

Some scholars who study the religious institution report a declining

relevance of the institution in contemporary life, suggesting that traditional
religions are having less and less influence on human behavior (Inglehart,
2021; Molteni & Biolcati, 2022). Inglehardt (2021) found strong evidence
of religious decline around the world, with the exceptions of Muslim and
some post-communist societies, and predicted that this decline will
continue. Religious decline is often measured in terms of membership in
religious organizations and attendance at religious services. Other
students of religion argue, however, that studying the religious institution
this way may overlook newer forms of religiosity that are not connected to
traditional religious groups and organizations (Roberts & Yamane, 2021).
They call attention to a contemporary trend toward the individualizing of
religion, creating personal meaning by drawing on multiple religious
traditions. Watts and Houtman (2023) refer to this trend as a “spiritual
turn.” Crockett (2021) suggests there is a current opening up to new
spiritual forces and calls attention to the phenomenon of “new animism,”
which attributes soul to plants, inanimate objects, and natural phenomena.
Crockett notes that religion has been deployed to colonize non-European
societies, and we are currently seeing a revival of Indigenous non-
Western religious and spiritual practices that were once dismissed as
savage and irrational. Indigenous worldviews that focus on the more-than-
human world are seeing a revival in Indigenous communities and
becoming popular outside those communities as well.

Although there is a long history of conflict and adaptation as the major

world religions confronted each other in the same political and geographic
areas, globalization has urgently increased the need for religious
communities to find ways to coexist globally as well as locally. A religious
belief system helps people to feel secure, and exposure to different belief
systems can be unsettling and sometimes perceived as a threat to the
integrity of one’s own beliefs and identity. Today, however, it is almost
impossible for believers in one religious tradition to be isolated from other
religious traditions. We are increasingly exposed to the beliefs, rituals, and
organizations of diverse religious groups, and this is not a trend that is
likely to be reversed. There are few choices about how to cope with this
trend. Religions can attempt to impose their belief systems on the world,
creating constant religious conflict. Or we can attempt to find a unified
ethical code that is consistent with all religious traditions and respectfully
agree to disagree if that doesn’t work, giving legal protection to all groups.
In the past, both choices have been put into practice at one time or
another.

We have been living in a time of much religious strife. There is conflict

between Christians and Muslims in sub-Saharan Africa and Buddhists and
Muslims in Southern Thailand. Hindus and Muslims kill each other in
India. The Druk Buddhists in Bhutan murdered and drove out the Nepali
Hindus in order to unite the country under one culture, religion, and
language. In the former Yugoslavia, Serbian Orthodox Christians engaged
in ethnic cleansing of Roman Catholic Croats and Muslim Bosniaks, and
then the Croats turned on the Bosniaks. Catholics and Protestants waged
a long and often violent battle in Northern Ireland. The Ku Klux Klan in the
United States used religious arguments to vilify and sometimes persecute
Jews, African Americans, and other groups. Mosques have been attacked
in New Zealand and the United States. Thousands have been killed and
injured in the name of Islam, but Muslims around the world are appalled at
Islamic terrorism (Kurzman, 2011). The United States has called on the
name of God, and the language of good and evil, to justify the invasion of
Afghanistan and Iraq. In the United States and Europe, anti-Jewish and
anti-Muslim attitudes go hand-in-hand (Roberts & Yamane, 2021). When
religious differences are woven with other forms of struggle, such as
social class, ethnic, or political struggle, the conflict is likely to be
particularly intense (Kurtz, 2016).

There are also historical and current stories of peaceful coexistence of

religious groups. In 1893, representatives of a wide range of religions
were brought together to create the Parliament of the World’s Religions.
The second meeting of the parliament did not convene until a century
later, in 1993 (Kurtz, 2016). It met again in 1999, 2004, 2009, 2015, 2018,
and 2023. The mission of the parliament is to “cultivate harmony among
the world’s religious and spiritual communities and foster their
engagement with the world and its guiding institutions in order to achieve
a just, peaceful and sustainable world” (Parliament of the World’s
Religions, 2023). The theme of the 2018 meeting was “The Promise of
Inclusion, The Power of Love: Pursuing Global Understanding,
Reconciliation, and Change.” The meeting included a women’s track and
an Indigenous peoples’ track. The theme of the 2023 meeting is “A Call to
Conscience: Defending Freedom & Human Rights.” The Parliament puts a
high value on religious pluralism.

There is much religious diversity in the world, but most countries are not
religiously diverse. The United States is one of the more religiously
diverse countries. Each of the major world religions has changed over
time and place and become more diverse. Kurtz (2016) suggests that we
should speak of all the major world religions in the plural—Buddhisms,
Christianities, Hinduisms, and Islams—because of the divisions within
them. He also argues that some of the most violent contests occur within
these religious traditions and not between them, as experienced by the
Christian Catholics and Protestants in Northern Ireland and the Muslim
Sunnis and Shias in some Muslim majority countries.

Each of the major world religions, but especially the Western religions,
has an internal struggle, sometimes called a culture war, between a
branch of traditionalists and a branch of modernists (Kurtz, 2016).
Traditionalists have a deep respect for long-held cultural and religious
values and see them as essential for societal stability. Modernists
embrace new ideas, styles, and social trends. These two branches often
engage in a struggle for the heart and soul of the religious tradition,
sometimes using violence to press their case. We are currently seeing
fundamentalist religious movements across religions and regions of the
world. These movements apply strict literal interpretation of original
religious texts, consider their religious beliefs absolute and all others
wrong, and want to see their religious beliefs represented in all major
social institutions. It is suggested that religious fundamentalism is a
reaction against global modernization, which is seen as neo-colonialism in
much of the Global South (Roberts & Yamane, 2021).

Christianity remains dominant within the United States, but there are
intense culture wars between traditionalists and modernists, with the
conflict centering on such issues as the definition of family, the beginning
and end of life, gender, sexuality, prayer in school, and theories of the
creation of the world. Both traditionalists and modernists base their
arguments on their understanding of biblical texts, but each tends to see
the other as immoral. Some examples will help to clarify the competing
moral precepts regarding some of these questions. Traditionalists see the
push for women’s rights as destructive to the traditional family and
motherhood. Modernists see women’s rights as necessary in a just
society. Likewise, traditionalists see the LGBTQ+ rights movement as a
particularly vicious attack on the traditional family, and modernists see it
as a struggle for dignity and inclusion. Traditionalists argue that school
prayer is essential to help students develop a moral code, and modernists
argue that it is an intrusion on religious freedom and respect. The culture
wars are intense because both groups wish for dominance in the political
institution.

Religion can play an important role in motivating people to advocate for

social change and social justice, and it can also play a role in creating and
maintaining inequalities and the marginalization of some groups. Religious
groups played a role in the anti-slavery and civil rights movements in the
United States, the anti-apartheid movement in South Africa, the Solidarity
movement in Poland, and liberation theology in Latin America. Religious
groups in the United States also opposed the anti-slavery abolitionist
movement and often led efforts to promote restrictive covenants to
promote race-based housing segregation (Rothstein, 2017). Religious
groups around the world have also played a role in marginalizing women
and people who deviate from cisgender and heterosexual normativity.

Sacred is a word used to describe a person or other entity worthy of great

respect or reverence. For many religious people, a deity or multiple deities
are sacred. Many Indigenous religious and spiritual traditions do not
worship a deity but see the sacred in all human and non-human persons
and in traditional spiritual ceremonies (Gone et al., 2020; Ruml, 2020).
Much attention is paid these days to the ways in which nation-states are
deemed sacred, a situation known as nationalism. Religion and politics
get woven together in such a way that the nation-state is sacred if it
represents a particular religion. In the United States, Christian
nationalism, more specifically white Christian nationalism, recognizes both
the flag and the cross as sacred (Gorski, 2022). Researchers who study
Christian nationalism identify six beliefs of the movement: (1) the federal
government should declare the United States a Christian nation, (2) the
federal government should advocate Christian values, (3) there should be
no separation of church and state, (4) Christian religious symbols should
be allowed in public spaces, (5) success of the United States is part of
God’s plan, and (6) prayer should be allowed in public schools
(Whitehead et al., 2018). Capitalism is another example of something that
is considered sacred, worthy of respect and reverence, by some people.

During the COVID-19 pandemic, many public health officials engaged with
religious groups, as they had learned to do with prior experiences with
Ebola, HIV/AIDS, and other epidemics (Marshall, 2022). Some religious
groups were directly involved in delivering health care and public health
messages aimed at containing the transmission of the disease. Some
religious groups were quick to comply with governmental requirements to
discontinue physical gatherings, and other religious groups brought
lawsuits against the government for violating their religious freedom with
such requirements. In some places, some religious groups were
scapegoated and blamed for the spread of the virus. For example,
Muslims were sometimes accused of spreading the virus in India
(Marshall & Wilkinson, 2022). Some religious groups presented pandemic
information that contradicted statements from public health scientists
(Marshall, 2022). During the early phase of the pandemic, religious
activities were disrupted or took new online forms, and spiritual care for
the sick, dying, and bereaved was restricted. As this chapter goes to
press, there are still concerns about dwindling religious membership and
flagging finances for religious organizations in the aftermath of the
pandemic, but also stories of revitalized religious and spiritual practices
(Marshall, 2022).

Given the clear evidence of the central importance of religion in the lives
of billions of people in the world, social workers must become comfortable
in assessing the role of religion and spirituality in the lives of people at the
individual, family, and community levels. We should not assume that all
persons of a religious group hold the same beliefs regarding social issues.
But we must be aware of religious beliefs—both our own and those of
other people—when working with controversial social issues.

Trends in the Family and Kinship Institution

Osvaldo Jimenez had close-knit family relationships with his parents and
two younger brothers during his childhood and adolescence in Mexico.
When he was 17, his aunt took him into her home in the United States
while he finished high school. Now Osvaldo does not travel to Mexico to
visit his parents for fear he will be detained while trying to return to school
in the United States. His younger brothers now live nearby in California,
and the brothers are resources to each other socially, emotionally, and
financially. Family and kinship is the most basic social institution, and in
small-scale relatively homogenous societies it fulfills many of the functions
assigned to other social institutions in complex societies. Although the
functions of family and kinship have been the subject of some controversy
in the contemporary era, most societies generally agree that the family
and kinship institution is primarily responsible for the regulation of
procreation, for the initial socialization of new members of society, and for
the economic, emotional, and physical care of its members.

As the primary unit of every society, families are altered as the result of
social change, and globalization is changing family life in some
extraordinary ways around the world (Leeder, 2020). There are
increasingly diverse ways of being a family around the globe, and there
seems to be an exception for almost every family trend identified. Chapter
10 of this book focuses on the family and kinship institution and will
examine some current trends in family life. For the purposes of this
discussion, eight trends in family life are identified and will be examined
later in Chapter 10.
 1. Diversity in family formation and family structure is increasing.
2. Marriages rates are dropping in many countries, but there are cross-
country variations in this trend.
3. More and more people are choosing cohabitation over marriage as
the way to form a family, but there are cross-country variations in this
trend.
4. There is an increase in single-parent families in many parts of the
world.
5. Both internal (within country) and external (across national lines)
migration has been greatly increasing, leading to family members
living at a distance from each other.
6. Multigenerational households are increasing in geographies where
nuclear family households have predominated, and nuclear family
households are increasing in geographies where multigenerational
households have predominated.
7. Women are increasingly involved in paid labor but are still paid less
than men.
8. It continues to be the case that in most places in the world, an
individual’s life opportunities are heavily influenced by the social and
economic class position of their family.

The COVID-19 pandemic produced major economic and social changes

for families. To reduce the spread of the virus, families around the world
were required to isolate themselves in their homes and restrict
movements and interactions outside the home. Job losses were
widespread in April 2020 and the unemployment rate rose, reaching
14.7% in the United States (Bureau of Labor Statistics, 2020). At the
beginning of the pandemic, women were overrepresented in the kinds of
insecure, low-wage jobs that were eliminated and absorbed a
disproportionate share of the increased domestic labor (Hayes & Lee,
2022). Schools, childcare organizations, and non-essential places of
employment were closed. Essential workers were exposed to risk of
transmission of COVID-19, increasing the risk to their family members,
and were not available to provide family oversight at home. Work,
schooling, childcare, and health care were merged in many family homes.
Many families spent a lot more time together, and more of their homelife
was visible to the world beyond the family as schooling, work, religion,
and health care were conducted by videoconferencing technology.
Families with children reported high levels of stress during the first wave
of the pandemic, including financial worries, sadness about the social
isolation, fear of the virus, and concerns about the well-being of the
children (Canzi et al., 2021; Singletary et al., 2022). A study of Italian
parents found that 40% of the parents reported some negative changes in
the family during the time of social distancing, including a feeling of being
caged, lack of personal space, and disruptive changes in family routines
and rituals (Canzi et al., 2021). However, parents reported more positive
than negative family changes, including feeling more emotionally close to
their children and spending more time in fun activities with them. Another
line of research indicates that family members reported a high level of
dissatisfaction with virtual communication with COVID intensive care units
during the pandemic (Ponnapa Reddy et al., 2022).

Social service programs serving families, children, and older adults need
to be responsive to changing trends in the family and kinship institution.
Social workers should lead the way in discussions about social policies
that can strengthen families and alleviate family stressors. These issues
get greater attention in Chapter 10 of this book.

Critical Thinking Questions 9.4

What do you think the goal(s) of the social welfare institution should be:
reduction of people’s vulnerability to risk, fighting poverty, promoting social
inclusion, contributing to social cohesion, stimulating investment and
economic growth, stabilizing societies, boosting human capital, or
something else? Explain your answer. Do you think there is a declining
relevance of the religious institution in contemporary life? Explain your
answer. What have your observed about growing diversity in patterns in
family formation and family structure? What are some recent media
images you have seen about the family and kinship institution that
reflected that growing diversity?

Diversity, Equity, and Inclusion in Social Institutions

Many disciplines, including social work, are emphasizing diversity, equity,

and inclusion in their educational programs. Diversity, equity, and inclusion
are also being emphasized as goals in major global social institutions, and
it is important to consider how well the institutions are meeting those goals
as well as the actions needed to further the goals. As discussed in
Chapter 1 of this book, diversity is the presence of human differences that
include a wide range of social identities that may include “age, caste,
color, culture, disability and ability, ethnicity, gender, gender identity and
expression, generational status, immigration status, legal status, marital
status, political ideology, race, nationality, religion and spirituality, sex,
sexual orientation, and tribal sovereign status” (Council on Social Work
Education, 2022, p. 9). When we think of human diversity, it is important to
think in terms of the intersectionality of social identities, the way that
people live at the intersection of multiple social identities. Equity is an
ethical norm that proposes that existing social, racial, economic, political,
and environmental inequalities require policies and practices that aim to
level the playing field for those in disadvantaged positions, recognizing
that not all people are starting from the same place. Social inclusion is a
multidimensional process to ensure that people at risk of being left out
gain the opportunities and resources needed to participate fully in all
aspects of life, including the major social institutions.

An in-depth analysis of diversity, equity, and inclusion in the major social

institutions is beyond the scope of this discussion, but the analyses
presented in this chapter provide some clues about how well the social
institutions are currently meeting these goals and suggest some
guidelines about how to further these goals. In the government and
political institution, equity should be understood in the context of a history
of colonialism and neocolonialism, where some groups were excluded
from governmental decision-making. Recent analyses indicate a
weakening of political rights and civil liberties in many countries (Freedom
House, 2022a), and democracy has eroded more in the United States
than in peer wealthy countries (Freedom House, 2022a, 2022c). Voting
rights are essential for minimal inclusion in the government and political
institution, and voting methods and hours should be designed to ensure
diversity, equity, and inclusion. Meeting the goal of inclusion requires that
people who are affected by a governmental policy have voice in the
process of developing and implementing the policy. This is especially
important when transnational centers of power dominated by countries in
the Global North engage with countries in the Global South. Special
efforts are needed at all governmental levels to create policies and
programs that provide resources and opportunities for groups previously
underserved and excluded in the governmental institution as well as other
major social institutions. A question that arises is whether equity requires
reparations to social groups who have been historically excluded in most
of the major social institutions. Special attention should be paid to revising
or overturning governmental policies and programs that exacerbate
economic inequality. Efforts should be made to diversify hiring pools at
every level of government and to create work environments that support
diverse employees. Due process rights should be granted to all people,
including recent migrants.

Because much economic inequality is created in the contemporary

economic institution, goals of diversity, equity, and inclusion are especially
important in this institution. The current high level of income inequality
means that people in the lowest paying jobs will not have the resources
for full inclusion in social life. Around the world, some people continue to
be excluded from or marginalized in the economic institution, including
women, disabled people, LGBTQ+ people, migrants, racialized people,
and many people living in the Global South. Governmental policies,
workers’ rights groups, and labor unions can all play important roles in
promoting diversity, equity, and inclusion in the current inequitable
economic institution.

Gender, racial, and economic class equity in the educational institution is

an ongoing challenge in many countries of the world. Educational
institutions should provide quality education to all students regardless of
gender, race, ethnicity, social class, ability, immigration status, sexuality,
religion, or other characteristics. Classrooms in many parts of the world
are increasingly diverse, and inclusive teaching strategies should ensure
that all students feel supported and safe to express their views. In the
United States as well as in some other countries, there are strong efforts
to curtail the full inclusion of LGBTQ+ students. It is also a concern that
racial and social class disparities in school outcomes are higher in the
United States than in some other wealthy countries. Social class
disparities in educational achievement cannot be fully addressed without
addressing issues of income inequality.

Diversity, equity, and inclusion in the health institution cannot be met

without universal access to preventive and curative health services. The
United States lags behind other wealthy nations in creating universal
access, and lack of access contributes to health disparities. There are
both global and within-country health disparities. In the aftermath of
colonialism and in the face of neocolonial policies developed by countries
in the Global North, the health institution is underdeveloped in many
countries in the Global South. As they develop their health institutions,
people in the Global South welcome resources and suggestions from the
Global North but want to maintain control over their health infrastructures
(Dutta, 2020). The U.S.-based National Academy of Medicine (2022)
recommends that equity should be a core health system performance
measure and that the health institution should seek input of marginalized
communities to improve equity. Improvement in health equity also requires
a reduction in economic inequality.

Meeting the goals of diversity, equity, and inclusion in the mass media
institution requires a reduction in the digital divide. In addition, attention
must be paid to diversity and inclusion in media content and staffing in
media industries. The mass media institution plays an important role in
influencing the images of different social groups and the ways in which
diversity, equity, and inclusion are presented. One conundrum is how to
manage misinformation and disinformation that targets and attacks
members of marginalized and otherwise excluded groups. That has
become a serious problem around the world, one that is compounded by
new media technologies. On the positive side, new media technologies
have made it easier for marginalized groups to create alternative media to
compensate for their absence or poor treatment in traditional media.

In the social welfare institution, a philosophy of universal social protection

furthers the goals of diversity, equity, and inclusion. Universal social
protection focuses on equity, inclusion, empowerment, and universal
rights. This approach emphasizes redistribution of resources and
universal benefits. Programs such as universal maternity care, child
benefits, paid parental leave, and childcare focus on giving all children a
good start in life to prevent cumulative disadvantage that threatens full
inclusion in social life. It is important that emergency social protections
offered during the COVID-19 pandemic are not retrenched so much that
they weaken the institution for the next crisis.

In the past, religious groups in the religious institution have played a role
in curtailing diversity, equity, and inclusion of some social groups in the
larger society as well as in the religious institution. Religious groups have
also played a role in promoting diversity, equity, and inclusion. Religious
pluralism and the protection of religious rights for people of all religions is
the only way to promote the goals of diversity, equity, and inclusion in
society where multiple religions are represented.
The family and kinship institution is the institution where people are first
socialized to respect or disrespect diversity, equity, and inclusion. Family
hierarchies may limit the full inclusion of family members in family life
based on age, gender, or some other social status. Diversity in family
formation and family structure is increasing, and the family and kinship
group may be challenged as they engage that diversity. LGBTQ+ people
have been particularly vulnerable to exclusion in family life.

Critical Thinking Questions 9.5

Which social institutions have the greatest impact on your day-to-day life?
Which social institutions do you think play the largest roles in meeting and
thwarting the goals of diversity, equity, and inclusion? Provide examples
for your answer. What are some examples of how social institutions
promote or deny equity and inclusion for you and people you care about?

Implications for Social Work Practice

The trends in social structure and social institutions discussed in this

chapter suggest several principles for social work practice. These practice
principles have the greatest relevance for social work planning and
administration, but some are relevant for direct social work practice as
well.

Develop adequate information retrieval skills to keep abreast of

trends in the interrelated social institutions and the impact of these
trends on diversity, equity, and inclusion.
Monitor the impact of public policies on poverty and inequality.
Learn to use political processes to promote social policies and social
programs that contribute to the well-being of individuals and
communities.
Be particularly aware of the impact of trends in the economic
institution on resources for human functioning and social inclusion.
Collaborate with other social workers and human service providers to
advocate for diversity, equity, and inclusion in the educational
institution.
Work to ensure that the voices of people in marginalized communities
are included in ongoing public dialogue about reform of the health
institution.
 Stay critically aware of the possibilities of misinformation and
disinformation in the mass media institution, especially as they
pertain to marginalized groups.
Collaborate with other social workers and human service providers to
influence media coverage of vulnerable populations and patterns of
social inequality.
Take the lead in ensuring that groups served by the social welfare
institution have a voice in policies and programs of the institution.
Consider the extent to which contemporary social welfare programs,
especially those with which you are personally involved, are
responsive to trends in the other major social institutions.
Be aware of the role religious organizations play in social service
delivery and the role religion plays in the lives of people you
encounter in practice.
Review social welfare programs serving children, older adults, and
other vulnerable persons to ensure they are responsive to changes in
the family and kinship institution as well as the economic institution.

Chapter Review

Key Terms

Bifurcate
Colonialism
Economic globalization
Economic institution
Educational institution
Family and kinship institution
Formal education
Gini index
Government and political institution
Health institution
Mass media institution
Neocolonialism
Neoliberal philosophy
Public health system
Religious institution
Social institution
Social protection
Social structure
 Social welfare institution
Therapeutic care
Transnational corporations (TNCs)

Active Learning

1. Visit the websites of the United Nations (www.un.org) and the United
Nations Development Programme (www.undp.org). What global
issues do you see being addressed on these websites? Which social
institutions are these issues related to? Choose a topic of interest to
you and investigate how this topic or related topics are covered on
these websites. On the website of the United Nations Development
Programme, take a look at their Agenda 2030. Does the agenda
include issues that are important to you? Are issues of diversity,
equity, and inclusion included?

2. There is an ongoing debate about the role of economic inequality in

social life. Talk to at least five people about this issue. Ask each
person the following questions:

Is economic inequality a good thing for society? If not, why not?

If so, in what way, and good for whom?
If we accept inequality as inevitable, how much is necessary?
Should societies try to maximize or minimize the amount of
inequality?
On what criteria should we measure inequality?
If we seek greater equality, is it equality of opportunity or of
outcomes?

What kinds of positions did people take? What types of support did
they provide for their positions? What would be the implications of
their positions for the government and political institution, economic
institution, educational institution, health institution, mass media
institution, social welfare institution, religious institution, and family
and kinship institution?

3. We have seen that people have different goals for the social welfare
institution, including poverty reduction as a last resort, risk reduction
for all people, mobilizing resources to make people (especially low-
income people) economically productive, and promoting social equity,
 social inclusion, empowerment, and universal rights. Talk to one
family member and one work friend who are not in social work, and
three friends who are social workers or studying to be social workers.
Ask them what they see as the primary goal of the social welfare
institution. What goals did they recommend? Did their
recommendations fit with any of the goals listed at the beginning of
this question? Did they suggest other types of goals not listed in this
question? If so, what were they? How did they support their
recommendations? Did you notice any differences between the
recommendations of social workers and those who are not social
workers?

Descriptions of Images and Figures

Back to Figure

The horizontal axis presents years from 1965 to 2020 in increments of 5

years. The y-axis represents the Gini index, it extends from 34 to 50 in
increments of 2. The line passes through the following points. (1970,
39.4), (1974, 39.7), (1980, 40.3), (1985, 41.9), (1990, 42.8), (1995, 45.0),
(2000, 46.2), (2005, 46.9), (2012, 47.7), (2016, 48.1), (2021, 49.4).

Back to Figure

A vertical double-sided arrow marks the most inequality at the top and the
least inequality at the bottom. The countries from the top with their values
are as follows.

United States: 41.7, Italy: 35.2, United Kingdom: 35.1, Australia: 34.3,
Spain: 34.3, Canada: 33.3, Switzerland: 33.1, Japan: 32.9, France: 32.4,
Germany: 31.7, Ireland: 30.6, Austria: 30.2, Sweden: 29.3, Netherlands:
29.2, Denmark: 27.7, Finland: 27.7, Norway: 27.7, Belgium: 27.2.

Back to Figure

A vertical double-sided arrow marks the most free at the top and the least
free at the bottom. The countries from the top are as follows.

Finland, 100

Norway, 100
Sweden. 100

Canada., 98

Denmark, 97

Ireland, 97

Netherlands, 97

Belgium, 96

Japan, 96

Switzerland, 96

Australia, 95

Germany, 94

Austria, 93

United Kingdom, 93

Italy, 90

Spain, 90

France, 89

United States, 83.

Back to Figure

The x-axis presents the percentage from 0 to 80 in increments of 10. The

percentage of each country is as follows;

Denmark, 67.0 percent

Sweden, 65.2, percent

Finland, 58.8 percent

Norway, 50.4 percent

Belgium, 49.1 percent

Italy, 32.5 percent

Canada, 29.4 percent

Austria, 26.2 percent

Ireland, 25.4 percent

United Kingdom, 23.4 percent

Japan, 16.8 percent

Germany, 16.3 percent

Netherlands, 15.4 percent

Switzerland, 14.4 percent

Australia, 12.4 percent

Spain, 12.4 percent

United States, 10.3 percent

France, 8.9 percent

Back to Figure

The first bar chart presents the health spending per capita in 2019. The
details are as follows:

Spain, 3,600 dollars.

Italy, 3,653 dollars.

United Kingdom, 4,500 dollars.

Finland, 4,561 dollars.

Japan, 4,691 dollars.

Australia, 4,919 dollars.

Ireland, 5,083 dollars.

France, 5,274 dollars.

Canada, 5,370 dollars.

Belgium, 5,458 dollars.

Denmark, 5,478 dollars.

Sweden, 5,552 dollars.

Austria, 5,705 dollars.

Netherlands, 5,739 dollars.

Germany, 6,519 dollars.

Norway, 6,745 dollars.

Switzerland, 7,138 dollars.

United States, 10,948 dollars.

The second bar chart presents the life expectancy at birth in 2019. The
details of each country is as follows:

United States, 78.9.

Germany, 81.4.

United Kingdom, 81.4.

Denmark, 81.5.

Austria, 82.0.

Finland, 82.1.
Canada, 82.1.

Belgium, 82.1.

Netherlands, 82.2.

Ireland, 82.8.

Ireland, 82.8.

France, 82.9.

Norway, 83.0.

Australia, 83.0.

Sweden, 83.2.

Italy, 83.6.

Switzerland, 84.0.

Japan, 84.4.

Back to Figure

Inside a circle, the four elements are in four directions, users, technology,
industry, and content, and interconnected to each other. At the center is
the social world which includes social, economic, political, and cultural
contexts. This social world is interconnected with all four elements.

Back to Figure

The x-axis presents the percentage from 0.00 percent to 30.00 percent in
increments of 5 percent.

The percentages of the respective countries in 1990 and 2019 are as

follows.

Ireland, 1990, 16.80 percent; 2019, 12.80 percent.

Switzerland, 1990, 12.10 percent; 2019, 17.00 percent.

Netherlands, 1990, 18.20 percent; 2019, 17.60 percent.

Australia, 1990, 13.10 percent; 2019, 20.50 percent.

Norway, 1990, 21.40 percent; 2019, 20.70 percent.

United Kingdom, 1990, 15.20 percent; 2019, 22.10 percent.

Sweden, 1990, 27.20 percent; 2019, 23.70 percent.

Japan, 1990, 19.20 percent; 2019, 24.90 percent.

Canada, 1990, 17.60 percent; 2019, 25.00 percent.

Denmark, 1990, 22.90 percent; 2019, 26.20 percent.

Germany, 1990, 15.70 percent; 2019, 26.70 percent.

Spain, 1990, 21.60 percent; 2019, 28.70 percent.

Finland, 1990, 23.30 percent, 2019, 29.00 percent.

Belgium, 1990, 24.40 percent, 2019, 29.00 percent.

Austria, 1990, 23.20 percent; 2019, 29.40 percent.

Italy, 1990, 20.60 percent; 2019, 30.10 percent.

France, 1990, 24.30 percent; 2019, 31.60 percent.

10 Families

Elizabeth D. Hutchison and Tawanda L. Hubbard

Learning Objectives

10.1 Analyze one’s own emotional and cognitive reactions to a

case study.
10.2 Analyze the merits of different approaches to defining
family.
10.3 Compare six theoretical perspectives for understanding
families (family systems, exchange and choice, symbolic
interaction, intersectionality, life course, and family stress).
10.4 Identify several types of diversity in family formation and
structure that might be encountered by social workers.
10.5 Describe how economic hardship, racialized bias and
discrimination, anti-LGBTQ+ bias and discrimination, migration,
domestic and family violence, divorce and cohabitation
dissolution, and problematic substance use challenge family life.
10.6 Apply knowledge of family theories, diversity in family
formation and structure, and family challenges to recommend
guidelines for social work engagement, assessment,
intervention, and evaluation.

A Case Study About Family

Case Study 10.1: The Sharpe Family Adapts

Bobby and Vivian Sharpe, both 49 years old, are a married African
American couple who lives in a small southwestern town with their
16-year-old son, Caleb, who was born with cerebral palsy. Their 25-
year-old daughter, Marcie, lives an hour’s drive away in a small city
where she works as an occupational therapist.

Bobby grew up in a close-knit family that included his mother and

father and three younger sisters, as well as a maternal grandmother
who lived with them. Several aunts, uncles, and cousins lived nearby.
Both parents had jobs outside the home, and Bobby’s grandmother
provided childcare when the children were small and helped to keep
the household running smoothly.

Vivian grew up a few blocks from Bobby. Her father died in Vietnam a
few months before she was born, and her mother moved her two
daughters back to the town where she had grown up. Vivian’s mother
struggled to raise her two daughters while working two jobs, with
some help from her mother, who lived in town but also worked two
jobs. Vivian felt blessed to have godparents living close by and
playing an active role in her life. This couple was never able to have
children of their own, and they enjoyed including Vivian in their lives.
She continues to consider them family.

When Bobby graduated from high school, he served in the army for 4
years. He received some good training, enjoyed making friends with
people from diverse backgrounds, and had two tours overseas but
never served in a war zone. After 4 years, he was eager to return
home to be near his close-knit family. Soon after returning home, he
ran into Vivian, who was working in the elementary school cafeteria.
They began to spend a lot of time together and were married a year
later. Marcie was born a year after they married.

After returning to his hometown, Bobby began working as a heating

and air conditioning technician and continues to work in that position.
When Marcie was born, Vivian cared for her at home while also
caring for her sister’s small children while her sister, a single mother,
worked. When Bobby’s father had an automobile accident and had to
miss work for 6 months, Bobby and Vivian provided some financial
aid to Bobby’s mother and younger siblings. Finances were tight, and
Bobby and Vivian were afraid they would not be able to keep up the
mortgage on their house. Bobby decided to join the Army National
Guard to bring in some extra money. He also looked forward to the
type of camaraderie he had experienced in the army. He went to drills
one weekend per month and took time off from work for a two-week
training each year. His unit was mobilized on two occasions to assist
with floods in the state. When Marcie entered public school, Vivian
went back to work at the elementary school cafeteria, and Bobby and
Vivian were able to start a college fund for Marcie.

Bobby Sharpe’s U.S. Army National Guard unit was deployed to Iraq
in 2004. During his deployment, Vivian and Marcie were able to get
along fine with the love and support of Bobby’s family; Vivian’s
mother, sister, and godparents; and Bobby’s boss. They missed
Bobby and worried about him, but Marcie was very good about
picking up more responsibilities to help Vivian with the chores usually
performed by Bobby. Bobby was injured by shrapnel in his last week
in Iraq and spent two weeks in the hospital in the nearest city when
he returned home. The family and friends network took care of Marcie
while Vivian juggled trips to the hospital with her work schedule.
Bobby healed well and was able to return to work.

Caleb was born in 2006, and Vivian took a leave of absence from
work as the family planned for his care. Because of his cerebral palsy
diagnosis, they were able to receive assistance from state-sponsored
early intervention programs. When Caleb was 2 years old, Vivian was
able to return to work part-time as her mother and godmother
assumed some care of Caleb when he was not receiving early
intervention services. Caleb continues to be involved in an after-
school program.

When Bobby’s Army National Guard unit was deployed to

Afghanistan in 2010, things at home were more complicated than
during the earlier deployment to Iraq. Bobby’s grandmother had a
stroke 2 years earlier, and his mother and father were working
opposite shifts at the local nursing home so that someone was
always home to care for her. One of Bobby’s sisters, a single mother
of a 2-year-old daughter, was serving in the army in Iraq, and her
daughter was living with Bobby and Vivian while she was deployed.
During Bobby’s deployment, Vivian’s mother moved in with Vivian
and cared for Caleb and the 2-year-old niece during the day while
Vivian worked and then turned their care over to Vivian so that she
could do a 6-hour shift caring for an older woman with dementia. To
help stabilize the family finances, Vivian accepted the offer to take a
supervisory position in the school district’s lunch program. She was
excited about the new responsibilities, but the demands of the new
job were a source of stress. Vivian was especially concerned about
monitoring Marcie’s after-school activities now that she was
approaching adolescence, but her godparents were a great help with
that, just as they had been for Vivian during her adolescent years.
The women’s group at the family’s church provided emotional support
as well as occasional meals and transportation for Marcie. Marcie
worried a lot about her dad’s safety, especially during weeks when
they did not know his whereabouts.

Bobby returned from Afghanistan with no physical injuries, but his

best friend from the Guard lost a leg to a roadside bomb. When
Bobby came home, Vivian, Marcie, and Caleb were thrilled and were
eager to pick up life where they left off. Bobby wanted to spend a lot
of time by himself, however, and Vivian realized that he was having
trouble sleeping, sometimes had nightmares, and was easily startled
by loud noises. She did some research on the Internet and decided
that she needed to give Bobby time to readjust. She did her best to
help Marcie and Caleb understand this also. She was pleased, but
also worried, when Bobby began to go for long walks and to spend
time with a new puppy. After 4 months, Bobby was able to talk about
the guilt he felt about surviving when other Guard members had died.
He gradually began to be more like his old self and was happy to get
back to work. He still makes time to spend with his friend who lost a
leg in Afghanistan. His grandmother died 6 months after he returned
from Afghanistan, and he and the rest of the family still miss her.

The Sharpe family entered a new phase when Marcie went away to a
state university on a track scholarship. Marcie found the transition to
university to be challenging, and her family missed her. By her
sophomore year, she had figured out some time management
strategies and had become more comfortable with the diversity in the
student body. One aspect of that diversity was the types of families
represented by the students. This led Marcie to think about what type
of family life she would like to build in the future if she did not return to
the small town where her family lives. She still thinks about that.
Bobby and Vivian were bursting with pride when Marcie finished
graduate studies in occupational therapy, a field that she felt drawn to
because of the family’s experience with Caleb. She soon started a job
in a nearby city and moved into an apartment with two roommates.
Bobby, Vivian, and Caleb miss her, but they have made a ritual of
visiting her twice monthly, bringing a picnic of her favorite foods to
share with her roommates.

Just as Bobby and Vivian were finding the rhythm of their family life to
feel less taxing, the family faced new challenges. Vivian’s nephew
died while serving in the Marines in Afghanistan in 2019. In 2020,
when schools pivoted to virtual learning because of the COVID-19
pandemic, Vivian and her staff scrambled to find a way to distribute
food to families and Vivian worried about some of the families that
she knew to struggle with food insecurity. Caleb also had to face a
rapid change in his schooling. Bobby’s mother and father both tested
positive for COVID-19 and had to be hospitalized. Both survived, but
Bobby’s father continues to be fatigued and has other recurring
symptoms, possibly related to long-term COVID-19. Vivian’s mother
has faced several challenging health conditions and recently moved
in with Bobby, Vivian, and Caleb.

What Is a Family?

Families are the primary unit of every society. Perhaps no other

relationships contribute as much to our identity and have such
pervasive influence on all dimensions of our lives as our family
relationships. Family is the place where we learn many of our norms
for social life and have many of our day-to-day needs met. The
United Nations Universal Declaration of Human Rights (United
Nations, 1948), article 16.3 states that “the family is the natural and
fundamental group unit of society and is entitled to protection by
society and the State.” This same statement appears as article 17.1
in the American Convention on Human rights (Inter-American
Commission on Human Rights, 1969).
The family is not monolithic and never has been. Culture and
structural arrangements influence what families look like, what they
do, and how they manage day-to-day activities. Complex intersecting
factors influence the social grouping we call family. Families have
always been changing as they coped with the many forces acting on
them. Family situations and their access to resources differ as a
function of their socioeconomic status and their social locations in
other hierarchical societal systems. Families are not only influenced
by local and national forces, but globalization processes are changing
families in North America and around the world (Ciabattari, 2022;
Gardiner, 2018; Leeder, 2020). We are living in a period of rapid
global social change, and in the early 21st century families around
the world are being influenced by such forces as culture, government,
transnational corporations, religion, natural and built environments,
viruses, and technology.

So, what is a family? We were all born into some sort of family and
may have created a similar or different sort of family. Family means
different things to different people. The definition of family varies from
culture to culture but can also vary among people in the same culture.
Even family scholars struggle to define how family is different from
other social groups. White and colleagues (2019) suggest that
families differ from other social groups in degree only. They propose
that nonfamily groups, such as friend networks, close neighbors, and
coworkers, often have some of the same properties as families but
usually to a lesser degree; families tend to last substantially longer
than other social groups, are intergenerational in nature, and link to
larger kinship networks.

The North American family literature includes many definitions of

family, but the many definitions center on three ways to form a family:
biologically, legally, or socially. Biologically, family refers to people
related by blood and genetically bound to each other, however
distantly. This is the definition of family being used when we are
asked for a family medical history. Families are created legally by
marriage, adoption, or formalized fostering. There are many ways
that families can be created socially, by social interaction, when there
is no biological or legal relationship. Increasingly, couples are
cohabiting without marriage and may consider themselves family.
Sometimes neighbors, godparents, or longtime friends are
considered family. These have been called fictive kin, chosen family,
or voluntary family. Vivian Sharpe clearly thinks of her godparents as
family, and they have come to be family for Marcie and Caleb as well.

The U.S. Census Bureau has used essentially the same definition of
family since 1930. According to its 2022 version of the definition, “A
family is a group of two people or more (one of whom is the
householder) related by birth, marriage, or adoption and residing
together” (U.S. Census Bureau, 2022). This definition includes
families formed biologically and legally, as long as they are living in
the same household, but not those formed socially without legal
sanction. How does this definition fit with the way you think about who
is in your family? How does it fit for Bobby and Vivian Sharpe’s
family? It would certainly include Bobby, Vivian, Marcie, and Caleb
during many years. It also could include Vivian’s mother in the
periods when she lives in the household. Did it still include Bobby
while he was deployed and not living in the household? Does it
include Marcie while she lives in the nearby city? Does it include
Bobby’s parents, siblings, aunts, uncles, cousins, nieces and
nephews, and Marcie’s sister and her children? Was Bobby’s 2-year-
old niece family while she lived in the household but not when out of
the household? Are Marcie’s godparents family? Many social groups
that consider themselves family do not reside together, and some
social groups who call themselves family are not related by birth,
marriage, or adoption.

Family scholars have attempted to develop more inclusive definitions

of family, definitions that include social as well as biological and legal
relationships, definitions that would embrace more forms of families.
The Office of the High Commissioner for Human Rights and the Inter-
American Commission on Human Rights argue for a wider-ranging
definition of family at the global level (Redmond & Martin, 2021).
Family sociologist Teresa Ciabattari (2022) suggests the following
four approaches to defining family:
 Family as structure: Family based on formal biolegal (biological
and legal) relationships among members
Family as household: Family as a residential unit
Family as roles: Family as members interacting and
communicating in the context of social roles
Family as interaction: Family as active creators of common
culture

Often, definitions of family include more than one of the categories of

definitions presented by Ciabattari (2022). For example, research by
Hull and Ortyle (2019) on the definitions of family used in LGBT
communities found that when asked “Who is your family?,” both
family structure and family as interaction (chosen family) approaches
were used. Respondents reported that biological and legal relatives
were members of their families and so were chosen family members.
As noted by Hull and Ortyle (2019), sometimes we think differently
about the question “Who is your family?” than we might think about
the more general question, “What is family?”

Another way to think about the definition of family is in terms of its

functions, the tasks it performs. Leeder (2020) suggests that while the
structure of families varies greatly around the world and across time,
there is commonality in the functions performed by global families.
She suggested the following seven functions of families around the
world:

procreation, or other ways of adding new members

socialization of members to the norms and values of society
division of labor to meet family needs
regulation of behavior (including sexual behavior)
providing care and economic provision
status-conferral, establishing where family members fit in the
social stratification system
meeting affectional and emotional needs

For the purposes of the discussion in this chapter, we recommend

this inclusive definition of family proposed by Baxter and Braithwaite
(2006): Family is a social group of “two or more persons,
characterized by ongoing interdependence with long-term
commitments that stem from blood, law, or affection” (p. 2).
Increasingly, we exercise the freedom to use the word family to
describe the social group with whom we have emotional closeness (a
social definition). However, our freedom to define our own families is
limited. We must interact with organizations that have their own
definitions of family and sometimes have the power to impose those
definitions on us. Local, state, and federal governments have
definitions of family and enforce those definitions when providing
goods, services, and legal sanctions. Examples include legal
standards about who can marry, who has the right to custody, who
inherits from whom, who can benefit from filing joint tax returns, who
receives survivor benefits, who can visit hospital intensive care units,
who can make medical decisions for another, and who is included in
immigration family reunification policies. A variety of types of service
organizations also define who is included in a family plan to receive
particular types of service. As social workers, we should be most
interested in whom a person considers to be family, but we must also
be alert to situations where legal definitions do not recognize a given
form of family and how enforcement of those definitions impinges on
the lives of some individuals and families. This is an area that calls for
social work activism.

Critical Thinking Questions 10.1

How would you define family? Who is your family? Where have you
gotten your ideas about what it means to be family? Have those ideas
changed over time? If so, what influenced those changes?

Theoretical Perspectives for Understanding Families

A number of theoretical perspectives can be used to understand

family functioning and how to assist families who are struggling.
Societies around the world are made up of diverse families. How
social workers engage, assess, and intervene with diverse families
are influenced by the theoretical perspectives they use. Theoretical
perspectives direct what social workers pay attention to, how they
define the situation, where problems are located, and the planning
and implementation of interventions. We have chosen six theoretical
perspectives that can be helpful in different circumstances faced by
social workers: the family systems perspective, the exchange and
choice perspective, the symbolic interaction perspective, the
intersectionality perspective, the life course perspective, and the
family stress perspective.

Family Systems Perspective

The family systems perspective is, perhaps, the most used lens for
social workers working with families. The family systems perspective
focuses on the family as a social system, with patterns of
communications, behaviors, interactions, and relationships,
recognizing that changes in these patterns take place over time. The
family systems perspective is not a family therapy model but has
been integrated with other approaches to develop several models of
family therapy, including structural family therapy, strategic family
therapy, intergenerational therapy, among others.

This perspective requires social workers to engage in systems

thinking, a way of thinking that involves wholes, connections, and
relationships (White et al., 2019). To say a family behaves as a
system is a metaphor (White et al., 2019), and family systems
thinking is tough to define. In its simplest form, “drawing on von
Bertalanffy’s definition of a system, the family system is a set of
humans who stand in interrelations to one another” (Priest, 2021, p.
5) within the context of larger systems. Family systems thinking
requires a focus on relationships within the family and interactions
between the family members and other social systems rather than on
individual family members’ behaviors. The idea is that individuals are
best understood by assessing the whole family. The symptoms or
problematic behaviors that family members exhibit are seen as an
expression of the family system. Family systems thinking sees the
family as an interactional unit with all parts of the family system
interconnected. Therefore, a change in one member affects all
members.
Indeed, we can see that Bobby Sharpe’s and his sister’s deployments
and their grandmother’s stroke affected the entire extended kinship
system. According to Priest (2021), families are autonomous and
adaptable, responding to stress from inside and outside the system
and changing its rules and boundaries to function. The Sharpe
family’s boundaries shifted over time to help cope with stressors
coming from within the family system and from its environment. For
the family to function, families develop organizational structures and
roles for accomplishing tasks, commonly shared beliefs, rules (explicit
and implicit), rituals, and verbal and nonverbal communication
patterns created and repeated by previous generations (White et al.,
2019). Like all systems, families have subsystems, such as parental,
sibling, or parent–child subsystems. Some family systems theories
focus on the relationships within the family system. In contrast, others
focus on the ecosystem in which the family lives and the relationships
between the family system and other social systems.

When focusing on the relationships within the family, family systems

theorists draw from different models, often using a mix of
psychodynamic and social systems perspectives. Theorists who
approach family situations from this perspective assume that current
personal and interpersonal problems result from unresolved problems
in the family of origin , the family in which you are raised (Allen &
Henderson, 2017). They suggest that these unresolved problems
continue to be acted out in our current intimate relationships. Patterns
of family relationships are passed on from generation to generation,
and intergenerational relationship problems must be resolved to
improve existing situations. Some social workers who employ this
approach draw heavily on Murray Bowen’s natural system theory,
which defines the family as an emotional system and claims the role
of the family is to govern its members’ behaviors and relationships
(Bowen, 1978; Kerr & Bowen, 1988). In other words, a family is an
emotional unit made up of a multigenerational network of
relationships that shape the interplay of individuality and togetherness
—the push and pull between family members to be together and to
be separate and autonomous. The concept of differentiation of self is
central to Bowen’s theory. Kerr and Bowen (1988) described
differentiation of self as one’s ability to operate independently from
others and balance the need for family connection with the need for
autonomy and individual identity. Bowen (1978) suggested two
aspects of differentiation of self in the family system:

1. Differentiation between thinking and feeling. Family members

must learn to own and recognize their feelings. But they must
also learn to think about and plan their lives rather than reacting
emotionally at times that call for clear thinking. It is assumed that
many family problems are based on family members’ emotional
reactivity to each other. This aspect of differentiation is very
similar to the concept of emotional intelligence, which is
discussed in Chapter 4.
2. Differentiation between the self and other members of the family.
While recognizing their interdependence with other family
members, individuals should follow their own beliefs rather than
make decisions based on reactivity to the cues of others or the
need to win approval. They should do this, however, without
attacking others or defending themselves. A clear sense of self
allows them to achieve some independence while staying
connected to other family members. This aspect of differentiation
is similar to Howard Gardner’s concept of interpersonal
intelligence, also discussed in Chapter 4.

The concept of differentiation has been criticized for Anglo American

emphasis on individualism versus collectivism. To some, it
pathologizes the value of connectedness that prevails in some
cultures. There is some merit to this criticism if the theory is misused
to interpret a strong sense of familial responsibility, as seen in the
Sharpe family and many other racialized families and ethnic groups,
as a sign of a lack of differentiation. A separate solid self is not a
value in many cultures, and maturity is understood as the ability to
live in respectful relation to others, appreciating human
interdependence. In this matter, as with all others, it is essential to
practice with a desire to understand the cultural context of the family
you are serving.

When using a family systems perspective that focuses on

relationships within the family for thinking about the Sharpe family,
you will want to create a multigenerational genogram, a visual
representation of a family’s composition, structure, and delineated
relationships of at least three generations. A family’s genogram is a
helpful tool for assessment and interventions: identifying patterns,
quality of relationships, events, sources of resilience, and strengths in
families over generations (McGoldrick et al., 2020). See Figure 10.1
for a simple family genogram for the Sharpe family. Symbols include
females by circles, males by squares, lines indicating marriages and
births, and so on. Much more information can be presented on a
genogram than is presented in Figure 10.1, depending on the
assessment situation. McGoldrick et al. (2020) present an excellent
resource for creating genograms for different situations and provide
updated symbols to represent diversity around such issues as gender
identity, race and ethnicity, migration, and much more. The Sharpe
genogram helps you to visualize and identify the patterns passed
down through the generations in Bobby’s and Vivian’s families of
origin and extended family relationships. It may lead you to think
about whether Bobby’s deployments triggered unresolved grief about
the loss of Vivian’s father for her and the loss of her husband for
Vivian’s mother. As you worked with the family, you would fill in more
parts of the genogram, making connections.
Description

Figure 10.1 Sharpe Family Genogram

Family systems theorists focusing on the family’s relationships with

other social systems take an ecological perspective. They are
interested in how the family system is interdependent with the
physical and social environments. For example, the multilevel family
practice model (Vosler, 1996) widens the theoretical framework to
include the larger systems in which the family system is embedded—
including the neighborhood, local community, state, nation, and global
socioeconomic system. Thus, the multilevel model is broadly focused
on acknowledging the economic, political, and cultural factors that
affect resources available to the family and how family members view
their current situation and future challenges. This model recognizes
that the family institution is interrelated with other social institutions—
religious, political, economic, educational, social welfare, health care,
and mass media. This perspective would call our attention to how the
Sharpe family is affected by terrorism and war, the global economy, a
global pandemic, and health and social welfare policies related to
elder care and children with disabilities. They are also affected by
mass media coverage of racialized issues.

A family ecomap can be used to assess the way the Sharpe family is
connected to larger social systems. The family ecomap is a visual
representation of how a family is connected to other individuals and
social systems; it uses circles, lines, and arrows to show family
relationships and the strength and directional flow of energy and
resources to and from the family at a point in time, like a snapshot
(Hartman & Laird, 1983; see also Vosler, 1996). Ecomaps help to
identify external sources of stress, conflict, and social support. Figure
10.2 is an example of an ecomap for the Sharpe family after the peak
of the COVID-19 pandemic. It shows that Bobby and Vivian’s nuclear
family has both external stressors and external resources.
Description

Figure 10.2 Sharpe Family Ecomap After the Peak of the COVID-19
Pandemic

Exchange and Choice Perspective on Families

The common theme in the exchange and choice perspective on

families is that family relationships are based on the exchange of
resources valued by the participants—that family members act to
maximize outcomes they most value. The assumptions of this
perspective can be summarized in this way (Anders et al., 2020;
Smith & Hamon, 2022):

Humans act out self-interest.

Humans make choices about relationships.
 Human interaction is based on perceptions of the costs and
rewards of different choices.
Social relationships are characterized by interdependence and
reciprocity.

John Thibaut and Harold Kelley, early exchange theorists, were

interested in relationship stability and satisfaction and in how people
evaluate the rewards and costs of their relationships. They proposed
the concepts of comparison level and comparison level alternatives
(Kelley & Thibaut, 1978; Thibaut & Kelley, 1959). Comparison level, a
standard for evaluating the rewards and costs of a given relationship,
is based on what the evaluator expects from the relationship. The
stable relationship is one in which all parties think that they are
getting what they expect from the relationship. This theory recognizes
that different people have different expectations for relationships.
Comparison level alternative is the lowest level of outcomes a person
will accept in a relationship in light of alternative relationship
opportunities.

Rusbult (1980, 1983) proposed an investment model of social

exchange that considers the level of commitment in relationships. In
this model, commitment is based on feelings of psychological
attachment and an intention to persist with the relationship in good
times and bad. Rusbult suggested three conditions that enhance
commitment:

There is a high level of satisfaction with the relationship based on

feeling that needs and expectations are being met by the
relationship.
Alternative relationships are perceived to be unavailable or
unattractive.
There is a history of investing resources in the relationship and of
receiving resources from the relationship.

Johnson and colleagues (1999) furthered the exploration of

relationship commitment by identifying three dimensions of
commitment: personal, moral, and structural. Personal commitment is
a personal desire to stay in a relationship. Moral commitment refers
to values and morals that obligate one to stay in a relationship.
Structural commitment focuses on the constraints against leaving a
relationship, including the quality or lack of alternatives, the costs
associated with ending the relationship, and the amount of
investment in the relationship.

Let’s think of Vivian and Bobby Sharpe. It seems clear that they both
have a commitment to the relationship and that they have persisted in
the relationship in good times and bad. They both have invested time,
effort, and identity in the relationship and have created and received
such resources from the relationship as mutual affection and respect,
extended family members, children, shared memories, a house and
other possessions, and mutual friends. They seem to have both a
personal desire to stay in the relationship and a moral commitment to
the relationship. They both also have a strong commitment to their
two extended families, who also have demonstrated a commitment to
them.

The exchange and choice perspective has been used to study how
people make choices about romantic partnerships. Here are some
examples of that research. Anders et al. (2020) studied what first-
year college students see as the rewards and costs of casual sex
(hooking up). The identified rewards were having fun, fulfilling sexual
desires, gaining status, and the potential to develop a relationship.
The identified costs were regrets, ambiguity about the nature of the
relationship, increased risk of negative sexual health outcomes, and
loss of respect. Decision-making about casual sex happened in the
context of alternatives such as romantic relationships or friends with
benefits. Hadfield and Nixon (2017) studied what a group of single
Irish mothers saw as the benefits and costs of dating. The mothers
identified the following benefits: an opportunity to play a desired
relationship role, receiving support, and a different gender model for
the children. They also identified costs of dating, including time
needed for dating and a fear of the instability that romantic
partnerships could bring to the family. Rochadiat et al. (2018) studied
the advantages (benefits) and disadvantages (costs) of online dating
as seen by Muslim American women involved in online dating.
Several advantages were identified: increased agency in initiating
romantic relationships, increased control over interactions, greater
control over presentation of self, and increased confidentiality,
privacy, and anonymity. Disadvantages were also identified: social
stigma, fear that others were misrepresenting themselves, worries
about maintaining cultural and religious practices, disappointment
with the process, and technology problems. Researchers have also
used the exchange and choice perspective to study differences
between women and men in attitudes about the sexual exchange
(Basow & Minieri, 2011; He & Tsang, 2019).

The exchange and choice perspective has also been used to study
whether couples stay together or separate. One research team found
that women with higher education and greater earnings were more
likely to stay married than women with lesser education and earnings
when their relationships were nonviolent. However, in abusive
marriages, women with higher education and earnings were more
likely to get divorced (Kraeger et al., 2013). Having more resources
provides more choices. Machia and Ogolsky (2021) found that
romantic couples were more likely to stay together if they considered
themselves friends and more likely to separate if they perceived a
high quality of alternatives to the relationship.

Some exchange and choice theorists focus on the norm of reciprocity

in relationships, a norm that assumes that receiving support and
resources in a relationship obligates one to also give support and
resources, in approximately equal measure (see Suanet & Tilburg,
2019; Ugargol & Bailey, 2021). Research indicates that when there is
an imbalance in social support exchanges—if one partner over-
benefits and the other under-benefits—the continuation of the
relationship is threatened (Hummon & Doreian, 2003). Of course,
perception and expectation are involved in the evaluation of the
balance, the fairness of the exchange. In long-term relationships, the
balance of supportive exchanges changes over time and reciprocity
may be delayed or ebb and flow. Jarvis et al. (2019) found that
partners who closely monitor costs and benefits of relationships are
more likely to overreact to conflicts in the relationship. Mills et al.
(2004) found that the balance of exchanges is more important in non-
kin relationships than in kin relationships.
The exchange and choice perspective has been a major perspective
in the field of aging for studying caregiving in intergenerational
exchanges. Many societies assume that parents will be “repaid” for
the resources they invested in bearing and rearing children when they
are old and need care (Kalmijn, 2019). Researchers in India have
found this to continue to be the case in India and other Asian nations,
even in a changing world where migration of the young adult
generation becomes more common (Ugargol & Bailey, 2021). In
contrast, a study in Norway, England, Germany, Spain, and Israel
found that older adults who were able to reciprocate in exchange
relationships with their adult children reported greater life satisfaction,
but the highest level of satisfaction was reported by older adults who
gave more to their adult children than they received (Lowenstein et
al., 2007). Both culture and aging policy influence such attitudes and
expectations. Using a sample from the Netherlands, Kalmijn (2019)
found that even in a country with strong government supports for late-
life adults, somewhere around age 75 to 76, late-life parents receive
more support and resources than they give in their exchanges with
their adult children. They become “net receivers.” One study found,
however, that frail older persons in assisted-living facilities used types
of deference, such as pleasantness, cooperation, and gratitude, to
gain reciprocity in their relationships with family and staff (Beel-Bates
et al., 2007). Equity and inclusion call for consideration of policies and
practices that would allow financially and otherwise marginalized
people to more fully participate in social exchange. As noted in
Chapter 1, the U.S. social welfare institution has, historically, put
primary emphasis on promoting independence and preventing
dependence. This emphasis on individualism and independence puts
people with limited physical and material resources at a disadvantage
in social exchange processes. In contrast, the European social
welfare states have put more emphasis on promoting social inclusion
and using the social welfare institution as an investment to protect the
health of the society.

The exchange and choice perspective has been criticized for its
assumption that all human behavior is based on self-interest and for
ignoring altruistic behavior. Some suggest that it assumes a separate
rather than a connected self, even though interdependence has been
a theme of exchange and choice theorists. These are valid criticisms,
but a number of versions of the perspective propose that values,
norms, and expectations are included in the evaluation of the benefits
and rewards of interpersonal exchanges, and researchers in such
collectivist cultures as China and India are finding support for social
exchange theory (He & Tsang, 2019; Ugargol & Bailey, 2021). The
inclusion of moral commitment in relationships can help account for
altruistic exchanges.

Symbolic Interaction Perspective on Families

Symbolic interaction theory has been one of the most influential

theories in family studies (Smith & Hamon, 2022; White et al., 2019).
In the simplest terms, the symbolic interaction perspective on families
understands family life as a system of meaning created through
interaction. People react to objects, situations, and interactions
according to the meaning they have for them. There are several
streams of symbolic interaction theory, with each focusing on
particular themes of social life. In this chapter, we focus on four
concepts that are particularly salient to family life: meanings,
symbols, rituals, and roles.

Symbolic interaction theory proposes that human behavior is based

on the meanings that people hold about objects and the social world.
It further proposes that meanings come from social interaction and
are based on interpretation of those interactions. Families are sites of
more or less intense interaction and are therefore sites for the
creation and testing of meanings. Family studies scholars are
interested in the meaning that particular types of behavior have for
family members and in how families make meaning as they interpret
cultural codes and beliefs. They are particularly interested in what
family means to family members and how that meaning is influenced
by cultural norms and expectations. Symbolic interactionists see
meaning making in the context of social interaction as fluid and
ongoing, bringing change as well as stability to family life. For
example, for the Sharpe family, family is a tight four-generational unit
that is committed to stay together and support each other in good
times and bad. It also is a unit that can incorporate members not
connected by birth or marriage, such as Vivian’s godparents. When
Marcie arrived at university where she was not embedded in the
family in day-to-day interactions, she began to understand that not all
of her peers held the same meaning of family and she confronted the
question of what she wanted family to mean in her future life if she
did not return to her hometown where her extended family interacted
on a regular basis.

Cultures and families use complex systems of symbols to build

cohesion and manage conflict. As noted in Chapter 6, a symbol is
something that stands for something else. It can be language (shared
family name or not), an object (a favorite family holiday ornament), or
nonverbal behavior (cooking from a family recipe carried down
through the generations). Some symbolic interactionists focus on
language and its impact on human behavior and family life. In this
tradition, queer theory has criticized the use of language binaries,
particularly those related to sexuality and gender, to simplify complex
human behaviors. Binary language related to such issues as
sexuality, gender, and race have a large impact on cultural
understanding of family life.

One research team (Suter et al., 2008) investigated how lesbian

couples negotiate a family identity through the use of symbols and
rituals. They interviewed mothers of 16 two-parent lesbian families
who had conceived their children through donor insemination. They
found that the great majority of the couples in their sample used two
types of symbols to develop a family identity. Most of the couples
chose to use a hyphenated last name for the mothers and the
children to signify to the world that they are family. One mother
reported continuing with her unhyphenated last name to remind her
parents who were unsupportive of her partner relationship that she
was their daughter and therefore her children were their
grandchildren—in hopes of encouraging them to behave like
grandparents to her children. All but one of the couples reported
choosing sperm donors who had physical characteristics similar to
the nonbiological mother, explaining that “looking related” symbolized
familyhood.
A ritual is a set of actions or words performed regularly. They occur in
the daily lives of families as well as to mark important events. Use of
family rituals has been found to provide meaning for family
interactions, develop narratives about family identity, promote family
cohesion, support children’s emotional development, and serve as a
coping mechanism to deal with family stress. They are also used as
markers for family transitions, such as graduations, marriages, and
deaths. Family rituals vary across cultures and families. Simões and
Alberto (2019) report on the coming of age rituals in urban southern
Angolan families. Other cultures have different coming of age rituals
and some cultures have none. Bocknek (2018) found that rituals that
connect children to previous generations serve as a protective factor
for young children in impoverished African American families. Family
rituals are often disrupted when families face severe medical
problems such as childhood cancer or hospitalization in the intensive
care unit (Amass et al., 2020). Santos et al. (2018) found that families
with a child who has cancer often transform old rituals and create
new ones to maintain family identity and cohesion. Family rituals of
marriage and mourning were disrupted during the COVID-19
pandemic, and many new electronic family rituals were developed to
stay connected (Delor et al., 2021). Bobby and Vivian Sharpe have
developed a new family ritual of twice monthly visits to share favorite
foods with Marcie and her roommates.

Role is a central concept in at least one stream of symbolic

interaction theory. A role is the set of social norms for a particular
social position or status. In families, social statuses may include
father, mother, partner, grandparent, brother, sister, and so on. Roles
are the expectations of how individuals should enact their social
statuses. There are several ways to think about role expectation.
There are the expectations that the larger society has for how family
roles should be enacted, there are expectations within a given family
of how roles should be enacted, and the individual occupying a
particular role has their own expectations about how the role should
be enacted. Role expectations may be clear or blurred. In some
places, gender role expectations have been changing for some time,
becoming more blurred over time but in some parts of the world more
than in others.
Role conflict is another important theme among symbolic interaction
theorists who focus on roles. A common type of role conflict occurs
when a person is expected to play two incompatible roles. In the
recent past, the family literature has been filled with research about
the role conflict that women face as they try to simultaneously
perform mother and work-related roles (see Brown & Sumner, 2013;
Meuleman et al., 2017). Less research has focused on how men
navigate role conflicts involved in family and work-related roles.
Vivian Sharpe experienced role conflict between mother and worker
roles when she assumed a supervisory position while Bobby was on
his second deployment. Marcie Sharpe faced role conflict as a
student-athlete who must complete academic work in a timely
manner, attend practices and perform at track meets, and try to get
home to be a part of family events. Such role conflicts lead to role
strain.

Intersectionality Perspective on Families

The intersectionality perspective on families focuses on the complex

way that intersecting systems of power affect the social position of a
family in the external world as well as the power relations within the
family (Curtis et al., 2020). Earlier feminist theories of the family had
called attention to the ways that gender is used to dominant and
subjugate women within the family. In the 1970s and 1980s, Black
feminists and critical race theorists introduced the concept of
intersectionality to challenge the idea that gender is a monolithic
category (P. H. Collins, 1990; Crenshaw, 1989). They suggested that
no single category is sufficient to understand systems of power and
social oppression, and categories such as gender, race, and class
intersect to produce different experiences for women of various races
and social classes. Since then, the intersectionality framework has
been extended to other socially constructed categories such as
sexuality, age, religion, ability, nationality, citizenship status, ethnicity,
among others (see P. H. Collins & Bilge, 2020). An intersectionality
perspective is now used in a number of academic disciplines,
including family studies (Crenshaw, 2021).
The core issue in the intersectionality perspective is that in a given
society at a given time, power hierarchies are built on a large range of
socially constructed social categories (P. H. Collins & Bilge, 2020).
These hierarchical systems are not discreet and mutually exclusive.
They are interrelated, they intersect, and they mutually shape one
another to create unequal and oppressive social relations. Families
should be understood by considering the interconnectedness of the
multiple social categories (identities) of their members—recognizing
the privilege and disadvantage associated with each category.
Identifying only one social category or identity is insufficient
(Crenshaw, 2021). The multiple intersecting categories and identities
create a distinct family entity (Gangamma & Shipman, 2018). The
intersectional perspective on families is used to understand how
socially constructed hierarchies affect families, and how family
processes reproduce or resist those hierarchies.

Here are two examples of recent use of the intersectionality

perspective on families in family research: the study of intimate
partner violence and child welfare policy. Barrios et al. (2021)
recommend an intersectional framework for analyzing women’s
processes of leaving abusive relationships. They found that
individual, familial, and sociocultural factors intersect to affect access
to resources for leaving and the decision to leave. Race, gender,
ethnicity, religion, and class intersect with psychosocial factors such
as mothering identity, psychological readiness to leave, social
support, and an immigrant’s level of acculturation, generational
status, language abilities, and citizenship status. All of these factors
play a role in access to formal resources. Williams-Butler et al. (2020)
used an intersectionality framework to analyze how an intersection of
race, gender, and class have influenced key U.S. federal policies
affecting Black children in the child welfare system. Their analysis
indicates that the current over-representation of Black children in the
child welfare system is the outcome of “racialized, gendered, and
class-based marginalization of Black mothers who are low-income”
(p. 76).

The intersectionality perspective was developed by African American

scholars in the United States, but it has been used in recent years to
understand the impact of neoliberal globalization on family social
position and family relationships in other parts of the world. Feminist
scholars in the Global South have use an intersectional approach to
understand differences in women’s situations in different geographic
regions (Jison, 2021). Chinese researchers have used an
intersectional perspective to consider the millions of rural families
who migrate to urban areas in search of work, a situation driven by
economic globalization. Gao and Hopkins (2022) write that although
rural Chinese women migrants may be able to create new
opportunities for gender justice, they also face new systems of
oppression related to gender, class, religion, ethnicity, and citizenship
in the urban areas to which they migrate. The Chinese state has
developed a hukou system in which rural residents and migrants are
perceived and treated as inferior. They are not allowed to settle in
cities as permanent residents and are not granted access to most
state-sponsored services provided to urban residents, including
housing subsidies, pensions, health care, and education. Thus, rural
or urban residential origin of one’s parents is one hierarchical system
that interacts with other hierarchical systems such as those based on
gender, ethnicity, migration status, and class to influence the social
position of a family. Gao and Hopkins (2022) report that religion is
another intersecting hierarchical system in this mix. A Christian
religious revival is occurring in China, more pronounced in rural areas
than urban areas, and rural Christian migrants to urban settings face
prejudice as well as state regulation and surveillance because of their
religion.

Lui (2018) analyzes the circumstances of inter-hukou families in

China, where one partner has rural origins and the other partner has
urban origins. These families may be denied access to state-
sponsored services, compromising the family’s social position. Lui
(2018) is most interested, however, in how rural or urban residential
origin interacts with other social categories to influence the power
dynamics in the family. Lui’s research found that rural wives of urban
men are socially stigmatized and devalued by their husband’s
families. This is an important reminder that intersecting hierarchies
have two types of influences on families: they influence the social
position of the family in the external world, and they influence the
power position each member of the family holds within the family.

In recent times, some family scholars have argued that most of the
theoretical and empirical investigation of families has been based on
White, middle-class, two-parent, first-married, cisgender,
heterosexual families with biological children. Too often a deficit
approach has been taken to understand families that fall outside this
intersection of social categories. These scholars recommend a new
model for theorizing about families, a model that integrates feminist,
intersectional, and queer perspectives to recognize the diversity of
ways of doing family (see Allen & Mendez, 2018; Few-Demo et al.,
2016; Goldberg & Allen, 2018). There is some tension in this
synthesis of theoretical perspectives because intersectionality theory
focuses on social categories of power and queer theory challenges
existing social categories, especially those based on binaries. Allen
and Mendez (2018) recommend that the life course perspective be
integrated into this model to recognize that social categories and
attitudes about them change over time and these changes impact the
roles and values of individuals and families.

The Bobby and Vivian Sharpe family must navigate a social world
based on a racial hierarchy that devalues Blackness. Their class
status is higher than some other Black families in their community,
including some families in their extended family network. It appears
that power and authority are shared in the Sharpe family. Landry
(2000) suggests that middle-class Black women “pioneered an
egalitarian ideology of the family” (p. 5) in the United States. The
Sharpe family resists some of societal guidelines for gender
hierarchies, but women in the family are still considered the primary
caregivers. It is important to consider how Caleb’s disabilities affect
his relationships with the outside world as well as his relationships
within the family. As Vivian’s mother moves in with the family, it is also
important to think about hierarchies based on age. In the external
world, we could examine racial relations in the small southwestern
town where the Sharpe family lives. We could also examine Bobby’s
experience as a Black man in the military, considering any racial
prejudice and discrimination he faced while serving. We should also
think about his sister’s military experience as a Black woman, how it
was the same and different from Bobby’s experience, as well as the
same or different from the white women with whom she served.

Life Course Perspective on Families

The life course perspective on families (LCPF) expands the concept

of family system to look at families over time. The LCPF considers
the importance of time in families in two ways: (1) the family in
historical context and (2) the family moving through time. With its
emphasis on historical time, the LCPF is one of the few theoretical
perspectives on families that addresses how family life is influenced
by changing social, cultural, and economic contexts and by events
such as wars and pandemics. Families must always be understood in
the context of the times and cultures in which they are living. Families
are also seen as multigenerational systems moving through time,
composed of people who have a shared history and a shared future.
Relationships in families go through transitions as they move along
the life course; boundaries shift, rules change, and roles are
constantly redefined. We certainly see that happening with the
Sharpe family. LCPF researchers are interested in how families
synchronize individual life transitions—such as job changes that
require relocation or death in the family—with family responsibilities,
needs, and wants (Trask, 2018). When Bobby was deployed to Iraq
and Afghanistan, he and Vivian were young adults with family and
work obligations. Bobby’s parents and Vivian’s mother were in late
middle adulthood with memories of the Vietnam War, even traumatic
memories for Vivian’s mother. Marcie was in middle childhood, a
period in which she was expected to be focused on school
achievement and had the cognitive capacity to understand the
dangers of war. Caleb was in early childhood during Bobby’s second
deployment and was old enough to miss his dad and be aware of the
climate in the family as members adapted structure and roles to
compensate for Bobby’s absence. The members of this one family
experienced the wars in Vietnam, Iraq, and Afghanistan in different
ways given their different positions in the life course.
Family life events is an important concept in the LCPF. LCPF
researchers are interested in the timing of life events and
expectations about the timing of life events (see Zimmermann &
Konietzka, 2018). Lei and South (2016) studied racial and ethnic
differences in leaving and returning to the parental home and found
that Black and Hispanic young adults are less likely than their white
peers to move out of the parental home and more likely to return at
some point. Both economic resources and family connectivity play a
role in these differences. Speirs et al. (2017) studied cultural
differences in Canadian young adults’ perceptions of the probability of
future family life events. They found that young adult study
participants of Asian and South Asian heritage were significantly
more likely than white study participants to report the expectation of
becoming a caregiver for aging parents, and white study participants
were significantly more likely than Asian and South Asian participants
to report the expectation of placing a parent in a nursing home.

LCPF researchers are also interested in family life event histories, in

the unfolding of life events and how life events at one point in time
are related to life events at another time. Using a mostly white sample
of young adults ages 25–34 living in seven U.S. states, Hall (2017)
studied the process by which family members get marginalized and
excluded in family life and found that such marginalization involves
many episodes of hurtful communication over time. LCPF
researchers are interested in turning points , or critical moments in
family life that leave a mark and change the family trajectory. Mayock
et al. (2021) studied the turning point experiences leading to youth
homelessness and found that parental separation, death of a parent,
and other acute disruptions in family life such as those caused by
parental substance abuse or family violence were important turning
points.

Like the family systems perspective, the LCPF emphasizes the

interdependence of human lives. Individual lives are linked to the
lives of other family members and family life is linked to situations
such as a deadly pandemic in the globalized world. During the
COVID-19 pandemic, family transmission was an important source of
spread of the virus and family clusters were common (Yan & Qu,
2021). Humans are linked genetically to their biological
intergenerational families, and they are also affected by parental
trauma exposures that occur before their birth, and perhaps before
their conception (Flanagan et al., 2020; Yehuda & Lehrner, 2018).
Family life circumstances in childhood have been found to have long-
term effects on physical and mental health at later life stages
(Umberson & Thomeer, 2020). One example of this research is the
Adverse Childhood Experiences (ACE) study that found that as the
number of adverse childhood experiences increased, so did the
likelihood of risky health behaviors, chronic physical and mental
health conditions, and early death (Felitti et al., 1998). The original
study considered five categories of adverse childhood experiences:
physical abuse, sexual abuse, or emotional abuse; physical or
emotional neglect; violence against the mother; living with household
members who were substance abusers, mentally ill or suicidal, or
ever imprisoned; and parental separation or divorce. Family life is
also linked to circumstances in the community and the globalized
world. Cultural expectations about family roles and structural
opportunities and obstacles influence family life trajectories (Trask,
2018).

The LCPF has been interested in diversity in family life course

trajectories. Trask (2018) suggests that an understanding of family
diversity must address both individualistic and collectivist family
cultures and calls for more attention to transnational families as family
members migrate to develop economic resources in the globalized
economy. LCPF provides a strong conceptual framework for
considering diversity in family lives but has only recently begun to
address the plurality of values, experiences, and power differentials
of racial and ethnic families in a globalized world. Research that
addresses the differences within families of the same racial and
ethnic group (an intersectional approach) and research about the
experiences of families marginalized because of sexual orientation
and gender identity are becoming more prominent in journals devoted
to family life. Recently, LCPF researchers have used narrative and
other qualitative research methods to develop deeper understanding
of marginalized families in their own voice. Here are a few examples.
Using the critical race life course perspective, DiAquoi (2018)
examined how Black parents have prepared their sons for racial bias
and discrimination across different historical eras. Brady and Gilligan
(2019) examined the educational pathways of young people with
foster care experiences in Ireland. Tasker and Gato (2020) studied
interest in becoming a parent among people who are transgender or
nonbinary. Petit et al. (2018) interviewed 24 Canadian trans parents
to understand the intersection of their parental and trans life
trajectories, examining the differences between trans parents who
became parents prior to transitioning and trans parents who became
parents after transitioning.

Family Stress Perspective

The family stress perspective focuses on how families cope with

stress. One theoretical foundation of this perspective is the ABC-X
model of family stress and coping, based on Rueben Hill’s (1949,
1958) classic research on war-induced separation and reunion. It
theorizes that to understand whether an event (A) in the family
system becomes a crisis (X), we also need to understand both the
family’s resources (B) and the family’s definitions of the event (C).
The main idea is that the impact of stressors on the family (the X
factor) is influenced by other factors, most notably the internal and
external resources available to the family and the meaning the family
makes of the situation. The ABC-X model has been criticized as
linear, oversimplified, and deterministic (E. Lee & Roberts, 2018), but
with some updating the theory continues to be the basis for
examining family stress and coping (see Chaney, 2020; Masarik et
al., 2022; Safia et al., 2021).

The ABC-X model describes a family transition process following a

stressful event. A period of disequilibrium is followed by three
possible outcomes: (1) recovery to the family’s previous level of
functioning; (2) maladaptation, or permanent deterioration in the
family’s functioning; or (3) bonadaptation, or improvement in the
family’s functioning over and above the previous level. Thus, under
certain circumstances, a stressor event can actually be beneficial if
the family’s coping process strengthens the family in the long term.
A more complex, double ABC-X model incorporates the concept of
stress pileup (McCubbin & Patterson, 1983). Over time, a series of
crises may deplete a family’s resources and expose the family to
increasing risk of very negative outcomes (such as divorce, violence,
or removal of children from the home). In this view, the balance of
stressors and resources is an important consideration. Where there
are significant numbers of stressors, positive outcomes depend on a
significant level of resources being available to family members and
the family as a whole. A family timeline , or visual representation of
important dates and events in the family’s life over time (Satir, 1983;
Vosler, 1996), can be particularly helpful in identifying times in the
family’s life when events have piled up. Family timelines can be used
to identify the resources that have been tapped successfully in the
past as well as resource needs in the present. Figure 10.3 presents a
family timeline for the Sharpe family. It suggests a pileup of stressors
for the family in the period before, during, and after Bobby’s
deployment to Afghanistan; consequently, they needed a significant
number of resources to allow for continued healthy individual and
family functioning. The years 2019 through 2022 appear to be
another period of stress pileup. Many families experienced stress
pileup during the early days of the COVID-19 pandemic, some losing
jobs, others being required to work as essential employees while
childcare facilities and schools were closed, many working from home
while supervising their children. Added to that stress was fear of
getting COVID-19 and loss of family members to COVID-19.
Description

Figure 10.3 Sharpe Family Timeline

Two types of stressors are delineated in the ABC-X model (McCubbin

& Figley, 1983). Normative stressors are stressors families face as a
result of typical family life cycle transitions, such as the birth of a first
child or the first child leaving home. Nonnormative stressors are
unexpected and potentially catastrophic events, such as natural
disasters, medical trauma, drug abuse, unemployment, and family
violence. These nonnormative events can quickly drain a family’s
resources and may leave family members feeling overwhelmed and
exhausted. Lower-level but persistent stress—such as chronic illness
or chronic poverty—can also create stress pileup, resulting in
instability within the family system and a sense of being out of control
on the part of family members.

Boss and colleagues (2017) recommend a contextual approach to

extend the family stress model, an approach that considers the
cultural, historical, and economic context of stressful family events.
Similarly, Prendergast and MacPhee (2018) recommend extending
the family stress model to include minority stress theory when
studying families headed by same-gender parents. They recommend
that any specific stressful event in these families must be placed in
the context of chronic stigmatization and discrimination. They note
that place matters, however, and some legal, political, religious,
neighborhood, workplace, and school climates are more hostile than
others. Prendergast and MacPhee also recommend an
intersectionality approach when studying same-gender parent
families, recognizing that lesbian and gay identity “intersect with
gender, social class, and racial and ethnic identities” (p. 29).

A contextual approach to family stress theory is also recommended

for the study of African American families (see Murry et al., 2018;
Smith & Landor, 2018). Both Murry et al. (2018) and Smith and
Landor (2018) recommend a sociocultural family stress theory that
incorporates the concept of mundane extreme environmental stress
(MEES), originally proposed by Peters and Massey (1983), for
understanding stress in Black families. This concept recognizes that
specific stressful family events occur in the context of the stress of
racism, prejudice, and discrimination, which is a common (mundane),
day-to-day experience for Black families and that the stress of racism
has a harsh (extreme) impact on the perceptions and emotional
resources of members of Black families. Murry et al. (2018)
recommend that mental health practitioners must recognize the risk
and protective factors that are common in Black families and propose
a resilience, strengths-based conceptual model for understanding
these families. In addition, to mundane extreme environment stress,
Smith and Landor (2018) argue that intersectionality must also be
included in sociocultural family stress theory to understand how
multiple areas of power and oppression occur both within and outside
Black families. The social positions of all Black families are not the
same; factors such as class, gender, sexuality, and skin tone intersect
with race to influence social positions both within and outside the
family.

The family resilience perspective extends the family stress and

coping perspective by seeking to identify and strengthen family
processes that allow families to bear up under and rebound from
distressing life experiences (see Walsh, 2016). Walsh (2016)
identifies family belief systems, organizational patterns, and
communication patterns as processes that can strengthen resilience
and warns that the concept of family resilience should not be
misapplied to blame families for not rising above harsh conditions.
Consistent with this warning, Leslie Anderson (2019) argues that we
must think critically about how processes of resilience may actually
impose risk on African American families. In this regard, researchers
have paid attention to the Superwoman or Strong Black Woman
Schema, a schema that includes feeling obligated to appear strong,
suppress emotions, avoid being vulnerable or dependent on others,
and always be helpful to others. Vivian Sharpe has learned from
women before her—her mother, godmother, grandmother, mother-in-
law, Bobby’s grandmother and women in the community—about
being strong and the importance of taking care of the family,
sometimes at one’s own expense. Internalization of the Superwoman
Schema has been found to be associated with physical and mental
health problems among Black women (Leath et al., 2022; Watson &
Hunter, 2016). Leslie Anderson (2019) reminds us that some social
groups are continuously exposed to adverse environments, and
assisting families to adapt to those environments is insufficient and
can be damaging. Efforts to promote social, racial, economic, and
environmental justice are called for.

Critical Thinking Questions 10.2

Which one of the preceding theoretical perspectives on families do

you find most useful for thinking about the multigenerational Sharpe
family? Which perspective do you think offers the least insight into
this family? Which of the perspectives do you find most useful for
thinking about your own family? The least useful? Explain your
answers. Did you feel challenged by any of the perspectives? If so,
what was challenging about the perspective? How will you address
the challenge to put you in a better position to genuinely engage and
work effectively with families?

Diversity in Family Formation and Structure

Earlier in this chapter, we noted that there is not now nor ever has
been a monolithic family structure or culture. We can’t emphasize that
enough. There has always been considerable diversity in family life,
and the ways of doing family are growing more diverse. Critical family
theorists suggest that while there has always been diversity in family
life, North American family theory and research has focused on one
type of family as the standard against which all other families have
been evaluated: the white, middle-class, two-parent, first-married,
heterosexual, cisgender family with biological children. It is important
to remember that not all families with that configuration of social
identities are the same nor should they be considered the norm and
other types of families seen as deviant.

It is beyond the scope of this chapter to undertake a comprehensive

examination of the diversity in family life around the globe. In this
section, we discuss diversity in family formation, compare and
contrast multigenerational and nuclear family households, and review
research on four family structures (single-parent families, childless
couples, repartnered families, and adoptive and foster families) that
are different from the nuclear, two-parent, first-married family with
biological children that has been the focus of past family theory and
research. Too often these four types of family structure have only
been studied in comparison to nuclear, two-parent, first-married
families with biological children and considered deviant or incomplete.

Family Formation

New families are usually started with the selection of a mate or

mates. Societies have cultural norms, some written into law, about
the choice of mates. Exogamy norms require that romantic and
sexual relationships should not occur within the immediate social
group. The best example of an exogamy norm is the almost universal
incest taboo that applies to sexual relationships between parent,
child, sibling, or grandchild. First cousin relationships are forbidden in
some societies and encouraged in others. Endogamy norms
discourage mating with people from outside one’s social group.
Mating with someone from a different caste or social class, religion,
race, tribe, or ethnic group has been discouraged and even
criminalized in different times and places. Some social groups and
societies are stricter in enforcing endogamy rules than other social
groups and societies, and in some places endogamy rules have been
loosened over time. For example, the United States decriminalized
interracial marriage in 1967.

Historically, romantic mating has resulted in marriage, but marriage

rates have been dropping around the world, with considerable cross-
country variation. Marriage rates remain high in the Middle East and
East Asia, where marriage is often considered a necessity. Marriage
rates in the United States have fallen by almost 50% since 1972
(Ortiz-Ospina & Roser, 2020; Sassler & Lichter, 2020). Some of the
decline in marriage is related to delayed marriage, a pattern in much
of the world, but a lot of it is because more and more people are
choosing cohabitation over marriage (Sassler & Lichter, 2020).
Cohabitation is widespread across Europe, North America, and
Australia. It is rare in Japan and South Korea but is increasing in
Taiwan and China (Sassler & Lichter, 2020). In the United States,
most young adults cohabit before marrying, but most cohabiting
partnerships do not end in marriage. Cohabiting relationships have
been becoming more stable in the United States but are still less
stable than cohabiting relationships in the rest of the world.
Cohabiting relationships have more legal status in some European
countries than in the United States (Ritzer, 2021). Cohabiting couples
may or may not have children.

Marriage and cohabitation take many forms. Monogamy is partnering

with one mate at a time. Anthropologists estimate that 80% to 85% of
the world’s societies prefer some type of polygamy (having more than
one spouse at a time; Haviland et al., 2017). Polygamy can take the
form of either polygyny (one man and multiple wives) or polyandry
(one woman and multiple husbands). Polyandry is much less
common than polygyny, however. Polygyny is found on every
continent but is most common in Islamic countries, African countries,
and parts of Asia (Gardiner, 2018). All societies allow monogamy,
and, indeed, most people of the world cannot afford to support
multiple spouses. In recent times, a new form of polygamy has
emerged globally; polyamory is the practice of engaging in multiple
romantic (and typically sexual) relationships, with the consent of all
people involved. Although polyamorous relationships have legal
standing in few places, children are increasingly born into
polyamorous relationship networks (Harder, 2021; Pain, 2020;
Schadler, 2021).

In the United States and other Western societies, partnering is a

culmination of romantic love, and it is assumed that everyone has a
right to choose a partner. In many Eastern societies, marriages are
arranged, and it is generally assumed that there are several possible
mates with whom one can establish a successful long-term
relationship. It is also assumed that parents will make wiser decisions
than young people would make for themselves (Gardiner, 2018). The
number of arranged marriages has declined in Japan, but they are
still preferred by a majority of people in India, where marriage across
caste lines is still uncommon (Gardiner, 2018; Martin, 2020).

Bobby and Vivian Sharpe lived in the same neighborhood and are of
the same race and religion. The decision to marry was theirs after
developing a romantic relationship. It appears that their marriage is
monogamous.

Multigenerational and Nuclear Family Households

We are all born into a multigenerational biological family and may

legally or socially join other multigenerational families. Most of us
have relationships with some members of our multigenerational
families—cousins, uncles and aunts, grandparents—but we do not all
live in multigenerational family households. Multigenerational family
households, also known as extended family households or joint
families, are households where two or more adult generations reside
together and share resources and tasks. They are often three-
generational, including grandparent(s), parent(s), and child(ren), but
they take other forms as well, and some are more complex than
others, including even distant relatives. Multigenerational family
households are more common in Asia, Africa, and Latin America than
in North America and Western Europe (X. Chen, 2016; S. Gupta et
al., 2021; Guvuriro & Booysen, 2020; Morrell et al., 2020; Palma,
2022).

Many of us have spent our lives in nuclear family households, also

called conjugal families, family households made up only of parent(s)
and child(ren). Nuclear families may have one or two parents,
married or unmarried parents, one child or multiple children, including
biological, adopted, or formally or informally fostered children. We
don’t know a lot about the functioning of nuclear families because
they are not often studied, except to compare other types of families
with them. It is probably safe to say, however, that not all nuclear
family households are the same.

The nuclear family household seems to be universal, occurring even

in countries where multigenerational family households are common
(Leeder, 2020). For example, S. Gupta et al. (2021) report that about
50% of current households in India, where the joint family has a long
history, are nuclear in composition. At the same time,
multigenerational living is increasing in some countries where nuclear
families are prevalent (Guvuriro & Booysen, 2020). The
multigenerational household is the fastest growing household type in
the United Kingdom (Maye-Banbury & McNally, 2020), and the share
of the U.S. population living in multigenerational households more
than doubled (from 7% to 18%) between 1971 and 2021 (Cohn et al.,
2022). Economic insecurity in a globalized economy appears to be
contributing to both trends, away from and toward multigenerational
living. Increased migration of young adults in search of work and
training is contributing to a decline in multigenerational family
households in places like India and China (X. Chen, 2016; S. Gupta
et al., 2021; Morrell et al., 2020). Economic instability in wealthy
countries like the United States and United Kingdom are pulling
people to multigenerational living to insulate them against economic
uncertainty (Cohn et al., 2022; Maye-Banbury & McNally, 2020). In
the United States, Asian American, Black, and Latinx families are
more likely than white families to live in multigenerational family
households, and immigrant families are more likely than native
families to live in multigenerational family households (Cohn et al.,
2022).
Multigenerational households can have financial advantages, even
though income must be shared among more people, and appear to
offer protection against falling into poverty (Cohn et al., 2022; Palma,
2022). They have more human resources to care for older adults,
children, and other vulnerable family members, and for this reason
they are an essential care system for societies with underdeveloped
service sectors and social welfare systems (Jackson et al., 2020;
Morrell et al., 2020; Palma, 2022). Multigenerational households have
been found to reduce work–family conflict for employed mothers in
Nigeria (Amah, 2021). Multigenerational households also present
some challenges. Lines of authority have to be prescribed or
negotiated across generations and among more people. Conflicts
over roles, who should be doing what, become more complex than in
nuclear families (S. Gupta et al., 2021). Good communication skills
are needed to develop cooperation and manage conflict (Guvuiro &
Booysen, 2020).

Bobby Sharpe was raised in a three-generation household where his

grandmother played a key role. For most of their marriage, he and
Vivian have lived in a nuclear family household while maintaining
strong ties to their multigenerational biological families. Vivian’s
mother moved in with Vivian and the children during Bobby’s
deployment to Afghanistan, creating a multigenerational household to
care for the children in Bobby’s absence. She has recently moved in
with Bobby, Vivian, and Caleb, again creating a multigenerational
household, this time to receive care for herself in her advancing age.

Single-Parent Families

Single-parent families , often called lone-parent families in the

sociological literature, are composed of one parent and at least one
child residing in the same household. They are headed by divorced,
widowed, or never-married parents. In recent decades, the
prevalence of single-parent families has dramatically increased in all
income groups in the United States and other societies around the
world but nowhere more than in the United States (Kramer, 2019;
Yorks, 2022). In 2020, one-fourth (25%) of children in the United
States lived with only one parent, up from 12% in 1970 (Kramer,
2019; Yorks, 2022). This is more than 3 times the worldwide average
of 7% (Kramer, 2019). Around the world, single mothers are the great
majority of parents in single-parent families, but households headed
by single fathers are on the rise and now make up almost 20% of the
single-parent families in the United States (U.S. Census Bureau,
2017).

It is difficult to generalize about single-parent families because of the

different pathways taken to create them and the diverse
circumstances in which they live. The single parent may have always
been single, or be separated, divorced, or widowed. They may be
casually dating, seriously dating, or not involved in romantic
relationships at all. They may have become a parent intentionally or
unintentionally. Some are co-parenting, and others are not. Some are
financially secure, and others are impoverished. Some have
extensive support from robust support networks, and others are
relatively isolated. Some live with parents or other relatives and
others do not. Some have chosen to parent alone, using processes
such as adoption, donor insemination, or surrogacy (Carone et al.,
2017; Gasse & Mortelmans, 2020). The status of single-parent
families often changes over time as the single parent moves in and
out of relationships.

An intersectionality approach is helpful to begin to understand the

lived experience of single-parent families. They are a diverse group
but also disproportionately disadvantaged by race, class, and gender.
They are often demonized by the media and politicians who
individualize their situations rather than examine the structural
arrangements that create class, race, and gender inequalities. French
researchers report that lone-parent families face housing
discrimination in Paris (Challe et al., 2021). Comparing lone-parent
families to two-parent families in Russia, Kapustina (2016) refers to
lone parenting as an “incomplete family structure” (p. 82). In the
United States, poor Black single mothers more than white single
mothers have been the targets of public ridicule (Yorks, 2022). Single
parents have challenges and struggles, but they also have coping
strategies and strengths that go unacknowledged. Sidel (2006)
interviewed 50 women from a variety of racial, ethnic, religious, and
social classes who had been single mothers at some point in their
life. She describes their lives in moving detail and suggests that they
are “unsung heroes” who seek to raise their children and make ends
meet in the face of immense challenges. Other researchers have
focused on the coping strategies of poor Black single mothers and
found them to be invested in their children’s well-being and
committed to providing them a “good life” (see Elliott et al., 2018;
Gates, 2018; Goodman, 2020). Recent research also indicates that
low-income noncustodial fathers, located at the bottom of the labor
force, report considerable desire to be more engaged fathers (Black
& Keyes, 2021).

Single parents around the world have some common challenges:

They are playing the dual roles of nurturer and income provider, often
with no partner assistance. On average, they work longer hours, have
more economic problems, and have less emotional support than
married parents. If they became single parents after divorce, they and
their children must cope with loss and grief, may have to relocate,
and face decline in their standard of living (C. Anderson & Anderson,
2016). Around the world, single-parent families headed by mothers
are especially vulnerable to economic insecurity and poverty
(Hakovirta et al., 2020; Skinner et al., 2017).

For decades, research has found that single mothers work longer
hours than mothers in married-couple families; they are also more
likely to face stressful situations, have more economic problems, and
have less emotional support (C. Anderson & Anderson, 2016). Cross-
national data show that single mothers have high rates of
employment across the wealthy nations, but they are
disproportionately situated in low-wage jobs that do not bring them
out of poverty (Maldonado & Nieuwenhuis, 2015). A preponderance
of research has also found that children in single-parent families are
more likely than children in two-parent families to have more
behavioral and emotional problems, poor school readiness, lower
school academic achievement, and higher school dropout rates. In a
longitudinal study of Australian children, Nicholson and colleagues
(2014) found that when they controlled for socioeconomic and
neighborhood factors, there were no differences in parenting
practices between single and couple mothers and the differences in
psychological distress of the children were greatly reduced. Other
studies suggest that poverty is a bigger factor than single parenthood
in the differences in child outcomes and parental functioning (Edin &
Kissane, 2010), and increasing the income in single-parent families
reduces children’s mental health problems (Hope et al., 2019).

Cross-national differences in government policies result in different

circumstances for single parents and their children. In a study of
poverty for single-parent families in 14 wealthy countries, Maldonado
and Nieuwenhuis (2015) found the lowest level of poverty in Denmark
(8%) and the highest level in the United States (33%). Countries
providing longer periods of paid parental leave after the birth of a
child (Hungary, Germany, France, and the Nordic countries) had
higher levels of employment among single parents, and employment
significantly but not fully reduces the poverty rate. The United States
has no governmental policy of paid parental leave. Likewise,
countries with high levels of spending on universal child allowance,
childcare, and preschool services had lower rates of single-parent
family poverty than countries that do not have such governmental
spending.
These parents and children enjoy family time, creating memories of
being together and having fun.

© iStockphoto.com/Drazen_

Childless Couples

Since the 1980s, there has been a global increase in the proportion of
married couples who are childless, especially in affluent nations
(Koropeckyj-Cox, 2018; Sappleton, 2020). However, childless
couples are not a new phenomenon and were actually more common
in North America in the 1930s than currently (Sappleton, 2020).
Couples may be temporarily or permanently childless. Permanently
childless couples may be voluntarily or involuntarily childless.
Although childlessness is a growing type of family structure, there is
very little research on childless couples; most of the research that has
been done focuses on childless women, with little or no attention to
childless men (fertility of men is much harder to study) or to the
childless couple system. Research on infertility has been more
inclusive of men. The research also often does not distinguish
between married and unmarried women.

The most comprehensive study of childless women in the United

States to date was conducted by Abma and Martinez (2006) at the
National Center for Health Statistics. The data are old, but they shed
some light on trends in childless couples. The study examined three
types of childlessness: temporarily childless, voluntarily childless, and
involuntarily childless. They studied both married and unmarried
women and did not make distinctions between these two groups.
They found that from 1976 to 2002, the percentage of women aged
35 to 39 who were childless increased from 11% to 20%, and the
percentage of women aged 40 to 44 who were childless increased
from 10% to 18%. In 2008, one-fifth (20%) of women between the
ages of 40 and 44 were childless but that had decreased to 15% in
2018 (Koropeckyj-Cox et al., 2018; Statista, 2022). In the Abma and
Martinez (2006) study, the voluntarily childless was the largest group
of childless women in 2002, making up 42% of all childless women;
30% were temporarily childless, and 28% were involuntarily childless.
As might be expected, given declining fertility between the ages of 35
and 44, women who were temporarily childless were more likely to be
in the younger cohort, ages 35 to 39, and women who were
involuntarily childless were more likely to be in the older group, ages
40 to 44.

All three groups of childless women were found to have more

egalitarian views on family relationships than the women who were
parents. There were some differences in the profiles of these three
groups of childless women, however. Consistent with earlier
research, the voluntarily childless women, compared with parenting
women and other childless women, were disproportionately white,
tended to be employed full time, had the highest incomes, and were
more likely to be nonreligious. However, from 1995 to 2002, the
percentage of Black women among the voluntarily childless increased
to be equivalent to their share of the total population of women ages
35 to 44. From 1976 to 2002, Latinx women were consistently
underrepresented among the voluntarily childless.
One finding from the Abma and Martinez (2006) study is that there
was a slight downturn in the percentage of women who were
voluntarily childless and a slight upturn in the percentage who were
involuntarily childless from 1995 to 2002. They speculate that this
change is probably related to the trend toward later marriage and
childbearing, resulting in some couples discovering that they had
fertility problems when they decided to become parents.

In many countries of the world, being a parent is an essential part of

one’s standing in the community. Childlessness is highly stigmatized
and is an economic disadvantage in places where children are
economic providers. Being a parent is considered a way of enacting
one’s gender roles (Hillier, 2017; Iram et al., 2021; Iskandar et al.,
2019; Ombelet, 2014; Swanson & Braverman, 2021). In the United
States and other Western countries, public acceptance of
childlessness has grown in the past two decades, especially among
younger adults (Koropeckyj-Cox et al., 2018). However, one study of
Australian childless women found that they reported high levels of
stigmatization and exclusion from certain social and civic domains of
life (Turnbull et al., 2016). In one vignette research project,
undergraduate students in liberal arts courses in one Florida
university perceived parents as warmer than childless couples;
parents were also perceived to have less positive marital
relationships than childless couples. Mothers were perceived to be
more stressed than childless women and childless men, and childless
women were perceived as more emotionally troubled than parents.
Women who planned to have no children were perceived as less
warm than either childless men or parents (Koropeckyj-Cox et al.,
2018). Valenzuela (2016) found that voluntarily childless couples are
viewed more negatively than involuntarily childless couples.

Existing research shows that voluntarily childless couples are

committed to childlessness and satisfied with the decision to remain
childless (Valenzuela, 2016; Sappleton, 2020). Reported benefits of
childlessness include freedom, independence, and the ability to focus
on the couple relationship (Sappleton, 2020). Myers (2017) suggests
that as more and more women entered the paid labor force, the
intensity of conflict about balancing mothering and work roles
contributed to an ideology of intensive mothering which involved high
expectation for the time spent on mothering activities. Research
indicates that as women entered the work force in greater numbers,
time spent on mothering activities actually increased (Bianchi et al.,
2012). Myers (2017) suggests that this happened because of fears
that devotion to work would lead to less devotion to mothering. Her
research indicates that many childless women hold an ideology of
intensive mothering, and this is a major factor in their decisions to be
childless. Her research also finds that some childless women with
strong dedication to the intensive mothering ideology are electing egg
freezing out of hope that they will be better prepared for balancing
work and mothering at a later time.

Infertility is usually the cause of involuntary childlessness. Infertility is

the inability to conceive after 1 year of unprotected sex. It can be
caused by problems in the reproductive system of the man, the
woman, or both. Often the cause is undetermined. Infertility is a
global problem, with an estimated 48.5 million couples globally
unable to conceive (Swanson & Braverman, 2021). It is estimated
that 16% of couples in the United States are infertile (M. Collins,
2019). In countries with low resources, infertility is most likely to be
caused by sexually transmitted diseases, unsafe abortions, and home
deliveries in unhygienic circumstances. Although there are many
assistive technologies for dealing with fertility problems, these are
inaccessible to most women in low-resource countries.

Research on the emotional impact of infertility indicates that it is a

major source of stress (Swanson & Braverman, 2021). Most of the
research on infertility has focused on heterosexual couples and less
is known about same-gender or nonbinary/transgender couples with
infertility. In heterosexual infertile couples, women have been found to
have high levels of distress compared to their partners but are also
more likely than male partners to seek support for their distress from
their family and friend network (Chaves et al., 2019). There is
evidence, however, that men do seek out support on online infertility
discussion boards (Richard et al., 2017). Women report feeling alone
and indicate that infertility impacts every area of their lives (M.
Collins, 2019). Men report feeling alone, emotionally exhausted, and
being distressed about the emotional impact on their partner (Chaves
et al., 2019; Richard et al., 2017). Both women and men experience
grief and feelings such as sadness, anger, jealousy, and disbelief.

Even in wealthy countries, the majority of infertile couples do not seek

treatment (Swanson & Braverman, 2021). Evaluation and treatment
are costly, invasive, and time intensive. Even in situations of male
infertility, women must assume the majority of fertility treatment
activities—tracking their menstrual cycle, monitoring their body for
signs of pregnancy, doctor visits, blood tests, transvaginal ultrasound,
and medication with unpleasant side effects. Contradictory findings
have been reported, however, on the impact of infertility stress on
marital satisfaction. Some researchers have found that couples
experiencing infertility report normal levels of marital satisfaction.
Other researchers have found that infertility is associated with lower
levels of marital satisfaction. Still other researchers report that
infertility brings partners closer (Swanson & Braverman, 2021).

Little is known about the life course of childless couples. Researchers

have found that childless couples adapt over time and develop closer
relationships with kin, friends, pets, and volunteer activities
(Valenzuela, 2016; Wenger, 2009). This is the way Vivian Sharpe’s
godparents have adjusted to involuntary childlessness, and they draw
great pleasure from being a part of the lively extended kin network in
which Vivian and Bobby are embedded.

Repartnered Families

Repartnered families, usually referred to as stepfamilies in the family

studies literature, have always been a relatively common family form
in the United States and around the world, but they have changed
over time. Prior to the mid-20th century, repartnered families were
typically the result of one parent dying and the other parent
remarrying. That is how the term stepfamily came to be used. Derived
from the Old English word steop, which means “bereaved,” stepchild
was used to refer to orphans and stepmother and stepfather were
used to refer to people who became parents to orphans. Nozawa
(2020) notes that some languages of the world do not have words for
repartnered families and their different members. Today, most
repartnered families are formed after parents divorce or dissolve their
partnership and go on to form new romantic partnerships.
Repartnered families are families in which at least one of the adults
has a child or children from a previous relationship. We don’t have
good current data on the number of repartnered families in the United
States, but it is estimated that 1 in 4 marriages (26%) include
stepchildren (Stykes & Guzzo, 2015). Increasingly, repartnered
families are more likely to be cohabiting than married, especially in
European countries (Ganong & Coleman, 2018). When stepfamilies
were formed after the death of one parent, stepfamilies typically lived
in one household. That is not the case when repartnered families are
formed after divorce or cohabitation dissolution; these repartnered
family systems live in more than one household. In these situations,
using a household definition of family is inaccurate and can be
confusing, or even damaging, to children if schools and other child-
serving organizations assume a household definition of family.

Repartnered families can be of several types. The most common,

known as the stepfather family in the family literature, is one in which
the mother has children from a previous relationship in the
household. Another type, known as the stepmother family, is one in
which the father has children from a previous relationship in the
household. Some repartnered families have children from both
partners’ prior relationships living in the household. Any of these
family forms can become more complex when children are born to
the new partnership. Repartnered families are also formed by same-
gender partners where one or both partners have children from prior
relationships living in the household. Many children reside with a
single mother and make visits to the father and his partner.

Repartnered families are complex family structures. They involve

complicated networks of relationships that include biological or
adoptive parents; stepparents; perhaps siblings, stepsiblings, and half
siblings; and multiple sets of grandparents, aunts, uncles, and
cousins. Children in many repartnered families move back and forth
between two homes and maintain connections with the nonresident
parent and members of that household. There are a number of
subsystems in the repartnered family, including the new couple, the
parent–child (biological, adoptive, or foster), the stepparent–stepchild,
the child–nonresidential parent, the first parents, the parent–
stepparent–nonresidential parent, and sometimes the sibling, step
sibling, or perhaps stepsibling-half sibling subsystem. The parent–
child subsystem is a more long-standing form than the new couple
subsystem.

Research on stepfamilies began to appear in the 1970s when

postdivorce stepfamilies first outnumbered postbereavement
stepfamilies. The early research focused on comparing first-married
families to stepfamilies in what Ganong and Coleman (2018) call a
deficit comparison model. In one much cited article, Cherlin (1978)
suggested that remarried families are incomplete families, an idea he
later denounced. Repartnered families were studied as a monolithic
social problem. In recent years, researchers have turned to studying
the processes of repartnered families to understand these families
rather than to compare them to first family nuclear households.
Increasingly, researchers are taking an intersectional, within-group
analysis to understand the great diversity within repartnered families.
For example, some same-gender repartnered families form after the
dissolution of same-gender partnerships and some form after the
dissolution of different-gender partnerships (Bergeson et al., 2020).
Although the study of stepfamilies started in the United States, this
family type is now a focus of research around the world, with attention
to culture and social institutions; recent research has come from
Asian societies (Balachandran & Yeung, 2020; Nozawa, 2020; To,
2020), Australasia (Gath, 2022), Nordic countries (Bildtgard & Öberg,
2022), eastern European countries (Kalbarczyk, 2021), and western
European countries (Arat et al., 2022; Leeuw & Kalmijn, 2020;
Pylyser, Buysse et al., 2018; Pylyser, De Mol et al., 2019; Pylyser,
Loncke et al., 2020). International research indicates that variations in
cultural norms around gender egalitarianism have an impact on the
processes of repartnered families.

The new repartnered family must negotiate rules, boundaries, roles,

rituals, and customs. Things as simple as foods served in the
household, bedtimes, chores, and methods of discipline may become
points of tension. This works best when the issues and expectations
are made explicit, and some research indicates that it goes more
smoothly when much of the negotiation happens before repartnered
families move in together (Crapo et al., 2022). It is quite common for
loyalty conflicts to arise involving several subsystems, with family
members feeling torn and caught between people they love (Bermea
et al., 2020; Pylyser, Loncke et al., 2020). The more children in the
repartnered family situation, the more complicated the negotiations
can become. Repartnered families have been found to work best
when all parties involved recognize that repartnered families are a
different system from first families—a more complex form, where
attachments cannot be assumed (Miran-Khan, 2017; Pylyser, Buysse
et al., 2018). Pylyser, Buysse et al. (2018) found that there is a
tension in many repartnered families, with members wanting to be
what they think of as a “normal” family and feeling different. That gets
exacerbated when external institutions such as schools assume a
first-family nuclear household. It is important for repartnered families
to create a shared family narrative that recognizes and honors the
type of family they are.

Much of the research on repartnered families focuses on the

relationship between stepparents and stepchildren, and researchers
are suggesting what works in these relationships. Using samples
from the United States, Ganong et al. (2022) and Sanner et al. (2022)
suggest that things work better when the biological parents maintain
the role as the primary disciplinarian and the stepparent’s role is
defined as supporting the biological parent’s disciplinary decisions.
Based on research in Belgium, Pylyser, Buysse et al. (2018) found
that that is always the case in the early stages of repartnered families
but is not necessary once stepparents have built a satisfying, trusting,
caring relationship with the stepchildren. Another suggestion is that
the biological parent should help facilitate one-on-one interactions
between the stepparent and stepchildren and avoid the kind of
gatekeeping that undermines stepparent–stepchild relationships. The
biological parent should encourage the stepparent and stepchildren
to discuss relationship problems openly and directly with each other
and minimize children’s exposure to conflict between parents and
stepparents (Sanner et al., 2022). Researchers also find that it is
beneficial if stepparents use high levels of warmth in their
relationships with stepchildren (Ganong et al., 2022), but research
with Native American stepfamilies found that stepparent warmth that
exceeded the child’s expectations was detrimental to the stepparent–
stepchild relationship (Limb et al., 2020). Reid and Golub (2018)
studied the stepfathering of low-income Black men in cohabiting
stepfamilies. These stepfathers reported navigating the relationships
through interactions with their partner, the stepchildren, and the
biological father. They let their partners take the lead in discipline.
Some of these stepfathers reported seeing themselves in the role of
“other father” and understood and respected the child’s relationship
with the biological father.

Adoptive and Foster Families

Families may also be made by adding members through adoption

and fostering. Both adoption and fostering involve caring for children
who are not biologically related. They are ways to provide a nurturing
family situation to children who cannot receive the care they need, for
whatever reason, in the birth family. Adoption is a permanent, legally
binding relationship that gives adoptive parents and children the
same legal rights as biological parents and children. However,
parents seeking adoption are dependent on the decisions made by
social workers, judges, and birth parents. Fostering is a temporary
addition of a child to a foster family. Decisions about the care of the
child are shared by the child welfare agency, birth parents, and the
foster family, but in most cases birth parents retain legal parental
rights.
Adoption can be a highly successful way to create a family.

© iStockPhoto.com/FluxFactory

There are different pathways to adoption, and adopted children join

the adoptive family at different ages. Some are adopted at birth but
many more are adopted in childhood or adolescence by stepparents
or foster parent(s) (Congressional Coalition on Adoption Institute,
2022). Every adopted child has two families, and disclosure about
and navigation of this complexity must be addressed. There was a
time when adoptive parents were told to go home and raise the
adopted child as if they were their biological child (Bergquist, 2021).
The goal was to have an appearance of the typical nuclear family.
Much has happened in the adoption process since that time, and the
guidance is very different today. Along with developing loving, secure
relationships, the adoptive family must develop a coherent story
about how they came to be family and cope with issues of loss, grief,
and attachment. Pinderhughes et al. (2021) propose that parents of
adopted children must take on the task of “adoption socialization,” the
introduction of information about the adoption process and
experiences. Adoption socialization may include the story of the
adoption placement and the parents’ decision to adopt, conversations
about the birth family, any plans for contact with birth families,
promotion of social engagement with other adopted children and
youth, possibilities of search and reunion, and assistance with loss
and grief related to adoptive status. Children who were adopted after
the birth parents’ parental rights were terminated are generally older
and have suffered abuse and neglect as well as multiple foster
homes. They are likely to need patient and loving care to heal from
trauma and loss. Like repartnered families, it is important for adoptive
families to create a family narrative that recognizes and honors the
type of family they are (Nelson & Colaner, 2020).

One way that adoption has changed over time is the movement
toward increased levels of openness and contact between adoptive
parents and birth parents, especially in private agency facilitated
adoptions. Past practices of sealed adoption records are being
challenged. There are degrees of openness in adoptions involving
both shared information and contact. The lowest level of openness is
the sharing of nonidentifying information between adoptive and birth
parents but with no contact. This information may be shared by a
third party. The most fully open adoption is one that involves direct
contact between the adoptive and birth family. Increasingly, both
adoptees and birth families are asking for more openness in the
adoption process, and some birth families are making some level of
openness a condition for the adoption. Open adoptions usually
include a written agreement that addresses boundaries and other
issues (Kim & Director, 2020). Boss (2007) suggests that some level
of openness assists adopted children to cope with the ambiguous
loss of having a loved one who is “there, but not there” (emphasis in
the original, p. 5). Kim and Director (2020) note that open adoptions
will have their tensions and may be “difficult, inconvenient, or even
intrusive” (p. 180). They require post-adoptive assistance for
navigating the complexity of relationships. Kim and Director (2020),
both adoptees working in the field of adoption, argue that the goal of
open adoption is to assist adoptees to develop a healthy identity.
Another way that adoption has changed in the United States and
other wealthy countries is the increase in transracial adoptions, many
of them intercountry adoptions (also known as international or
transnational adoptions). Pinderhughes et al. (2021) report that 50%
of adoptions in the United States are transracial, involving largely
white parents and children of color. The United States is the leading
country for international/intercountry adoptions, followed by France
(Miller et al., 2020). Transracial adoptions have a history in
colonialism when white adopters from colonizing countries adopted
children of color from colonized countries, forcing assimilation and the
loss of the child’s connection to cultural, racial, and ethnic groups. In
the United States, social workers facilitated the adoption of
Indigenous children by white families through the federally sponsored
Indian Adoption Project from 1959 to 1967 (Thibeault & Spencer,
2019). In the 1960s, when there was a decreased availability of white
infants released for adoption, social workers began to place Black
infants and children with white adoptive families. In the 1970s, both
the American Indian Movement (AIM) and the National Association of
Black Social Workers (NABSW) protested transracial adoptions,
arguing that such adoptions were a form of cultural genocide
(Bergquist, 2021). The NABSW also argued that white parents would
not be well-situated to assist their Black adopted children with racial
prejudice and discrimination. This controversy contributed to a great
increase in international adoptions in the United States, largely from
Korea, Vietnam, and China, and international adoptions became a
very large segment of transracial adoptions in the country. In 2020,
the highest number of children involved in intercountry adoptions in
the United States came from Ukraine, China, South Korea, Columbia,
India, Bulgaria, and Haiti (Congressional Coalition on Adoption
Institute, 2022).

Transracial adoptive families are publicly visible and have been found
to be particularly vulnerable to stigma, microaggressions, and
discrimination (Miller et al., 2020; Pinderhughes et al., 2021). They
face discrimination based on bias against adoption as well as racial
bias. Pinderhughes and colleagues (2021) propose that white parents
raising children of color face the task of ethnic-racial socialization
(ERS) as well as adoption socialization. ERS includes cultural
socialization to ethnic and racial history and culture, preparation to
cope with race- or ethnicity-related bias, information on colorism,
provision of opportunities for mentors or play dates with adoptees
who share the child’s cultural background, and the involvement of
cultural experts on the child’s culture in family life. At the same time,
transracially adopted children are socialized to the culture of the
adoptive family and, in essence, become bicultural. Parents in
transracial adoptive families must help their children understand both
adoption and race/ethnicity simultaneously.

One final way that adoption has changed in some countries, including
the United States, is same-gender parent adoption. Even though
research indicates similar child outcomes in same-gender and
different-gender parent adoptions, same-gender adoption has been
controversial (Patterson, 2017). Some research indicates that same-
gender couples are more likely than different-gender couples to
prefer adoption to other routes to becoming parents (Goldberg &
Conron, 2018). There is also evidence that lesbian mothers are more
likely than gay fathers to try biological parenthood before deciding to
adopt (Costa & Tasker, 2018). Older studies indicate that lesbian and
gay parents are more likely than different-gender parents to adopt
children with various challenges that have made them hard to place.
It has not been known whether this occurred because of implicit
biases in the adoption system or because lesbian and gay parents
are more open than different-gender parents to adopt children who
present more challenges. A research team from Portugal and the
United Kingdom explored that question with a sample of adoptive
parents from the United Kingdom (Costa et al., 2021). They found
that gay and lesbian parents were more likely than different-gender
parents to adopt “hard-to-place” children but also indicated a greater
openness to adopt children with hard-to-place profiles. It could not be
determined, however, if the same-gender parents had internalized
messages that they were adoptive parents of last choice or would be
stringently scrutinized about their parenting abilities. The researchers
found that gay fathers were more likely than lesbian or different-
gender couples to have adopted boys and older children. Unlike
earlier studies, Costa et al. (2021) were able to control for differences
in prenatal and childhood adversity among the children, and they
found that when controlling for earlier adoptee adversity, there were
no differences in child outcomes across the three types of adoptive
families: lesbian, gay, and different-gender couples. Farr, Vázquez et
al. (2022) found most of a sample of birth parents and their relatives
to be open to adoption by same-gender couples, and some had
specifically pursued same-gender couples. Some of the birth parents
preferred same-gender couples because of personal connections to
LGBTQ+ people. Others reported valuing diversity, believing that
same-gender parents would be open-minded, and wanting to give
same-gender couples a chance to become parents.

Families who foster are a unique family structure providing temporary,

safe, and stable homes to children who have been maltreated or are
otherwise under the legal care of the state. Foster families do family
under the oversight of child welfare agencies (Julien-Chinn et al.,
2017), and may or may not be coordinating care with members of the
birth family. In 2020, 213,964 children under age 18 entered foster
care in the United States, and a little over 400,000 children and youth
were in foster care on any given day (Annie E. Casey Foundation,
2022; U.S. Children’s Bureau, 2022). On September 30, 2020,
117,470 children in foster care were waiting to be adopted. About
one-third (35%) of children in foster care were in kinship foster home
placements, being cared for by relatives (U.S. Children’s Bureau,
2022). An unknown number of children were also being informally
fostered, most often by relatives. Vivian Sharpe voluntarily fostered a
niece while her mother was serving in the military in Iraq. The
temporary nature of fostering presents its own special challenges for
the child, the foster family, and birth family. Foster parents are
typically called on to manage difficult behaviors of children with a
history of trauma and to deal with various complex relationships and
roles with birth families and foster care social workers (Van Holen et
al., 2019).

Family communication scholars have been interested in the

communication processes by which adoptive and foster families
develop and maintain a sense of family, a family identity. They
suggest that families without biological ties must rely heavily on
communication processes to create a family identity (see Miller-Ott,
2017; Nelson & Colaner, 2020; Nelson & Horstman, 2017). The study
of family communication in foster families is building on earlier work
about family communication in adoptive families. Suggesting that
narratives, or stories, are the foundation of human relationships,
Nelson and Horstman (2017) explored the way that foster parents
create and tell stories about the child’s entrance into foster care.
These stories include birth families and boundary management.
Nelson and Horstman found that foster parents tended to tell a
negative story about the birth family but often noted that the parents
were learning and trying to be better parents. They also found that
some foster parents tell a forever story about the foster child’s
position in the family, noting that no matter how long they lived there,
they would forever be a loved part of the family. Other foster parents
tell a temporary story. Some foster parents fully address the trauma of
separation involved in the foster placement and others do not. Miller-
Ott (2017) found that foster parents engage in several boundary
management strategies to overcome the stigma and temporary
nature of foster family relationships. The foster parents in their study
reported that they could not create a new family identity apart from
the biological family, because the children wanted to stay connected
to the biological family. Family identity must include that complexity.
Foster parents reported two strategies for integrating the foster and
biological families. They listen to and validate the children’s often
complex feelings about the biological family and answer children’s
questions about the biological family. They also find ways to
incorporate the biological family into the foster family, such as
sending update letters, pictures, and papers from school. Family
rituals was another strategy used by foster parents to develop family
identity. With another sample of foster parents, Nelson and Colaner
(2020) found that open communication in both everyday talk and talk
about the foster family situation helped to develop a shared foster
family identity.

Researchers have examined the relationships between foster care

workers, foster families, foster children, and biological families. Here
are some themes from that research. Foster care workers report that
they have insufficient time to provide adequate support to the
complex needs of the foster child–foster parents–biological family
system. They report secondary traumatization from the situations
they encounter but also compassion satisfaction, the satisfying
feeling that comes from helping others (Verheyden et al., 2020).
Foster parents report mixed experiences with timely responses when
they reach out to the caseworker. They would like to see improved
services for child mental health problems and for youth who are
preparing to age out of care. They identify the need for increased
information about and more direct contact with the biological family
(Leffler & Ahn, 2022). Foster children would like more contact with the
biological family (M. Martinez et al., 2016). Biological parents report
that they want their love for their children to be recognized by the
foster family and foster care workers (Bengtsson & Karmsteen,
2021). Biological children of foster parents report feeling invisible in
the fostering process, with no involvement in the decision to foster
and the intense attention to needs of the foster child. They think
foster care should be viewed as a family project (Possick et al.,
2022). One issue that has received research attention is the contact
visits between foster children and the biological family. Foster care
workers and foster parents see such visits as important for
maintaining the child’s attachment to the biological family and for
allowing the child to develop a realistic understanding of the biological
family. They agree, however, that these visits need greater planning
and preparation and are often unsatisfactory for all involved. They
suggest that guidance is needed for when contact visits are
counterindicated (Fuentes et al., 2019; M. Martinez et al., 2016).

Three social justice issues related to foster care have been identified
in the recent foster care literature. Degener et al. (2022), a research
team from the Netherlands, acknowledge that in North America and
Western European countries, racial and ethnic minority youth are
overrepresented in the foster care system. Drawing on the adoption
literature on ethnic-racial socialization, they suggest that racial and
ethnic minority foster children and youth may become disconnected
from their cultural backgrounds and lack assistance with the racial
and ethnic discrimination they face. They propose the need for racial
and ethnic socialization in the foster family and suggest that biological
families can be helpful in this process. In a similar vein, van Bergen et
al. (2022), another research team from the Netherlands, write about
the challenges of trans-religious foster care in which the foster and
biological families are affiliated with different religions. They argue
that foster children and biological parents are entitled to expect
reasonable efforts to accommodate their religious preferences while
the children are in foster care. It is important to consider that
adolescents do not always share the parents’ religious preferences.
Another social justice issue related to foster care is the over-
representation of LGBTQ+ youth in the foster care system and the
discrimination they face while in foster care (Salazar et al., 2020).
They experience a higher number of placements; have been ejected
from foster homes at private, faith-based agencies; and are more
likely to be placed in group homes rather than family foster care.
This father and son share a moment of joy during a welcome home
ceremony when the Arkansas National Guard’s 39th Infantry Brigade
Combat Team returns from deployment to Iraq.

© Staff Sgt. Chris A. Durney

Critical Thinking Questions 10.3

Which, if any, of the family structures discussed above did you grow
up in? What do you see as the major strength of this type of family
structure? The major challenge? Which, if any, of these family
structures are you living in now? If this is different from the type of
family structure you grew up in, what do you consider to be its major
strength and major challenge?

Challenges to Family Life

Contemporary families of all types face many stressful situations that

challenge their ability to provide nurturance and the necessary
resources for healthy development of family members. Every
historical era and every culture presents its own set of challenges to
families. In the following sections, we discuss seven challenges to
contemporary families: economic hardship, racialized bias and
discrimination, anti-LGBTQ+ bias and discrimination, migration,
divorce and cohabitation dissolution, domestic and family violence,
and problematic substance use.
We are all born into a multigenerational family and may legally or
socially join other multigenerational families.

© iStockphoto.com/Geber86

Economic Hardship

Families facing economic hardship struggle, sometimes

unsuccessfully, to meet basic needs such as housing, food, clothing,
health care, education, transportation, and safety. It is important to
place family economic hardship in the context of the economic and
political environments in which families live. For example, research in
China, where governmental policy limits the ability of rural laborers to
relocate to seek work in urban industrialized areas, finds much
greater economic hardship in rural communities (Zhang et al., 2020).
In the United States, low-income families are constrained from using
low-cost loans and must turn to predatory lending agents to secure
loans (Friedline et al., 2021). The neoliberal approach to capitalism,
which emerged in the 1970s, emphasizes individual responsibility and
limited state public welfare provision (Friedline et al., 2021). This has
produced increased economic inequality, higher in the United States
than in other high-income countries (Horowitz et al., 2020). Shocks in
the economic system can have long-term impact, particularly on the
families with the fewest financial resources. In many countries,
including the United States, families in the lowest income groups lost
a higher percentage of their income during the COVID-19 pandemic
than families in higher income groups (Baranov et al., 2022; A. Gupta
et al., 2020; Kochhar & Sechopoulos, 2022). It is too early to know
the long-term economic impacts of COVID-19, but early data suggest
that world poverty increased, with the poorest countries most
negatively affected (Baranov et al., 2022). Countries varied in
financial relief provisions during the hardest days of the pandemic
and the recovery period that followed, and future research will
indicate the impact of such governmental policies on the economic
welfare of low-income families.

A large volume of interdisciplinary research indicates that individual

physical and mental health, relationships between parents, parent–
child relationships, and child outcomes decline as economic hardship
increases. Much of that research is grounded in the family economic
stress model that was influenced by Elder’s research on the impact of
the Great Depression and developed by Conger and Conger (2002)
to explain the impact of economic adversity on white families living in
the rural Midwest during the agricultural economic downturn in the
1980s. In the family economic stress model, economic hardship
produces economic pressure, which increases the likelihood of parent
distress, which increases the likelihood of disrupted family
relationships, which increases the likelihood of child and adolescent
adjustment problems (see Figure 10.4; Conger & Conger, 2008).
Description

Figure 10.4 Family Economic Stress Model

Source: “Understanding the Processes Through Which Economic

Hardship Influences Families and Children,” by R. Conger and K.
Conger, in D. R. Crane & T. Heaton (Eds.), Handbook of Families &
Poverty (Figure 5.1, p. 67), 2008, Sage.
In a longitudinal study, Neppl et al., (2016) found that economic
hardship led to economic pressure, which was associated with
parental emotional distress and couple conflict. Conflict between the
parents increased the likelihood of harsh parenting and child behavior
problems. Other researchers have found economic hardship rippling
through the family in similar ways, increasing the likelihood of
parental emotional distress (Brown et al., 2022; Kavanaugh et al.,
2018; Low & Mounts, 2022; Zhang et al., 2020), conflict between the
parents (Hong et al., 2021; Roper et al., 2016; Wheeler et al., 2019),
troubled parent–child relationships (Hong et al., 2021; Lee, 2022;
Shelleby, 2018), and a number of problematic child outcomes. Family
economic hardship has been found to be associated with low
academic readiness in preschoolers (Palermo et al., 2018);
internalizing behavior, low self-control, and low interpersonal skills in
middle childhood (H. Lee, 2022; Neppl et al., 2016); low academic
engagement, bullying, depression, anxiety, and risky sex in
adolescence (Brown et al., 2022; Hatem et al., 2020; Hong et al.,
2021); and depressive symptoms in young adulthood (Kavanaugh et
al., 2018). Families living with economic hardship are often reported
to child protective services for neglect. Given the serious negative
impact of financial hardship on child development, what is needed is
child and family policies related to economic hardship. The American
Rescue Plan Act of 2021—with enhanced Supplemental Nutrition
Assistance Program (SNAP) benefit, extended unemployment
benefits, family and child care tax credits, and direct cash payments
—reduced child poverty in the United States. Making these types of
benefits permanent, as they are in most European countries, would
have deep consequences for the economic well-being of families and
children and reduce racial inequities in economic hardship (Thomas &
Waldfogel, 2022).

The findings are clear that economic hardship is stressful for families.
It is important to note, however, that research on economic stress in
low-income families, especially racialized low-income families, has
focused on parental deficits with little attention to their coping
strategies or strengths. A common coping strategy for families with
low income and high debt is to cut back on expenditures on food,
recreation, electricity, gas, water, phone or Internet service, medical
care, and transportation. Some cope by borrowing money or
receiving public assistance (Bourova et al., 2019; A. Gupta et al.,
2020; Lindow et al., 2021). Bower et al. (2020) found that a sample of
low-income African American daughters caring for their mothers
reported finding strength in their faith; they also reported receiving
caregiving assistance from extended family members. One group of
low-income parents shared the creative shopping strategies they use
to acquire food with limited resources (Lindow et al., 2021).

In terms of strengths, a sample of low-income Black parents identified

characteristics of positive parenting, such as warmth, cultivating their
children’s trust, helping children develop empathy, emphasizing
kindness, encouraging enthusiasm for living, supporting children’s
development of self-regulation, racial socialization, spirituality, and
school involvement (McWayne et al., 2017). These low-income Black
parents reported that when they could not be at their children’s
schools themselves, they sent another representative of the family.
Another small sample of low-income mothers receiving public
assistance reported that even though COVID-19 was stressful for
their family, they enjoyed the increased family time and getting to
know their children better (Haskett et al., 2022).

Racialized Bias and Discrimination

In Chapter 1 of this book, we described racialized groups as people

who are not considered white in the process of categorizing and
marginalizing people according to race for the purpose of maintaining
white supremacy and social exclusion. In this section, we consider
the challenges faced by racialized families. In the United States, that
includes Black/African American, Latinx, Asian American, and
Indigenous families. Although they include a mix of ethnic groups and
are categorized by religion rather than race, Muslim scholars in North
America and Europe suggest Muslims have become a racialized
group (see Noor et al., 2022).

Racialized families are affected by racist ideology, racist rhetoric, and

racist actions in their everyday life at work, at school, in the
neighborhood, and in interactions with representatives of social,
economic, and political institutions. Early exposure to racialized bias
and discrimination has both short-term and long-term detrimental
effects on mental and physical health. This is true for all racialized
families, regardless of race or ethnicity, but there are also differences
in the historical and current circumstances faced by different
racialized groups. Critical race theory (CRT) proposes that the racial
hierarchy places whites at the top and Blacks at the bottom, with
other people of color falling between whites and Blacks. African
American families have a long history of being discriminated against
in voting, housing, schooling, policing, the labor market, and health
care. They have been stereotyped as threatening and dysfunctional
people (Cartwright, 2022; Glover et al., 2022). Although Asian
Americans are a culturally diverse ethnic group, Asian American
families are racialized as a monolithic group of overachieving model
minorities but also perpetual foreigners (Nguyen-Truong et al., 2020).
This stereotype is used to denigrate other racialized families and
ignores the long history of U.S. exclusion of migrants from Asia and
the recent alarming level of anti-Asian racism and racial violence (Qin
et al., 2022). Even though some Latinx families have been in the
United States for centuries, and no matter their immigration status,
Latinx families are subjected to anti-Latinx discourse about illegal
immigration. They are sometimes denied access to resources and
are targets of policing, surveillance, and interpersonal discrimination
(Shin et al., 2022). Indigenous people of North America as well as
other countries around the world were systematically destroyed, had
their land stolen, their children taken, and their right to govern
themselves denied. Contemporary Indigenous groups experience the
most pervasive and severe health disparities of any racialized group
(Burnette et al., 2018). Scholars of race are increasingly using the
term racialization to understand the experience of Muslims in Europe
and North America, as “racialized Arab/Middle Eastern/Muslim”
(Zahrawi, 2020, p. 125). They note the role of gender in the
racialization of Muslims, with women stereotyped as “imperilled and
in need of saving” and men as terrorists (Selod, 2019, p. 553). Both
women and men are surveilled.

Research shows that parents in racialized families use a variety of

strategies to help members, especially children and youth, cope with
racialized bias and discrimination. The most often cited strategy is
racial-ethnic socialization, with the primary components being racial-
ethnic pride and preparation for racial-ethnic bias. This parental
strategy is reported for Asian American families (Qin et al., 2022),
Black/African American families (Glover et al., 2022; Manning, 2021),
and Latinx families (Romero et al., 2022). Indigenous families report
heavy use of racial-ethnic pride but not preparation for racial-ethnic
bias. Burnette et al. (2018) describe experiential intergenerational
teaching and learning of ethnic identity and pride among Indigenous
peoples of the Southeastern United States. Elders are the reservoirs
of ethnic knowledge, and engagement with nature and
connectedness with an extended family network are important parts
of the process of learning spiritual beliefs, traditions, and values such
as harmony, sharing, and respect. Latinx and Indigenous families
report family meetings and family problem-solving to talk through
problems of racialized bias and discrimination (McKinley & Lilly, 2022;
Romero et al., 2022). Zahrawi (2020) writes that being relatively new
at being racialized and considered a problem, some Arabs in Europe
and the United States are focusing on developing a new group
consciousness (Zahrawi, 2020). Glover et al. (2022) found that
preparation for bias is the most common racial-ethnic socialization
message reported by Black/African American parents.

Other coping strategies noted by researchers range from

accommodative strategies to strategies of resistance. Let’s start the
discussion with the more accommodative strategies. Racialized
individuals and families may internalize the white supremacy so
prominent in European American culture. Family relationships may
reflect colorism, the practice of favoring people with lighter skin over
those with darker skin related to a globalized preference for
whiteness traced to European colonialism and slavery (Dixon &
Telles, 2017). Another coping strategy reported by racialized
individuals and families is to seek cultural capital by cultivating
appearances, ways of carrying the body, and dispositions that appear
deferential and unthreatening to white people to avoid discriminatory
targeting (Cartwright, 2022; Glover et al., 2022). Some report learning
to repress emotions, ignore racist encounters, remove themselves
from hurtful situations, and avoid locations where bullying is likely to
occur (Romero et al., 2022). While some Arab Americans cope by
ignoring or pretending they don’t hear anti-Muslim bias, others cope
by seeking supportive and open discussions about who they are
(Zahrawi, 2020). Parents in Asian American, Black/African American,
and Latinx families report encouraging children and youth to stand up
for themselves and call out racism. They also instruct their
adolescents to let them know if the adolescent needs backup with
these efforts (Glover et al., 2022; Qin et al., 2022; Romero et al.,
2022). Black parents report seeking out-of-school activities that help
their children and youth learn about racial history; they also report
helping their youth navigate white social spaces while also seeking
out Black social spaces (Manning, 2021). Asian American,
Black/African American, and Latinx parents report getting involved in
their children’s schools and building relationships with teachers and
administrators in an attempt to create more supportive school
environments for their children (Delale-O’Connor et al., 2020; Qin et
al., 2022; Solorzano & Bernal, 2001). Parents and youth in racialized
families also resist processes of racialization by participating in
marches, demonstrations, and other actions to promote racial justice
(Brayboy, 2005; Romero et al., 2022; Solorzano & Bernal, 2001).
Different circumstances call for different coping strategies, and
racialized families have developed a large range of strategies.

Anti-LGBTQ+ Bias and Discrimination

There is a broad set of social categories that represent people who

do sexuality, gender, and family outside of the dominant cisgender,
heterosexual socially created categories. Some of the people and
families discussed in this section may reject LGBTQ+ (lesbian, gay,
bisexual, transgender/transsexual, queer, or questioning, intersex,
asexual, and all other genders and sexualities) social categories and
the application to their families. Some prefer to be understood as
queer families and others reject that label. Much of the research
related to LGBTQ+ people has focused on individual people rather
than on LGBTQ+ families, how LGBTQ+ people do family (Fish &
Russell, 2018). In this section, we are interested in how LGBTQ+
people do family, using the language of LGBTQ+ families to mean
any family with at least one member who identifies as LGBTQ+.

LGBTQ+ individuals and families face bias, discrimination, resistance,

stigma, hate, and violence in the external world beyond the family.
LGBTQ+ individuals may also face bias, discrimination, resistance,
stigma, hate, and violence in the internal world of the family. Much of
the early research of LGBTQ+ families was between-group research
that compared LGBTQ+ families to cisgender, heterosexual (cishet)
families from a cishet normative perspective. That kind of research is
in a long tradition of research that compares marginalized groups with
dominant groups and fails to contribute to understanding of the
stigma and discrimination they face and the strengths they
demonstrate (Fish & Russell, 2018). Comparative research
documents health and well-being disparities between LGBTQ+
families and cishet families and has been used to pathologize
LGBTQ+ families (Lawlis, 2021). However, research comparing cishet
families and LGBTQ+ families has also been used to understand the
oppressive structures and particular stressors faced by LGBTQ+
families. For example, Goldsmith and Bell (2022) provide evidence
that members of the LGBTQ+ community are more likely than
cisgender, heterosexual populations to experience adverse physical
environments.

Recent research has recognized the great diversity of LGBTQ+

families and begun to take an intersectional approach to understand
the ways in which gender and sexuality intersect with other social
categories such as race, class, religion, immigration status, and so
forth to create unique family situations as well as multiple intersecting
oppressions (Goldberg & Allen, 2018). Families can consist of any
number of combinations of children, youth, and parents in which at
least one family member identifies as LGBTQ+. To capture some of
that diversity of experience, we present a selection of recent research
regarding families with LGBTQ+ youth, same-gender partnerships,
and gender diversity in families.

The majority of LGBTQ+ youth and young adults have grown up in

families with cisgender, heterosexual cultures and expectations. Both
the LGBTQ+ youth and the people they call family must navigate
issues of sexuality and gender in complex disclosures and
interactions, and often they do that in the context of intersecting
oppressions such as those based on race, class, or disability
(Schmitz et al., 2020; Toft et al., 2020; Tyler & Abetz, 2022). Family
acceptance and a continued sense of family belonging are linked to
positive physical and mental health for LGBTQ+ youth (Gonzalez et
al., 2022). Coming out to family as LGBTQ+ is an ongoing process of
communication, and strategic choices are made about what and to
whom to disclose. Some youth see too much peril to disclose their
sexuality and/or gender to the family, or they do risk disclosure and
get rejected, and may face physical assault and/or being kicked out of
the home. This is especially true among youth from families with
cultural and faith traditions that condemn sexuality and gender that
does not conform to a cishet normative perspective (see Gonzalez et
al., 2022; Schmitz et al., 2020). Other youth come out to family
members who listen and hear them, make an effort to keep lines of
communication open, and clearly express ongoing love. Most families
fall somewhere between these two extremes, with ambiguous and
clumsy communications in which both the LGBTQ+ youth and their
family members are left to decode what is meant and struggle to stay
connected (Gabb et al., 2020). Even in accepting families, there are
likely to be moments of misunderstanding (Tyler & Abetz, 2022).

When parents are not accepting, LGBTQ+ youth may find accepting
and supportive siblings or other relatives (Gonzalez et al., 2022). In
qualitative research with a multi-ethnic sample of 26 LGBTQ youth
(ages 16–21) with diverse genders and sexualities, Stone et al.
(2022) found that almost all of them had a cousin, an aunt or uncle, a
sibling, a grandparent, or fictive kin whom they knew or suspected
was LGBTQ+. These relatives provided validation and support with
the emotional work of managing tumultuous relationships with
parents; they also introduced the youth to LGBTQ+ culture. Stone et
al. (2022) found that these youth found it easier to challenge
heteronormativity than cisnormativity in the family culture. Hailey et
al. (2020) found that African American LGBTQ+ youth often form
chosen families with peers and older LGBTQ+ persons. Fish et al.
(2020) investigated the use of online support among LGBTQ+ youth
during the early days of the COVID-19 pandemic. They found that
some youth posted about being stuck at home with unsupportive
parents while other youth described freedom from the prejudice and
discrimination they faced at school. In a study of cisgender and
transgender/nonbinary LGBT+ adolescents, Meanley et al. (2021)
found that cisgender adolescents who identified as gay or lesbian
reported higher self-esteem than adolescents who reported any other
combination of gender and sexuality.

There is also diversity in the experiences of same-gender

partnerships. Here are some examples from recent research. It is
important to consider the political and social context in which same-
gender partners reside. Some countries of the world have laws that
criminalize same-gender partnerships. More than half of the states in
the United States do not include sexual orientation and gender
identity in their nondiscrimination laws (Freedom for All Americans,
2022). Some communities in the United States and around the world
are LGBTQ+ friendly, and many others are openly hostile to LGBTQ+
partners (Petruzzella et al., 2019). These contextual differences
matter as does the intersection of LGBTQ+ oppression with other
forms of oppression. Researchers have found that sexual-orientation
stigma and minority stress can have a negative effect on relationship
satisfaction (Gusakova, 2022; Neilands et al., 2020; Oren, 2021;
Petruzzella et al., 2019). Gusakova (2022) found that same-race gay
couples that included two men of color experienced higher levels of
minority stress than interracial gay couples that included a white male
and a male of color. Ghabrial (2017) found that several respondents
in an eastern Canadian sample of LGBTQ+ people of color reported
feeling disconnected from both their racial/ethnic communities and
the larger LGBTQ community. These respondents also criticized the
in-out-binary approach to “coming out,” noting that being entirely out
was not feasible in their community. Karpman et al. (2018) found that
queer women of color who wish to become parents choose known
sperm donors rather than using commercial sperm banks because
the desired donor characteristics are not available from the
commercial banks.
In a five-year longitudinal research project, Goldberg et al. (2018)
studied the quality of relationships in same-gender women partners
who differ in sexual identity, with one partner being monosexual
(attracted to same gender only) and the other partner being non-
monosexual (e.g., bisexual, pansexual attractions). They followed the
couples over the first five years of adoptive parenthood and found
that same-gender partners who differ in sexual identity can maintain
highly committed and loving relationships while also having conflict
about the sexual identity difference. Bisexual and other non-
monosexual individuals have been found to face more prejudice than
monosexual LGBTQ+ individuals, from the LGBTQ+ community and
other social networks (Dodge et al., 2016; Gonzalez et al., 2022;
Meanley et al., 2021). This has been found to be true for both
adolescents and adults (Meanley et al., 2021). Belgian researchers
Song et al. (2022) found no difference between lesbian and gay
couples in their use of visibility management (the careful, planned
decisions about whether or not to disclose one’s sexual orientation) in
response to minority stress. Pistella et al. (2022) found that conflict
can occur when partners have different approaches to visibility
management.

Families often struggle to understand and accept gender variant

members and gender transitions. Gender transitions can happen in a
variety of ways: changing of name and pronouns, change in dress,
changing gender designation on legal documents, hormone
treatment, surgery, or other social, legal, or medical procedures. The
most common forms of gender variance are binary transgender and
nonbinary. Binary transgender people identify within the gender
binary of male or female but not with the gender they were assigned
at birth. Nonbinary people do not identify with a binary model of
gender; they may be both male and female or neither male nor
female, or identify with a gender outside of the existing gender binary
(e.g., gender fluid, agender, pangender). Binary transgender and
nonbinary people may experience stigma, discrimination, and
violence in the family, the community, and major social institutions. S.
Allen et al. (2022) suggest that family acceptance of transgender
people (including both binary transgender and nonbinary) is often
presented as a binary accept or reject. Their research indicates five
different profiles of family-of-origin environments as perceived by the
transgender participants:

Disengaged—neither supportive nor unsupportive (20% of

sample)
Embracing and affirming—inclusive, caring, accepting, and
supportive (14.1% of sample)
Repudiating—active barriers, condemning, and disaffirming
(9.7% of sample)
Moderate family ambiguity—near-identical scores on both
accepting and nonaccepting measures (29.7% of sample)
High family ambiguity—near-identical scores but higher than the
moderate profile (26.7%)

In the Allen et al. (2022) study, participants who were assigned male
at birth, compared to respondents who were assigned female at birth,
were more likely to rate their families of origin as having either
moderate or high family ambiguity rather than as embracing and
affirming. Latinx participants were more likely than Black/African
American participants to rate their families as having high family
ambiguity rather than embracing or affirming. Participants with devout
religious upbringings were more likely than other participants to rate
their families as repudiating and having moderate and high ambiguity.
Allen et al. (2022) further found that family profiles of disengaged,
repudiating, and both moderate and high family ambiguity (86.1% of
the sample) were negatively associated with physical and mental
health of the participants. Comparing binary transgender and
nonbinary people in a sample made up mostly of people of color,
Coburn et al. (2022) found that nonbinary people reported
significantly higher levels of community connectedness than binary
transgender people. These findings raise questions for future
research but suggest that both family support and community
connectedness are important resources for binary transgender and
nonbinary people.

Gender variant people also have relationships with romantic partners

and children. In an Australian study, Von Doussa et al. (2020) found
that all 13 of their sample of transgender or gender diverse adults had
put their gender transition on hold for a period of time to avoid family
conflict and protect parents, partners, or children. The participants in
this study also reported a lack of support for their families from health
and social service organizations during the transition process. In an
exploratory study of relationship commitment when a gender
transition occurs after the start of the relationship, Platt (2020) found
that years in the relationship before gender transition was a predictor
of continued commitment. The likelihood of continued commitment
decreased as the number of years in the relationship increased.
Satisfaction in the relationship prior to gender transition mediated the
effect of years in the relationship. Both binary transgender and
nonbinary individuals are parents. Most of them were biological
parents before the gender transition, and a smaller group become
parents after the transition. For those who were parents before the
transition, the adjustment of the children to the transition is
considered. Dierckx et al. (2017) found that a Belgian sample of
children reported fear of social stigma and loss of family continuity
during a parental gender transition. Good family communication and
acceptance by the cisgender parent, wider family, and community
were protective factors for the children.

Migration

People have been migrating from one place to another for many
centuries, but there is evidence that the pace of migration has picked
up (Sun & Yang, 2021). The great majority of people who migrate
from one place to another migrate within the same country in search
of jobs or training programs. In recent years, both internal and
international migration have greatly increased (Sun & Yang, 2021). In
2021, the largest populations of international migrants moved from
the following countries: India, China, Bangladesh, Pakistan,
Philippines, Afghanistan, Mexico, and the Russian Federation. The
United States was the country receiving the largest number of
international migrants (International Organization of Migration, 2022).
Considerable research indicates that migration, whatever the reason,
is disruptive, stressful, and can damage physical and mental health
(Tuggle et al., 2018). People migrate for different reasons and have
different pre-migration, migration, and post-migration experiences. In
this brief analysis, we focus on three important themes in
contemporary migration: crisis migration, labor migration, and family
reunification migration.

Crisis migration refers to large numbers of individuals and families

migrating because of natural disasters, political persecution, wars,
violence, and other life-threatening circumstances. Crisis migrants
include refugees, asylum seekers, and other migrants who leave
home because of some type of disastrous situation (Vos et al., 2021).
Most crisis migrants resettle in a new country, but in times of natural
disasters, large numbers of people may migrate to another region of
their home country (Ash & Obradovich, 2020; T. Chen & Lee, 2022).
Crisis migrants often face trauma in all three migration phases: pre-
migration, migration, and post-migration. In the pre-migration stage,
migrants may have lost their home to natural disaster, war, or gang or
drug cartel violence; they may have watched friends or family
members injured or killed; they may have faced multiple forms of
trauma including food insecurity, political persecution, or physical and
sexual violence (Malm et al., 2020; Sangalang et al., 2019; Tuggle et
al., 2018; Vos et al., 2021). The migration journey will usually start
with separation from a home, family, and support network. It may
involve a treacherous and sometimes violent journey by foot,
automobile, or water. Loved ones may be lost in the journey, time
may be spent in a refugee camp that felt threatening, and migrants
may face harsh border enforcement policies and practices (D.
Martinez, 2022; Tuggle et al., 2018; Vos et al., 2021).

Recently, the study of migration has shifted to post-migration stress,

the stressful circumstances migrants face in the receiving country.
Crisis migrants often move from Global South to Global North
countries where immigration policies have become more stringent
and highly racialized in recent years (D. Martinez, 2022). They often
face anti-immigrant hostility and discrimination and exclusion related
to racial/ethnic, skin color, religious, language, or cultural biases and
are aware of hateful social and political rhetoric about immigrants
(Sangalang et al., 2019; Vos et al., 2021). Both documented and
undocumented migrants from some regions fear deportation, and
parents may fear getting separated from their children if asylum or
refugee status is not granted (Sangalang et al., 2019; Vos et al.,
2021). Crisis migrants often face socioeconomic adversities and poor
living conditions (Malm et al., 2020). Acculturation, the process of
adjusting to the new culture, produces stress, and family tensions
often develop over the differential pace of acculturation among
different members (Tuggle et al., 2018). A new identity, including
place identity, must be developed over time (Ballentyne et al., 2021).
Migration-related stress is associated with physical and mental health
problems as well as changes in family roles and communications
(Malm et al., 2020; Tuggle et al., 2018; Vos et al., 2021).

Labor migrants move from one place to another to seek employment.

They typically move out of choice, not necessity, and often send
remittances, cash or goods, to the family back at home. Labor
migrants may be internal or international migrants. With immigration
policy tightening in the Global North, family migration for economic
purposes has become a difficult undertaking (Mazzucato & Dito,
2018). One approach taken by some families in low-income
countries, typically in the Global South, has been to have one family
member migrate for employment in a wealthier country, typically in
the Global North (Princeton et al., 2021). Young people become labor
migrants more often than middle-aged or older adults. When the labor
migrant stays connected financially and socially to the family in the
sending country, they create a family form known as transnational
family (Mazzucato & Dito, 2018). Parents may leave children behind,
or one individual may leave a spouse, children, siblings, and parents
behind. Sometimes these families plan to migrate in a stepwise
pattern, with multiple family reunifications occurring over time. Some
research has focused on transnational motherhood, female migrant
workers who become family caregivers to families in wealthier
countries, leaving their own children at home to be cared for by an
extended kin network. DePalma et al. (2022) suggest that these
mothering labor migrants are actively reinventing motherhood by
casting financial contribution as a form of mothering and often come
from cultures where “mothering” is shared in extended family
networks.
Researchers report psychological distress from transnational
separation (Galvan et al., 2022). Princeton et al. (2021) report that
labor migrants are at higher risk than native workers of holding
insecure jobs with short-term contracts, hard physical labor, and long
work shifts. Although their wages are lower than native unionized
workers, they are high compared to wages in their sending country.
Unions in some European countries, particularly the Nordic countries,
are trying to engage labor migrants and provide them some labor
protections (Refslund, 2021). These young labor migrants must cope
with separation from family and social networks, isolation, adapting to
a new culture, and a stigmatized identity, and they have been found
to have high rates of mental health problems (Princeton et al. 2021).

Other people migrate for the purpose of family reunification. Some

families of labor migrants engage in sequential migration, which may
happen over a period of years with unexpected delays. Family roles
and relationships must be reorganized each time a new member
migrates (Galvan et al., 2022). Sometimes older adults migrate, either
internally or internationally, to be close to adult children who
previously migrated when they recognize the need for familial
assistance with the aging process. In terms of internal migration,
Thomas and Dommermuth (2020) found that 40% of internal
migration events occur to move closer to members of the
intergenerational family. Life events such as separation, widowhood,
and childbirth seem to be a catalyst for this type of family reunification
migration. Artamonova and Gillespie (2022) found that widowed,
divorced, and never-married older adults were more likely than older
adults with a partner to move to be closer to siblings. They speculate
that as more couples are childless, siblings might become more
active players in the family networks of older adults.

Critical Thinking Questions 10.4

Think of the economic location; racial-ethnic, gender, and sexuality

identities; and migration experiences of your family of origin and your
current family. What experiences have you had with family economic
hardship, racialized bias and discrimination, anti-LGBTQ+ bias and
discrimination, and migration that will be helpful to you in your social
work career? What are the limitations in your experience with family
economic hardship, racialized bias and discrimination, anti-LGBTQ+
bias and discrimination, and migration? What can you do to build your
understanding and skills in this area?

Domestic and Family Violence

The family is the social group from whom we expect to receive our
greatest love, support, nurturance, and acceptance. And yet, family
relationships are some of the most violent, and domestic and family
violence is a global public health problem (Sardinha et al., 2022).
Family members spend a lot of time together, their intimate
relationships are impacted by their experiences in the outside world,
and they interact in the context of familial power differences. It is very
difficult to produce accurate statistics about the amount of family
violence in different categories because the family is the most
intimate of social groupings; what happens in families is usually
behind closed doors, away from the watchful eyes of strangers,
relatives, and neighbors. During the stay-at-home period of the
COVID-19 pandemic, families were forced to spend even more time
together while economic and other types of stress increased and
informal and formal resources of support became less accessible.
Around the world, children, women, and older adults are vulnerable to
family violence, and family violence is more likely to occur when
families are the targets of bias, discrimination, exclusion, and other
forms of oppression (Bean, 2022). In this section, we will focus on
familial child maltreatment, intimate partner violence, elder abuse,
and adolescent-to-parent violence.

It is estimated that, worldwide, 1 million children are victims of

physical, sexual, or emotional violence each year (Rapp et al., 2021).
Research shows that familial child maltreatment is the result of
complex intersections of risk factors across societal, cultural,
community, familial, and individual ecological levels (Bullinger et al.,
2022). Major life events, neighborhood hardship, natural disasters,
and other traumatic events have been found to disrupt family life and
increase the likelihood of mistreatment of children. Increased parental
stress, lack of social support, social isolation, and unemployment and
other forms of economic hardship, as well as parental substance
abuse and mental health problems, have been found to be
associated with child maltreatment (Amick et al., 2022; Ming et al.,
2022). Along with the fear of COVID-19, in the early days of the
coronavirus pandemic, many parents became unemployed or
furloughed and faced food and housing insecurity. Other parents
were considered essential workers and continued to work while
childcare facilities and schools closed down. And, still other parents
worked from home while also being responsible for the care and
education of their children. Clearly the pandemic exacerbated factors
that contribute to child maltreatment, but it is not yet clear what
impact the pandemic had on the rate of child maltreatment (Rapp et
al., 2021). With childcare facilities and schools closed down, and
hospital emergency rooms focused on COVID-19 care, fewer reports
of child maltreatment were made by mandated reporters (Amick et
al., 2022). Some family service providers perceived an increase in
child maltreatment during the pandemic (Bullinger et al., 2022), and
parents reported an increase in the use of neglectful and harsh
parenting behaviors (Connell & Strambler, 2021; S. Lee et al., 2021).
Future research may clarify what happened to the care of children
during the COVID-19 pandemic.

Intimate partner violence (IPV) is violence that takes place in a

romantic relationship. It occurs in cisgender heterosexual
relationships, in LGBTQ+ couples, and in cohabiting, married, and
dating relationships. Both women and men perpetrate and are
victimized by IPV, but a great deal of research indicates that women
are more likely than men to be the victim of multiple types of abuse,
be severely injured, raped, and killed (Hardesty & Ogolsky, 2020).
Intimate IPV is most common against women between the ages of 18
and 24, and higher rates of IPV are found among poor women,
women of color, immigrant women, and other marginalized women
(Hardesty & Ogolsky, 2020; National Coalition Against Domestic
Violence, 2022). Johnson (2008) developed a typology of IPV that is
frequently used in research: coercive controlling violence, violent
resistance, and situational couple violence. Coercive controlling
violence, sometimes called intimate terrorism, occurs in a context of
general control over the partner and includes patterns of dominance,
isolation, intimidation, coercion, minimizing, and disparagement.
Violent resistance occurs when abused partners retaliate with
violence to defend themselves. Situational couple violence occurs
when one or both partners use violence to cope with tension and
conflict; it may be minor and rare, and it may be a regular pattern of
resolving conflict. The risk of IPV is higher during pregnancy and just
after childbirth (Baird et al., 2021). There was a rise in IPV around the
world during the COVID-19 pandemic when intimate partners spent
more time together (Howard et al., 2022).

Elder abuse occurs when a trusted person, usually a caregiver,

causes harm or creates risk of harm to an older adult. It includes
physical abuse, sexual abuse, emotional or psychological abuse,
financial exploitation, and neglect or abandonment (U.S. Preventive
Services Task Force, 2018). The World Health Organization (2022)
estimates that, around the world, about 1 in 6 people age 60 and over
experience some type of abuse in community settings each year.
Elders with disability or dementia are at higher risk of abuse. People
who commit elder abuse in the community are most likely to be adult
children or partners, male, socially isolated, have a history with the
criminal justice system, and experiencing major stress (Ciabattari,
2022). It is thought that the rates of abuse of older people is high in
nursing homes and long-term care facilities as well, but there is little
research about this. The World Health Organization (2022) reports
that 64.2% of staff in such facilities report perpetrating some form of
abuse in the past year. One research team in Norway examined
nursing home leaders’ perceptions of elder abuse in nursing homes
and identified three types: resident-to-resident abuse, abuse from
visiting relatives, and abuse from direct-care staff (Myhre et al.,
2020). More research is needed about elder abuse in senior care
facilities. The World Health Organization (2022) reports that elder
abuse increased during the COVID-19 pandemic.

In many high-income countries, adolescent-to-parent abuse is gaining

attention as a significant social problem. Adolescent-to-parent
violence (APV) refers to abusive behavior toward a parent by youth in
the adolescent years. Research from a number of countries suggests
that 5% to 20% of adolescents have hit their parent(s) at least once
during their adolescent years, but it is thought that the reported APV
rates are underestimated. Much higher rates of verbal aggression are
reported. All studies indicate that mothers are four times as likely as
fathers to be the victims of adolescent-to-parent abuse, and male
adolescents are more likely than female adolescents to be the
perpetrators (Nam et al., 2022). Nam et al. (2022) found that earlier
child abuse victimization was significantly associated with APV
perpetration.

Exposure to family violence of various kinds, either as victim or

observer, has long-term negative impacts on physical, mental, and
behavioral health. Victims of intimate IPV report high rates of PTSD
and depression. Children who are victims or observers of family
violence have been found to be more likely than non-victimized
children to demonstrate both externalizing (hostile and aggressive)
and internalizing (withdrawal, anxiety, and depression) behaviors
(McFarlane et al., 2017).

Intervention in situations of family violence requires careful

assessment, and even with the best assessment, it is difficult to
predict future behavior. The decision that must be made is whether
protective steps are necessary: Must children be removed? Are
restraining orders necessary? Must the abused partner flee for
safety? How to protect the vulnerable older person? There are no
ideal solutions. Removing children from abusive households may be
necessary to protect them physically, but this solution carries its own
risks. Children suffer emotional damage from the separation and loss
and may blame themselves for the family disruption. They may be
vulnerable to further abuse in the foster home if they have intense
care needs. There are also risks to leaving children in homes where
they are abused, including the risk that the child will be killed.
Unfortunately, the available resources are often insufficient to meet a
distressed family’s needs. Clearly, no one solution fits every situation
of child abuse. In cases of IPV, protective removal is imperative in
any form of escalating violence. On the other hand, systemic couples
work, in which couples are taught other methods of conflict resolution,
may well be appropriate for couples involved in situational couple
violence. Social workers in adult protective services report that they
feel challenged personally and professionally in managing the risks
when working with families involved in elder abuse (Kirk et al., 2019).
It is imperative that social workers check their explicit and implicit
race and class biases as they make decisions in situations of
domestic and family violence.

Divorce and Cohabitation Dissolution

Most people who get married do not anticipate that they will divorce,
and many people who cohabit hope to stay together long term, and
yet divorce and cohabitation dissolution are very common. Almost all
societies have mechanisms for dissolving marriages, whether it is
divorce or civil or religious annulment. There is much complexity in
the analysis of divorce rates, but the divorce rate in the United States
appears to have increased steadily from the late 19th century through
the 1970s, with a sharp drop in the 1950s, and a steep incline
beginning in the 1960s. It peaked in 1981 and has been dropping
slightly since then, but it is still one of the highest in the world; the
marriage rate has also been dropping in the same period (Ciabattari,
2022). Couple dissolution rates are similar for same-gender and
different-gender couples in the United States, but same-gender
couples have higher dissolution rates than different-gender couples in
some other countries (Farr et al., 2020). Research indicates that
same-gender and different-gender couples end their relationships for
similar reasons: relationship dissatisfaction, lack of commitment, and
conflicts about parenting (Farr et al., 2020).

Divorce and cohabitation dissolution is a process, not a single event.

For the partners, it is a process of uncoupling. The first step is not
usually mutual. It typically begins with one person who has a nagging
feeling of dissatisfaction but a lot of ambivalence about moving
toward divorce or cohabitation dissolution. In the United States and
most European countries, two-thirds to three-quarters of divorces are
initiated by women. Partner conflict often escalates as one party
begins to disengage emotionally, and the decision to decouple
frequently ends up being mutual (Ahrons, 2016).

The divorce and cohabitation dissolution process must be negotiated

in multiple dimensions, including legal, physical, financial, emotional
and social, and parental (Ciabattari, 2022; Vaughan, 1986). In the
following discussion, we use divorce to include both divorce and
cohabitation dissolution. Where there was a legal partnership
contract, legal divorce must be negotiated in the legal system. The
legal divorce process is an adversarial one that often fuels animosity
between the partners and leads to more difficult adjustments for both
adults and children. Alternative processes, such as mediation and
collaborative divorce, have been developed to promote a less
adversarial process, but these approaches are not accessible to all
families (Pruett et al., 2021). In some places, cohabiting couples can
access some of these services.

Physical divorce must also occur; a couple or family who once

resided under one roof must typically develop a plan for living in
separate places. At least some member(s), and maybe all, of the
family will have to relocate. Where there are children or other co-
residing family members, decisions must be made about who resides
with whom. Belongings of all types must be separated. When children
are involved, they may need physical spaces in two households.
Research across 9 European countries found no difference in
physical custody arrangements between divorce and cohabitation
dissolution (Zilincikova, 2021).

Financial divorce is an important part of the divorce process. Partners

must disentangle their financial interdependence and resolve issues
about fairness in the distribution of financial resources. There is some
evidence that cohabiting couples are less likely than married couples
to integrate their finances (van Houdt & Poortman, 2018; Zhang &
Axinn, 2022). In most situations, the income that once supported one
residence must now support two residences. Both cisgender
heterosexual families and LGBTQ+-parent families often face
financial challenges after divorce and cohabitation dissolution (Farr et
al., 2020). In cisgender heterosexual families, women and children
are more likely to become economically disadvantaged after divorce
or cohabitation dissolution than men (Bonnet et al., 2021; Tach &
Eads, 2015). In situations of sole rather than joint physical custody,
custodial parents are more likely to be economically disadvantaged
than non-custodial parents (Bastaits & Pasteels, 2019). The financial
aspects of divorce laws vary within and between countries and will
have an impact on the gendered outcomes in marital divorce.

No matter who initiates the process of divorce or relationship

dissolution, emotional and social divorce is stressful. Two people who
have thought of themselves as a couple must develop independent
identities. All involved family members experience a sense of loss,
and many experience anger and blame (Ahrons, 2016). Social
networks must be renegotiated. Where does the dissolved family fit
with their former network of coupled friends? What happens to the
patterns of interactions with shared friends? How much interaction
will partners have with the former partner’s kin? New friendships are
often formed, and social networks are reorganized. van Houdt and
Poortman (2018) found that married couples are more likely than
cohabiting couples to have a joint social life in which friendships and
social networks are shared. They also found that couples with a joint
social life were less likely to dissolve their partnership than couples
with separate social lives.

When the couple has children, a primary decision is how to care for
the children; this decision is central to the parental divorce process.
Both legal custody (who has legal rights and responsibilities to make
decisions about the children) and physical custody (where the
children will reside) must be decided. In the past, legal custody and
physical custody always went to the same parent, to the father in the
19th century and to the mother more recently. Today, both parents
often share legal custody and the child resides primarily with one
parent. When custody decisions are disputed, general practice
recently has been that each parent’s postdivorce parenting
responsibilities should be based on their predivorce involvement with
the child. Joint custody, both legal and physical, has become
common (Ciabattari, 2022).
Family studies researchers have been interested in how adults and
children are affected by divorce and cohabitation dissolution. Demo et
al. (2021) present a divorce variation and fluidity (DVF) theoretical
model, a model that seems applicable to cohabitation dissolution as
well. This model has two basic principles derived from decades of
divorce research: (1) there is a large variation in how family members
experience and adjust to divorce, and (2) children’s and adults’
adjustment following divorce changes over time. Research indicates
that some adults and children experience intense setbacks to
physical and mental well-being, some experience fairly minor or
short-term setbacks to physical and mental well-being, some maintain
their predivorce level of well-being, and some rebound quickly from
the stress of family dissolution with improved well-being (Demo et al.,
2021).

Both adults and children may demonstrate what are considered

normative reactions to the stresses of family dissolution, such as
anger, confusion, anxiety, and sadness. Some adults develop
depressive and anxiety symptoms and behaviors such as binge
drinking (Zhang & Axinn, 2022). Amato (2010) found that after
divorce, children often feel persistent psychological pain, but
psychological adjustment may not be affected in any enduring way.
Demo et al. (2021) report that stress increases in the run-up to the
divorce, during the divorce, and in the immediate aftermath. However,
the stress level typically begins to subside within a year after divorce
as families adjust to new relationships and routines. Divorce and
cohabitation dissolution is a crisis, one that usually lasts for 1½ to 2
years. It involves loss and a grief process. Adults and children ebb
and flow in their adjustment to the family disruption, including
changes in residence, neighborhoods, schools, extended families,
friends, and perhaps standard of living. Family stress theory would
predict that children and adults may exhibit greater adjustment
problems when experiencing sequential situations of divorce or
cohabitation dissolution, or when divorce or cohabitation dissolution
coincides with other family transitions and stressors. Research
identifies three factors that contribute to healthy adjustment of
children to divorce and cohabitation dissolution: (1) having basic
economic and psychological needs met, (2) ongoing interaction with
important people in their lives, and (3) a generally supportive and
cooperative relationship between their parents.

Problematic Substance Use

Problematic substance use (PSU) is often part of the fabric of family

life and usually affects the partner relationship and child
development. For the purposes of this discussion, problematic
substance use is defined as serious and persistent problems with
alcohol and/or other substances and does not refer to a specific
clinical diagnosis. There is evidence of substantial increases in PSU
during the COVID-19 pandemic and also evidence of diminished
treatment for PSU during the period (Harker et al., 2022; Taylor et al.,
2021). PSU is often described as a family problem, not only because
of its effect on the entire family system but also because of the
growing evidence of a strong genetic component in the etiology of
PSU (Latvala et al., 2022; Waaktaar et al., 2018). The effect of PSU
on the partner relationship has received less research attention than
the impact of parental PSU on children.

Research indicates that living with a partner with PSU puts strains on
everyday life, including compromised mental and physical health,
economic worries, reduced intimacy and sexual satisfaction, social
isolation, and disrupted parenting. Most of the research on partner
relationships in situations of PSU has reported on female partners,
and there is much consistency in themes found across qualitative and
quantitative findings. Partners report a need to manage the stigma
associated with being a partner to a person with PSU. They report
efforts to keep the PSU secret, protect the problematic substance
using partner, and avoid social situations that might expose
problematic behavior of the partner with PSU (O’Shay-Wallace, 2020;
Weimand et al., 2020). Another theme is the strain of unpredictability
and uncertainty, with the ups and downs of PSU becoming the center
of gravity for the family (Sperandio et al., 2021; Weimand et al.,
2020). Both female and male partners report fearing for their own
safety and cite incidents of violence, especially during periods when
the partner with PSU was intoxicated, in withdrawal, or craving the
substance (Gilchrist et al., 2019; Sperandio et al., 2021; Weimand et
al., 2020). Both female and male partners report feeling helpless and
powerless over the PSU and the events that transpire from it
(Sperandio et al., 2021; Weimand et al., 2020).

For many partners, there is a moment when they realize the extent of
the substance use problem, after which a gradual shift occurs in the
quality of the relationship. Strained communication and sexual
problems are common (Sperandio et al., 2021; Wilson et al., 2019).
One reported concern is the need to pick up major family roles that
are neglected by the partner with PSU (Birkeland et al., 2018;
Sperandio et al., 2021; Weimand et al., 2020). Partners report a need
for more support for both themselves and their partner with PSU.
Stigma keeps them from seeking both formal and informal supports,
and the most empathic support comes from Al-Anon and other peer
support groups (Sperandio et al., 2021; Wilson et al., 2019). Wilson et
al. (2019) recommend more online services for partners of people
with PSU. In families with children, the greatest concern reported by
partners is the safety and well-being of the children (Sperandio et al.,
2021; Weimand et al., 2020; Wilson et al., 2019). They report feeling
a need to always be present to protect the children and struggling to
balance the children’s need to understand the situation with a desire
to protect them from knowing (Weimand et al., 2020).

Several decades of research indicate that experiencing parental PSU

as a child and adolescent is associated with enduring physical and
mental health problems, behavior problems, problematic social
relationships, and poor education outcomes. In a meta-analysis of 56
studies, Kuppens et al. (2020) conclude that parental PSU is a risk
factor for subsequent child well-being but caution against interpreting
that to mean parental PSU is the causal risk factor. Reviews of the
research on the impact of parental PSU on children suggest that the
impact varies by the age of the child (Adlin Bosk et al., 2017; Neger &
Prinz, 2015). Prenatal exposure to alcohol and other drugs can have
a negative effect on the developing brain and regulatory functions
and increase the likelihood of difficult temperament, irritability, sleep
and feeding disturbances, excessive crying, and physical ailments
such as gastrointestinal problems. Being parented by a parent with
PSU during the first three years of life increases the likelihood of
insecure and disorganized attachment and problems in speech and
language development. School-aged children living with parents with
PSU demonstrate higher levels of aggressive behavior, fewer friends,
and more peer conflict than children living with parents with no
substance abuse problems. Adolescents of parents with PSU have
higher rates of psychopathology, depression, anxiety, and substance
abuse. Adolescent boys are more likely than adolescent girls to report
anger and aggression (Nattala et al., 2022). Young adults who grew
up in homes where at least one parent had PSU report pervasive loss
and grief, including loss of feeling loved, loss of a reliable parent, loss
of a “normal” lifestyle, and loss of childhood itself. They also report
feeling loneliness, stigma, shame, and chronic stress from the
unpredictability and insecurity in the home. They were confused
about what was happening at home and describe a climate of
secrecy which led to social isolation (Meulewaeter et al., 2022).

Although not all parents with problematic substance use abuse their
children, there is an increased risk of child maltreatment while using
(Adlin Bosk et al., 2017; Neger & Prinz, 2015). Given that substance
abuse is often characterized by cycles of relapse and recovery,
parental substance abuse does not mean that everything falls apart,
particularly during phases of abstinence or reduced use, but parental
conflict and fighting do typically increase during periods of excessive
substance use. Children’s lives are often dominated by the needs,
feelings, and behaviors of substance-abusing parents. The children,
especially girls, sometimes become caregivers to their parents,
putting them to bed when they are drunk or cleaning up after a parent
who urinates on the floor. They may also become caregivers to
younger children (Nattala et al., 2022). There is considerable
evidence that parents with problematic substance use engage in less
monitoring of their children’s behavior.

The evidence is clear that many families with parents who have
problematic substance use do not fare well, and many of these
families end up in the child welfare system, especially if the mother is
the one with a substance abuse problem. In the United States, it is
estimated that 40% to 80% of child welfare cases have a substance
abuse component (Adlin Bosk et al., 2017), and a similar pattern has
been noted in other countries (Bröning et al., 2019). In recent years,
the opioid epidemic has overwhelmed the child welfare system, just
as the earlier crack cocaine and methamphetamine epidemics did.
Caregivers with substance use problems have been more likely than
other caregivers in the child welfare system to lose custody of their
children, and their children are likely to remain in foster care longer
than other children.

In recent years, child development scholars have argued for services

that address both substance abuse problems and parenting
difficulties, and the child welfare system has been reconsidering how
to enhance permanency for children without out-of-home placement.
In the United States, the 2018 passage of the Family First Prevention
Services Act (FFPSA, 2018) shifted federal funds to a prevention
model that aims to prevent unnecessary removal of children from the
parents’ care. Different models of care for children of parents with
PSU are being explored (see Freisthler et al., 2021; Huebner et al.,
2021). Adlin Bosk and colleagues (2017) argue that we need new
models of practice for families with a parent with PSU. They suggest
that existing policy and practice models are based on the idea of
substance abuse as an acute problem that can be “cured,” but in
reality it is a chronic, relapsing condition. What is needed, they argue,
are policies and interventions that anticipate relapse and can respond
to the chronic nature of substance use disorders. In qualitative
research in Norway, Wangensteen and Westby (2021) found that
young adults who had grown up with a parent with PSU reported that
three things are needed by children with parents with PSU: the
opportunity to maintain relationships with biological parents and other
important people in their lives, safe living conditions when biological
parents are impaired, and respectful (of their biological parents as
well as themselves) and caring conversations with professionals to
make sense of their complicated relationships with their biological
parents. These young adults have provided clues for the ongoing
development of policies and practices that promote permanence for
children with parents with PSU. The best approach might not be the
same for all families.
Critical Thinking Questions 10.5

Three challenges to family life are discussed in the previous sections:

domestic and family violence, divorce and cohabitation dissolution,
and problematic substance use. Are domestic and family violence,
divorce and cohabitation dissolution, and problematic substance use
new or enduring challenges for families in the United States? Do
these challenges appear to occur across cultural and national lines?

Implications for Social Work Practice

This discussion of families and family life, in the context of larger

social systems, suggests several practice principles.

Be curious about the way that families you work with define
family and who is family to them.
Assess families from a variety of theoretical perspectives. Be
particularly aware of the impact of changes in larger systems on
families’ resources and functioning.
Use appropriate family assessment tools, including the
genogram, ecomap, and timeline, to help you develop a more
comprehensive understanding of the families with which you
work.
Recognize diversity in the family formation processes and the
family structures represented by the families with whom you work
and be sensitive to the relative strengths and weaknesses of
different family structures.
Approach all families with respect and an open mind.
Develop awareness of any biases you have about family
structures and families living with different types of challenges.
Recognize cultural diversity among families and make a
commitment to culturally sensitive practice that involves ongoing
learning, both about and from families that are different from your
own.
Assess any bias, discrimination, and social exclusion faced by
the families with whom you work and consider ways to promote
equity and inclusion.
 Give families credit for struggling well in adverse circumstances.
Learn as much about their coping strategies as their challenges.
Understand policies that affect families at the local, state, and
national levels and the ways they affect both your own work and
the lives of all families—particularly low-income, marginalized,
and stressed families.
Where appropriate, encourage family members to become
involved in neighborhood, local, state, and national efforts for
positive change.
As appropriate, work toward your agency’s becoming involved in
policy and advocacy work on behalf of families, including
development of needed programs and services.

Chapter Review

Key Terms

Differentiation of self
Exchange and choice perspective on families
Family ecomap
Family economic stress model
Family of origin
Family stress perspective
Family systems perspective
Family timeline
Family
Intersectionality perspective on families
Life course perspective on families
Multigenerational genogram
Nonnormative stressors
Normative stressors
Reciprocity
Role
Single-parent families
Stress pileup
Symbolic interaction perspective on families
Turning points
Active Learning

1. Theory and your family. We have used different theoretical

lenses to look at the family of Bobby Sharpe. If you were a social
worker working with a family similar to the Sharpes, you would
want to be aware of how your own family experiences influence
your practice with families. You can use theory to help you do
that as well. To begin this process, reflect on the following
questions related to your family of origin and your childhood:

What value was placed on connectedness, and what value

was placed on the differentiated self?
What were the external boundaries—who was in and who
was out of the family?
Was there an expectation of reciprocity of exchange of
support and resources?
What were important symbols of family life? What types of
rituals enhanced family life? What roles did family members
play?
What intersection of social identities were represented in the
family? How were these identities related to systems of
power and social oppression?
Were there any important family events that became turning
points for your family?
Can you recall any periods of stress pileup? If so, how did
your family cope during those periods?
How do you think your experiences in your family of origin
might serve as a barrier or an aid in work with a family
similar to the Sharpe family?

2. Visualizing your family. Sometimes we learn new things about

families when we prepare visual representations of them. There
are several tools available for doing this. You will use three of
them here to visualize your own family.

Referring to Exhibit 10.1, prepare a multigenerational

genogram of your family, going back to your maternal and
paternal grandparents.
 Referring to Exhibit 10.2, prepare a family ecomap of your
current family situation.
Referring to Exhibit 10.3, prepare a family timeline,
beginning at the point of your birth or earlier if you think
there were significant earlier events that need to be noted.

After you have prepared these materials, work alone or in small

groups to consider how useful each tool was in helping you think
about your family of origin. Were any new insights gained from using
these visual tools? What is your overall reaction to using tools such
as these to understand your family?

Descriptions of Images and Figures

Back to Figure

The genogram reads as follows.

Bobby (age 49) and Vivian (age 49) are married with a daughter
Marcie (age 25, no longer lives at home) and a son Caleb (age 16,
born with cerebral palsy). Bobby has both parents alive and has three
sisters, of which one of them is engaged and has a child who has
moved into Bobby’s and Vivian’s house. Vivian’s mother is a widow
who has moved into Bobby’s and Vivian’s house. Vivian has a sister
who is separated from her partner. They have a daughter. Their son
died in Afghanistan in 2019.

Back to Figure

The ecomap is as follows.

Bobby (aged 49) and Vivian (aged 49) live in a support relationship
with their children Marcie (aged 25) and Caleb (age 16).

Resource flow both ways from and to the whole family: Bobby's
Aunts, Uncles, & Cousins, Church, Vivian's Sister, Bobby's Sisters,
Vivian's Godparents.
Stressful relationship with the whole family: Vivian's Mother, U.S. War
Effort, Vivian's Nephew, COVID-19.

Resource flow both ways from and to Bobby: National Guard,

Bobby's Dog, Bobby's Military Friend, Bobby's Parents, Bobby's
Employer.

Resource flow both ways from and to Vivian: Vivian's Employer.

Resource flow both ways from and to Marcie: Marcie's Employer,

Marcie's Roommates

Resource flow both ways from and to Caleb: After-School Program,

School.

Resource flow one way to Caleb: Medical Team.

Back to Figure

The timeline reads as follows.

1973: Vivian's father killed in Vietnam. Bobby is born. Vivian is born.

1991 to 1995: Bobby serves in Army.

1995: Bobby begins to work as heating and air conditioning

technician.

1996: Bobby and Vivian marry.

1997: Marcie is born.

1999: Bobby's dad has serious automobile accident. Bobby is

deployed to Iraq.

2004: Bobby joins the National Guard.

2005: Bobby returns from Iraq with injury.

2006: Caleb is born.

2007: Bobby's grandmother has a stroke.

2010: Bobby deploys to Afghanistan. Vivian takes administrative

position with school system. Vivian's mother moves in with Bobby and
Vivian.

2011: Bobby returns from Afghanistan with some difficulties

readjusting.

2012: Bobby returns to work. Bobby's grandmother dies.

2015: Marcie enters university.

2019: Marcie graduates from university and begins work. Vivian's

nephew dies in Afghanistan.

2020: Beginning of COVID-19 pandemic.

Back to Figure

The infographic is described as follows.

Step 1 Economic Hardship: Low income, High debt, low assets,

Negative financial events.

Step 2 Economic Pressure: Unmet material needs, Unpaid debts,

Painful cutbacks.

Step 3 Parent Distress: Emotional problems, Behavioral problems.

Step 4 Disrupted Family Relationships: Interparental

conflict/withdrawal, Harsh, inconsistent parenting.

Step 5 Child and Adolescent Adjustment: Emotional, behavioral

problems, Impaired competence.
11 Small Groups

Elizabeth P. Cramer

Learning Objectives

11.1 Analyze one’s own emotional and cognitive reactions to a

case study.
11.2 Define small groups and identify some of their uses in social
work practice.
11.3 Summarize and give examples of three dimensions of group
structure.
11.4 Compare the benefits and drawbacks of heterogeneity and
homogeneity in group membership.
11.5 Analyze the potential usefulness for social work practice of
five theories of group process: psychodynamic theory, symbolic
interaction theory, status characteristics and expectation states
theories, exchange theory, and self-categorization theory.
11.6 Summarize the role of social workers in interdisciplinary
teams.
11.7 Apply knowledge of small groups to recommend guidelines
for social work engagement, assessment, intervention, and
evaluation.

A Case Study About Small Groups

Case Study 11.1: The Sexuality and Gender Group at a Women’s Residential Substance Abuse
Treatment Facility

The sexuality and gender group at the women’s residential substance

abuse treatment facility meets twice a month. This is a support group
for lesbian, bisexual, and questioning women (those women who are
unsure of their sexual orientation). Women who identify as
transgender also attend the group. Women in the treatment facility
are informed about the group by their counselors, and participation in
the group is strictly voluntary. The facilitator is a licensed clinical
social worker who is also a social work professor and a lesbian. The
composition of the group can change each session because women
are entering and exiting the facility regularly. Typically, 8 to 15 women
attend the group. The duration of the treatment program is 90 days;
however, some of the women choose to leave the program before
treatment has been completed. Many of the women in the group are
parents; some of them have brought their children into treatment with
them because one of the treatment programs at this facility allows
women and their children to come into residence. Most of the women
in this group identify as African American or Hispanic/Latina and
range in age from 19 to 50. The facilitator is white, Jewish, and in her
early 40s. The following is an account of one of the group sessions.

It’s a hot day, and Deb is driving her non-air-conditioned car to the
substance abuse treatment facility to facilitate the sexuality and
gender group. She’s been facilitating this group, which was the first of
its kind at this facility, for about a year. It has been a good learning
experience for her, and she has grown quite attached to the group.
She particularly is impressed with the candidness of the group
members and often refers to this population of women as superb “BS
detectors,” because they are not afraid to call each other out when
denial or deceitfulness surfaces. For a moment, Deb feels sorry for
herself because she doesn’t have air-conditioning in her car and she
lives in the South, but then she remembers that most of the women in
group do not even own cars. That moment of self-pity quickly passes.

The group members are already in the lounge where group meets
when Deb arrives. She smiles and acknowledges each of the group
members through eye contact. She notices that out of the dozen
women in the room, about eight of them were there for the last group
session. Deb introduces herself and makes a point to say that she is
a lesbian but not in recovery, although she has worked with many
women who are in recovery. She mentions where she works and how
long she has been facilitating this group. She then asks the women to
introduce themselves using first names. In their introductions, some
of the women mention why they have come to group or how long
they’ve attended group. Two of the women share that they were
curious about the group but don’t identify as lesbian or bisexual;
however, they have considered same-sex relationships and have had
feelings of same-sex attraction. One of the group members notes that
she has recently exited the prison system and had relationships with
other women while she was incarcerated but never while “on the
streets.”

Deb describes the purpose of the group as a place for members to

talk about sexual orientation, whether they are lesbian, bisexual, or
questioning. Deb stresses that what is said in the room stays in the
room and that members should refrain from sharing someone’s story
with others outside of the group. Confidentiality is especially
important to emphasize in residential programs. Deb also mentions
that the group is open and that members can freely discuss what they
want to.

Deb usually has a loosely planned agenda for each group session but
also waits to see what issues may get raised in the introductions and
check-in at the beginning of the group. Today, she brought the
documentary film All God’s Children to show the group (Mosbacher et
al., 1996). The film highlights the experiences of African American
lesbians, gays, and bisexuals, particularly related to family, church,
and community. It’s a powerful film and reminds the group members
that their sexual orientations are not experienced in a bubble; rather,
the intersections of faith, neighborhood, geography, and other
identities and characteristics influence how they experience their
sexual orientations.

One part of the film seems to arouse much energy and discussion:
whether a person is born gay or makes a decision or choice to be
gay. Tamika, one of the younger women in group, strongly asserts
that a person chooses to be gay. She shuns the labels of lesbian and
bisexual; instead, she prefers to allow herself to date or fall in love
with whoever is attractive to her, whether that person is male, female,
or transgendered. Monica, a woman in her early 50s, disagrees that
sexual orientation is a choice. She shares a story of how she “knew”
she was a lesbian when she was 12 and she fell head over heels for
a girl in her neighborhood. She tried to suppress those feelings and
pretended she was into boys all through middle school and the
beginning of high school. By her junior year, she just couldn’t pretend
anymore. She secretly would date girls, but no one in her family or
her church knew. To this day, many years later, she has never openly
said to any of her family members that she is a lesbian. They all
seem to know that she is, but it isn’t discussed. She experienced a
deep hurt at her church when her pastor delivered a sermon that
Monica thought was very antigay. Her parents insisted that she attend
church. She really didn’t want to go to church after that sermon, but
she also didn’t want to tell her parents the reason why. That wasn’t
the first and last time that antigay remarks were made in her church.
Gail, usually quiet in group, shares that her experience at church has
been the opposite of Monica’s. Her family attended a progressive
church and persons of all sexual orientations were welcomed. She
still hesitated to come out to her family members when she first
began dating women but then eventually began to disclose to the
family members to whom she felt closest. Their positive responses
encouraged her to continue to disclose to other family members and
close friends.

The discussion of the film moves the group into deeper core themes
related to their sexual orientation and their addiction. As the facilitator,
Deb looks for opportunities to work the parallel process in group—to
note the similarities between the negative consequences of an
addiction and the experience of being a sexual minority who is often
discriminated against and ostracized. A few of these common issues
include shame, fear, emotional dependence, despair, and loneliness.
Shame is a particularly powerful emotion; the women in the group
connect shame to experiences they’ve had as sexual minorities and
the guilt and embarrassment about behaviors in which they’ve
engaged while they were using drugs. Negative judgments from
others about their sexual orientations and/or their addictions
exacerbated the shame. One of the group members shares with the
group about how she would get high to allow herself to be intimate
with women. She thought it was the only way she could mask her fear
and shame about her attraction to other women. Many of the group
members struggle with feelings of internalized homophobia. In the
group, Deb emphasizes how acceptance of oneself is important to
group members’ emotional health.
The group is coming to a close. Most of the women have spoken in
group today. The film seemed to strike a chord with many of them. On
the way back to her workplace, Deb thinks about all the group
members and what they shared that day. She feels fortunate to be let
in to the inner lives of the women during a time when they are
working hard to heal.

Small Groups in Social Work

As Isaac Wilhelm (2020, p. 661) suggests, “Groups are everywhere.”

Much of human behavior takes place in small groups. The sexuality
and gender group is a type of small group with special relevance to
social work practice, but most people also become involved in other
types of small groups: friendship groups, task groups at work, self-
help groups, or sports teams, to name but a few. Donelson Forsyth
(2011) reminds us that “people, no matter what they are doing—
working, relaxing, studying, exercising, worshipping, or sleeping—are
usually in a group rather than alone” (p. 19). We interact with others
in many sizes of groups, and research indicates that humans
generally prefer groups of small size (Macchia et al., 2016). The
focus of this chapter is on small groups. We carry out our
relationships with significant others in small groups, but it is important
to remember that small groups also provide the structures on which
communities, organizations, and the larger society are built.

In a mobile society, small groups serve a useful function. Figure 11.1

shows how group members may benefit from belonging to a small
group. Small groups offer individuals an opportunity to meet others
and work together to achieve mutual goals. They provide social
support; they socialize us to the norms, values, behaviors, and skills
for living in a given society; they provide a sense of belonging; they
provide us with companionship and conversation; and they help us to
connect to the wider world. Robert Putnam (2000) suggested that in
our rapidly changing globalized society, small groups are an
important source of social capital, or connections among individuals
based on reciprocity and trustworthiness.
Figure 11.1 Benefits of Small Groups

Small groups may be formally defined in several ways. A few

scholarly definitions of small groups, along with examples from the
sexuality and gender group, are displayed in Table 11.1. Although
these definitions differ, there is general agreement that small groups
are more than a collection of individuals who may have similar traits
or be in physical proximity. Persons who live on the same block may
be in proximity but have little social interaction and not perceive
themselves as a group. Thus, we may define a small group as “two or
more people who interact with each other because of shared
interests, goals, experiences and needs” (Ballantine et al., 2020, p.
129).

Table 11.1
A significant element of social work practice today is group work ,
which serves people’s needs by bringing them together in small
groups. Group work emerged in the United States in the late 1800s
and early 1900s. Early group work took place within the settlement
houses, YMCA/YWCA, Jewish community centers, and the Boy
Scouts and Girl Scouts. These groups focused primarily on
recreation, social integration, immigration issues, character building,
and social reform (Nadal & Scher, 2022; Ortega & Garvin, 2019;
Steinberg, 2019). We are now seeing a resurgence in recreation and
social skill–building groups, reminiscent of early group work (see
Rosenwald et al., 2013). Social skills groups with elementary-age
children (Lane et al., 2003), children diagnosed with autism spectrum
disorder (Leaf et al., 2017), and adolescents (Tucker, 2009), hoops
groups (basketball) with adolescent males (Leclercq et al., 2021),
arts-based mindfulness groups with LGBTQ youth (Lander, 2020),
psychodrama with a variety of groups (Giacomucci, 2021),
photography with Chinese male caregivers (So et al., 2021), and
physical activity, reminiscence, and motivation groups for older adults
(Hughes et al., 2005; Melunsky et al., 2015) are several examples.

By the 1930s and 1940s, formal organizations were promoting group

work. In 1935, the Group Work Section of the National Conference on
Social Work emerged, and in 1937, the American Association for the
Study of Group Work formed. The American Association of Group
Workers, which started in 1946, later merged with other organizations
to become the National Association of Social Workers (NASW) in
1955. Some authors argue that a strong group work identity was lost
in the merger (Andrews, 2001).

During World War II, group work became popular in hospitals and
other clinical settings in the United States, resulting in some tension
between group workers and caseworkers. Following the war, the
philosophy of group work shifted from a strengths focus to a more
problem-focused orientation. Nevertheless, group workers continued
to attempt to influence the social work profession as a whole. During
the 1960s and 1970s, social work education included courses on
group work, and some students majored in group work. But then
group work content declined as social work education shifted its focus
to individuals and families. Ironically, at the same time, joining groups
became more common in the United States. The 1980s and 1990s
saw the rise of mutual aid groups (Gitterman & Shulman, 2005),
today a popular type of social work group.

With today’s concern about cost containment, groups are viewed as a

financially prudent method of service delivery, and the use of groups
by social workers is on an increase (Sweifach, 2015). During the
early days of the COVID-19 pandemic, social workers around the
world transitioned to technology-assisted group work, and more
research is needed to understand how that worked in different
settings (McVeigh, 2021). Empirical studies have shown the
effectiveness of groups in addressing a number of social, health, and
emotional problems, such as mental illness, suicidal ideation,
substance abuse (Drake et al., 2004; Lau et al., 2010; Varmaghani et
al., 2019), and cancer (Khng et al., 2016; Rosenfeld et al., 2018;
Spiegel & Classen, 2000). Culturally responsive groups can be
beneficial for individuals with marginalized social identities. For
example, an experimental, pre-post evaluation of a treatment group
for Black women who were experiencing depression and stress called
“Claiming Your Connections” (CYC) showed that women who
participated in CYU reported significant less depression and
perceived stress following the intervention (L. V. Jones & Warner,
2011). Social workers’ use of groups in empowerment and feminist
practice encourages a focus on the individual in the sociopolitical
environment and is thus especially helpful for people who desire a
path for activism as a component of their healing (Lee & Hudson,
2017).

Group work content is coming back into the social work curriculum,
and social work students are being exposed to group work through
their field placements (Steinberg, 2019). Furthermore, graduating
students have informed me that potential employers ask if they have
had course content on group work. And yet research on group work
content in social work curricula suggests a need for social work
students to receive more education on group processes and skills of
group facilitation (LaRocque, 2017; Sweifach, 2015). Sweifach (2015)
argues that the two most important skills for group workers are skill in
facilitating mutual aid and skill in managing group conflict. LaRocque
(2017) warns that use of manualized group treatment is not a
substitute for good group facilitation by a leader who understands
group process.

A number of scholars have established classifications for groups

encountered in social work (see, for example, Kottler & Englar-
Carlson, 2015; Toseland & Rivas, 2017; Zastrow, 2015). This chapter
focuses on five: therapy groups, mutual aid groups,
psychoeducational groups, self-help groups, and task groups. Table
11.2 compares these five types of groups on several major features—
purpose, leadership, size, duration—and gives examples of each. As
you read about them, remember that groups may not fall exclusively
into one category; rather, they may share elements of several group
types. For example, a group for parents and friends of seriously
mentally ill persons may include psychoeducational material about
the nature of mental illness and its impact on family members,
provide mutual aid to its members through discussion of taboo areas,
and offer a therapeutic component in the examination of family
patterns and dynamics. In recent years, even before the COVID-19
pandemic, all types of groups have been meeting in virtual format,
and we take a look at this trend in this section.

Table 11.2
Therapy Groups

One common type of group is known as the therapy group , or

psychotherapy group. Group psychotherapy uses the group milieu to
enable individuals to work out emotional and behavioral difficulties.
The individuals in the group often reproduce their emotional and
behavioral problems within the group setting, thus giving the leader
and group members an opportunity to provide feedback about them
(DeLucia-Waack et al., 2014). An example of this type of group is a
therapy group for adult incest survivors.

Therapy groups typically have fewer members and meet for a longer
duration than self-help, psychoeducational, or mutual aid groups.
Such a group may have six or fewer members, may be led by people
who consider themselves to be therapists, may meet weekly for a
year or more, and may involve intrapsychic exploration of thoughts
and emotions. Talk or verbal therapy groups are not the only type.
Increasingly popular are art therapy groups, which have
demonstrated the standard therapeutic factors of verbal therapy
groups as well as some factors unique to art therapy (Malhotra et al.,
2022; Wood et al., 2011). In addition, therapy groups do not
necessarily meet for long periods. Brief treatment models , which
usually last 6 weeks or less, are becoming more and more popular in
a managed care environment.

Mutual Aid Groups

In mutual aid groups , members meet to help one another deal with
common problems. The members of the group thus become as
important to its success as the facilitator (Fernandes-Jesus et al.,
2021; Steinberg, 2014; Sweifach, 2015). In the sexuality and gender
group, we witness many benefits of mutual aid groups:

Sharing data: coming-out stories, events in the members’ lives

related to their sexual orientation and addiction
Engaging in a dialectical process of discovery: theories about
sexual orientation, insight into when one first felt one was not
heterosexual
Discussing taboo subjects: open discussion of intimacy, admitting
shame or guilt about feelings or behaviors related to addiction
and/or sexual orientation
Realizing that one is not alone (all in the same boat): others who
are not heterosexual and have had similar feelings regarding
coming out and disclosure
Finding support: a place to be oneself in a homophobic society
Making mutual demands: challenges to internalized self-hatred,
dishonesty about one’s feelings and behaviors, and unhealthy
coping mechanisms that lesbian and bisexual women may use
as a way to live in two worlds
Problem solving: disclosure decisions for individuals and the
larger issue of self-disclosure of stigmatized identities (as a
sexual minority and a recovering addict)
Rehearsing new behaviors: role-playing of disclosure scenarios
or confrontations with people who make antigay jokes
Finding strength in numbers: reading literature and watching
films that portray the lived experiences of “out” lesbian and
bisexual women of various races, ethnicities, faiths, and abilities
offers positive role models to group members
Therapy group. Members in therapy groups share experiences and
obstacles they have encountered. Group therapy assists individuals
in resolving emotional and behavioral problems.

© iStockphoto.com/barnardbodo

In general, mutual aid groups are led by someone, either a

professional or a trained individual, who identifies with the population
the group targets. For example, the facilitator of the sexuality and
gender group self-identifies as a lesbian. In fact, some mutual aid
groups form as an alternative to professionally led therapy groups. In
this way, they may be similar in purpose to self-help groups. There is
no requirement, however, that in order to be an effective leader one
must have “been there.” The groups may be time-limited (for
example, a 10-week group for siblings of children with disabilities) or
ongoing (such as a weekly support group for incarcerated males). As
in therapy groups, art therapy may be utilized in mutual aid groups.
For example, art therapy has been shown to be beneficial for children
with disabilities, including to promote social skills’ development in
youth with autism (Epp, 2008).

Mutual aid groups also have the potential for activism. A group of
people may meet initially to gain support and share concerns but may
transform some of their healing energy into social change efforts. For
instance, members of a mutual aid group for survivors of intimate
partner violence may attend a Take Back the Night march (to protest
violence against women) as a group and then courageously approach
the microphone to speak about their own experiences of victimization
and empowerment. For some populations, organizing a group along
social justice principles is recommended, such as for groups for
individuals who identify as transgender (dickey & Loewy, 2010).

Psychoeducational Groups

Psychoeducational groups , in which social workers and other

professionals share their knowledge and expertise to educate group
members about a specific life problem or developmental issue, are
becoming more common in the United States (N. Brown, 2011;
Weiner et al., 2022). The topics include problems such as substance
abuse, mental health diagnoses, and divorce as well as more general
interests, such as child development or the aging process. Those
who participate are primarily looking for information rather than
intervention for emotional and behavioral problems. Thus, the format
of group meetings may be a lecture by the group leader or a guest
speaker, with minimal group discussion. The group could be a one-
time workshop, or it could last several sessions.

Although a psychoeducational group is not a therapy group, it can be

therapeutic when members share feelings and concerns. An example
is a one-time group meeting for family and friends of persons in a
drug rehabilitation center. The stated purpose may be to provide
education about the recovery process to family members and friends,
but during the session, group members may share feelings about
their loved one’s addiction and how it has affected their lives. Pet
bereavement groups may also combine elements of education (e.g.,
normalizing reactions to pet loss) and support (Hess-Holden et al.,
2017).

Self-Help Groups

In general, self-help groups are not professionally led, although a

professional may serve in the role of consultant. These groups are
composed of people who voluntarily meet because of a common
identity or life situation, thus offering members an opportunity to
receive assistance from others who are also struggling with similar
issues (Landstad et al., 2022). An informal leader may emerge in a
self-help group, or leadership may be rotated among the
membership. Self-help groups are often used as a supplement to
professional treatment. For example, someone who is receiving
outpatient substance abuse treatment may be referred to Alcoholics
Anonymous; someone in a family preservation program may be
referred to Parents Anonymous. Self-help groups often have no limit
on their life span and have rotating membership (people come and go
from the group).

It appears that humans have developed and maintained self-help

groups for ages (Teshome et al., 2012). Although there is no
trustworthy estimate of the number of self-help groups in the United
States and around the world, there is much evidence that both face-
to-face and virtual self-help groups are numerous. During the COVID-
19 pandemic, some in-person self-help groups found that they
needed to pivot to virtual. For some populations, such as people with
substance use disorder, online recovery support meetings, including
12-step, have been essential for treatment continuity (Bergman et al.,
2021). Self-help groups have several benefits. People can offer help
to others, as well as receive help, which produces psychological
rewards (Toseland & Rivas, 2017). In addition, self-help groups can
run with few resources. For example, a religious institution might
donate space for meetings, and there generally are no costs for the
group facilitators.

Self-help groups offer their members some of the social functions

mentioned in the beginning of this chapter—a chance to meet others
and have meaningful interactions, a place to feel as though one
belongs and to give support to others. In short, self-help groups offer
a social support system. As discussed in Chapter 5, social support
has been shown to help people prevent and overcome disease and to
maintain good psychological health. In addition, some believe that
attending a self-help group is less stigmatizing than a “treatment” or
“therapy” group, the latter being more often associated with those
who are seriously ill or have major problems in living. Some people
view self-help groups as a form of support by and for laypersons
(“folks just like me”), and the idea of attending one can be much less
intimidating than a therapy or mutual aid group. The absence of
agency affiliation for many self-help groups is attractive to those who
would rather think of themselves as getting support from people in
similar situations than going to an agency for assistance. Yet others
may find comfort in knowing that a particular self-help group has an
affiliation with a national, state, or local organization. Self-help groups
can demonstrate helping characteristics (e.g., universality, support,
and communication of experiential knowledge) similar to those of
mutual aid groups.

Another benefit of self-help groups is their potential for activism. One

study found that parents of children with cancer who were members
of self-help groups were significantly more involved than other
parents of such children in working to improve the medical system in
which their children were involved (Chesney & Chesler, 1993).
Another researcher (Tesoriero, 2006) found that women’s self-help
groups in India become active in community action projects and
sometimes move their activism beyond the local community. Another
study of microcredit self-help groups with widowed and abandoned
women in rural India found that the program resulted in an increase in
self-efficacy among the women as well as the development of a
collective political voice (Newransky et al., 2014). A study of women’s
postpartum depression self-help groups (Taylor, 1999) found that
these groups incorporate consciousness raising and advocacy with
medical and mental health professionals and politicians to effect
change in institutional responses to women experiencing postpartum
depression. In a qualitative study of adults at a rehabilitation center,
Landstad et al. (2022) found that peer support in self-help groups can
contribute to new self-awareness, promote adjustment, and facilitate
skill development and transfer of learning.

Mothers support group. Here, mothers join together to share stories,

struggles, and insights about the adjustment of becoming a parent.

© iStockphoto.com/SolStock

Task Groups

Most of us have been involved in task groups, such as a committee at

school or work or a task force in the community. It appears that the
use of task groups is increasing in the workplace (Kottler & Englar-
Carlson, 2015). In social work practice, task groups are often short
term and formed to accomplish specific goals and objectives. Task
groups are used frequently by social workers involved in planning,
administration, community organizing, and social action roles but are
much less common in other social work roles. An example is a needs
assessment committee formed at an agency to determine the
problems and concerns of the population the agency serves.
Although members of other types of groups may take on tasks (e.g.,
researching a subject and presenting it to the group), the task group
is created with the express purpose of completing some specific task.

Task groups are often formally led by professionals appointed or

elected to chair the group. Leaders may be chosen because of their
position in the agency or their expertise in the area. Task groups
formed in the community to advocate for change may be led by
community members or co-led by professionals and community (lay)
members.

In task groups as well as other kinds of groups, members fulfill what

are commonly referred to as “task and maintenance” roles. The task
specialist focuses on the goals set by the group and the tasks needed
to accomplish them. These may include providing information to aid
group discussion, giving directions for how to proceed with a task, or
summarizing members’ ideas. Maintenance roles refer to those that
enhance the social and emotional bonding within the group. These
include inquiring about how close members feel to each other,
encouraging open and respectful discussion of conflicts, and inviting
reluctant members to participate in group discussion (Coyne, 2014).

Critical Thinking Questions 11.1

In what types of small groups have you participated? What benefits

have you derived from participating in small groups? What
frustrations have you faced from participation in small groups?

Technology-Facilitated Groups

Increasingly, group work is delivered or supplemented by technology

—for example, asynchronous Internet-based groups, groups that use
videoconferencing for synchronous group sessions, and groups that
offer both virtual and in-person attendance, to name a few. Starting
with using the telephone to offer therapeutic and support groups
(Toseland & Larkin, 2010; Toseland & Rivas, 2017), technology-
delivered groups now include computer-mediated support groups,
which have proliferated in the United States and around the world (A.
Jones & Meier, 2011). Increasingly, social workers and other
professionals are using a combination of telephone and computer-
assisted communication (Muuraiskangas et al., 2020; Young et al.,
2022) as well as real-time (such as “chat rooms”) and post and
response modalities (such as e-mail, bulletin boards, and listservs)
(Zastrow, 2009).

While we have increasing technology, employed by necessity during

the COVID-19 pandemic, access to computers, the Internet, or
smartphones remains elusive for some populations. The Pew
Research Center recently reported that people with disabilities,
compared to those without, are less likely to own a computer or a
smartphone (Perrin & Atske, 2021). Although people with low
incomes are gaining increased access to technology, their access is
routinely unstable and undependable (Gonzales, 2016). The digital
divide is shrinking but still exists. Therefore, telephone support
groups are especially helpful for people who don’t have access to
computers and the Internet. They are also helpful for people who
have transportation challenges to access in-person groups, including
those in rural areas or who would have to travel long distances to
attend group. Additional populations that benefit from telephone-
mediated groups are people with chronic and long-term illnesses and
caregivers of frail older adults, to name a couple (Toseland & Rivas,
2017).

While there are advantages and disadvantages to telephone-

mediated groups, they are generally more cohesive than face-to-face
groups (Gonzales, 2016; Wagner et al., 2014). As a form of
synchronous interaction, telephone groups offer the opportunity for
immediate knowledge and support exchange among participants
(Park & Bonk, 2007; Young et al., 2022) versus the wait-for-feedback
format of asynchronous online groups where one posts a request or
response on an online board and listserv and waits for others to
respond later.
Disadvantages of telephone groups include difficulty for leaders to
track individual participation and interpret subtle verbal cues; difficulty
for group members to gauge each other’s reactions because of the
lack of visual cues; the challenge of including members who are
d/Deaf or hard of hearing; concerns about confidentiality when other
members of the household are present; distortions related to
technological problems or background noise; and inability to use
hands-on program activities, flip charts, and other visual aids. Some
researchers noted more hostility in telephone-mediated groups than
in face-to-face groups, and others noted less hostility. Toseland and
Larkin (2010) provide useful guidelines for developing and leading
telephone groups. They suggest that social group workers use the
same skills in telephone-mediated groups as with face-to-face groups
but need to be more active to ensure clear communication because
of the lack of visual cues.

Computer-mediated groups are commonly identified as “any virtual

social space where people come together to get and give information
or support, to learn or to find company” (Wright, 2016, p. 67). Online
groups can be accessed via several digital devices, including
computers, tablets, and smartphones. Online support has become
increasingly popular over the last decade. Approximately 20% of all
Internet users have sought out support from online groups (Wright,
2016). This could be attributed to the diverse outlets for online group
support, including e-mail-based groups, chat rooms, blogs,
newsgroups, podcasts, video conferencing, and discussion forums.
Online support allows people with similar concerns and interests from
diverse areas of the world to convene in a virtual space (Chung,
2014).

Research indicates that computer-mediated groups provide benefits

to some of the same groups of people that benefit from telephone-
mediated groups: people living in rural areas, people who are
homebound, older adults, and caregivers who cannot leave their care
recipients (A. Jones & Meier, 2011; Wright, 2016). In addition,
computer-mediated groups are becoming more common in cancer
treatment (Elwell et al., 2010; Vilhauer, 2014). The benefits of such
virtual groups include decreased symptoms of depression and
anxiety, and increased sense of connectivity and group belonging
(Wright, 2016). Groups conducted within virtual environments, such
as Second Life, have the additional capability of creating a
dimensional space in which group members can interact in facsimile
to an authentic group experience (Reinsmith-Jones et al., 2015).
Group identity and group cohesiveness do not appear to require
member co-presence. On the other hand, miscommunication has
been found to be more frequent in computer-mediated team meetings
(Levi, 2014). A. Jones and Meier (2011) note that like face-to-face
groups, computer-mediated groups must develop “coherent and
compelling missions, recruit and retain members, establish and
enforce group norms, and manage conflict” (p. 103).

Social workers who refer clients to any type of technology-facilitated

group may want to first discuss the potential benefits and limitations
of such groups (Chung, 2014). For example, because of the
anonymity of some Internet-based support group sites, participants
may engage in antagonistic and inappropriate behavior not unsimilar
to what one can experience in an ineffectively moderated face-to-face
setting (Zilberstein, 2015). A good group moderator will intervene in
such behavior. Also, cyberstalking is another danger for those who
desire to participate in web-based groups (Hitchcock, 2006; Kaur et
al., 2021). Social workers should discuss with clients any potential
safety concerns in accessing and participating in online groups
(National Network to End Domestic Violence, 2020). Web-based
groups demand skills that may require additional training from their
participants. Additionally, though virtual groups allow members from
all over the world to connect, additional time must be spent to
navigate schedules across varying time zones (Janutaitė et al.,
2015). Group leaders may require additional training themselves to
ensure competence in the technological medium they are using, and
they should stay abreast of changing technologies for service
delivery, including which technologies are HIPAA compliant (Camper
& Felton, 2020; Reamer, 2018).

Several social work organizations jointly published the “Standards for

Technology in Social Work Practice,” which includes important
considerations for students and practitioners when they intend to use
technology to provide social work services (NASW, ASWB, CSWE, &
CSWA, 2017). Among their recommendations is that social workers
using technology to deliver services should assess potential
participants’ level of familiarity and comfort with technology, whether
language translation software is available and will be used, and the
accessibility of the technology, including access to the Internet, for
various populations, including persons with disabilities.

Dimensions of Group Structure

The sexuality and gender group serves a variety of functions. But that
one group cannot provide all group members’ needs. Group
members are also involved in friendship circles, 12-step groups, and
educational classes. Each group plays a unique part in group
members’ lives. For example, friendship circles are important to
maintaining recovery when those friends reinforce the attitudes and
behaviors that support staying clean and sober. But all these groups
are obviously structured quite differently. They can be categorized
along three dimensions.

1. How they develop. The types of groups encountered in social

work have typically been organized for a purpose. Such formed
groups have a defined purpose and come about through the
efforts of outsiders, such as an agency (Toseland & Rivas, 2017).
Examples of formed groups include not only therapy groups,
mutual aid groups, psychoeducational groups, self-help groups,
and task groups but also such groups as college classes, PTAs,
and choirs. Natural groups , in contrast, “come together
spontaneously based on naturally occurring events, interpersonal
attraction, or the mutually perceived needs of members”
(Toseland & Rivas, 2017, p. 12). Families, peer groups, street
gangs, and a group of patients who have befriended each other
in a psychiatric hospital are examples of natural groups.
2. How long they last. A time-limited group is one with a set time for
termination; an ongoing group has no defined end point. Both
formed and natural groups may be time limited or ongoing, short
or long term. A formed group, for example, may last for a 2-hour
 period (e.g., a focus group) or for months or years (e.g., the
sexuality and gender group noted in the chapter’s case study). A
natural group may last a lifetime (a group of close friends from
high school) or just through some event (tablemates at a
workshop).
3. How they determine membership. Finally, both natural and
formed groups may be open or closed or may fluctuate between
open and closed. Open groups permit the addition of new
members throughout the group’s life. In closed groups , the
minimum and maximum size of the group is determined in
advance, before the group begins or as it is being formed, and
others are prohibited from joining once that limit is reached. A
group can start off open and then become closed. An example is
a group of people who have been attending a drop-in support
group for women in abusive relationships who decide after a few
months that they would like to close the group to do some more
intensive work in group sessions. Alternatively, a closed group
may open up, as when the number of members has decreased
considerably and new members are needed to keep the group
going.

These three dimensions of group structure interact in complex ways.

The sexuality and gender group is a formed group, yet it is open and
ongoing. Attendance has ranged from 8 to 15 persons, and the group
may continue indefinitely. An example of a closed natural group is an
informal group of middle school girls who call themselves the “lunch
bunch.” The five girls eat lunch together every day and have let it be
known among their peers that no others are welcome. An example of
a formed, time-limited, closed group is a 12-week group for people
going through a divorce. Interested persons must register prior to the
group’s beginning, and once the first session begins, no new
members are permitted. An example of an ongoing, open, formed
group is a bereavement group that meets every Tuesday evening at
the local hospital and allows anyone who would like support to join
the group on any Tuesday. Another example is a group that
spontaneously meets at the basketball courts on Sunday afternoons
to play ball. Whoever shows up can get into a game, with no
predetermined limit to the number of people allowed to play.
Group Composition

Another important element of small groups is their composition—the

types of people who are members. Natural groups often have implicit
or explicit rules about who gets to belong and who doesn’t. Take the
previous example of the lunch bunch: The girls determined who
would belong. Formed groups have rules of membership too. A
sorority or fraternity establishes a process to select who will belong.
Sometimes social workers work with naturally occurring groups and
do not make decisions about group composition. But for many groups
facilitated by social workers, the social worker decides which
members are included in the group. Space constraints and personnel
issues may determine the size of the group, but the social worker
must still make decisions about who gets to belong. One of the most
important issues is how to manage diversity in the composition of the
group.

Heterogeneity Versus Homogeneity

Diversity is becoming more common in the workplace, schools, and

the community, and social work groups are increasingly
heterogeneous. The degree of heterogeneity (diversity) or
homogeneity (sameness) of group membership may vary along
several dimensions, such as age, race, sexual orientation, gender,
level of education, skills, coping style, religion, socioeconomic status,
disabilities, and problem areas or strengths. In natural groups,
heterogeneity or homogeneity may be affected by such variables as
the location (some geographic areas are highly homogeneous),
preferences of group members (people tend to form natural groups
with those with whom they feel some connection), and social norms
and values (acceptance or condemnation of mixed groups).

Usually, social work groups are homogeneous on one or a few of

these dimensions and heterogeneous on the rest. For example, the
sexuality and gender group is homogeneous regarding sexual
orientation and substance abuse but quite heterogeneous on other
dimensions, including race, age, socioeconomic status, disabilities,
educational status, occupation, age at first awareness of sexual
orientation, and amount of disclosure of sexual orientation to others.

Which is better for group work, heterogeneity or homogeneity? The

best answer is, “it depends.” First, there is much agreement that
homogeneity in members’ purposes for joining the group is essential.
Beyond that, Magen and Mangiardi (2005) recommend two principles
of composition that seem to have widespread acceptance. The first
principle, which they attribute to Fritz Redel, is that “groups should be
homogeneous in enough ways to insure [sic] their stability and
heterogeneous in enough ways to insure [sic] their vitality” (Magen &
Mangiardi, 2005, p. 355). The second principle, the Noah’s ark
principle, they attribute to Irvin Yalom. This principle recommends that
group composition should not isolate any one member on an
important characteristic, such as age, race, or gender. Differences
among people may be overridden by the overall purpose of the
group, however. I am reminded of a friend who spoke to me of her
experiences attending a support group for family members who had
lost their loved ones. As the only African American group member,
she said she felt like a “fly in a milk carton,” but her fellow group
members were the only people she knew who truly understood her
grief.

Often heterogeneity/homogeneity is a matter of perception. For

example, in several studies of racially mixed groups, European
American group members had a different perception from African
American members regarding the racial balance of the group (Davis,
1984). If the group was in proportion to the population of African
Americans in the geographic area, then the European American
members perceived the group as balanced. If the group had equal
numbers of white and Black members, the Black members viewed
the group as balanced. In such situations, however, the white
members perceived the group as imbalanced because the number of
African Americans exceeded the psychological threshold of tolerance
for European American members. In another study conducted by the
same researcher and colleagues (Davis et al., 1995), the researchers
tested perceptions of African American and white male participants in
task groups with three racial mixtures: 25% African American, 50%
African American, and 75% African American. They found that the
harmony of the group atmosphere, the success of the group, and the
perceived satisfaction with group decisions were all more favorable
when either African Americans or whites were in the majority and
least favorable in groups in which neither African Americans nor
Whites were in the majority (50% white, 50% African American). Most
important, both the African American and white group members had
similar reactions to the three racial configurations. In another study,
Asian persons showed higher levels of participation and leadership
skills in work groups that were racially balanced or all Asian
compared with Asians in white-dominated groups (J. Li et al., 1999).
Black therapist Guilaine Kinouani (2020) writes about the racialized
silencing techniques used by white group members in groups with
only one or a small minority of members of color. She also writes
about the resistance to recognize the racial trauma experienced by
group members of color in such group situations.

Group workers must also give serious thought to whether to have

gender homogeneity or gender heterogeneity in group membership.
Clearly some group purposes call for gender homogeneity, but
gender heterogeneity is often seen to be of value to maximize the
range of ideas generated in a group. Research indicates that gender
composition is an important variable in group interaction.
Researchers have found that women speak more often and have
greater influence in groups with gender homogeneity than in groups
that include men. One research team found that women speak less
than their equal share when they are in the minority in a group and at
equal rates when they are in a large majority (Karpowitz et al., 2012).
Women gained greater influence as their numbers grew. These
researchers also found that when group decisions are made
unanimously rather than by majority vote, women are not
disadvantaged in either voice or authority when they are in the
minority. Another research team (Toosi et al., 2012) found that racial
diversity in group composition changed the gender dynamics. In
racially homogeneous groups, white women spoke less than white
men and had less influence, but in racially diverse groups, white
women spoke as much as men and had as much influence. These
researchers emphasize that no social identity stands alone, and
researchers and group workers must take an intersectionality
approach and consider how identities interact with each other.
Additionally, group workers are advised to consider how transgender,
genderqueer, and nonbinary individuals would experience groups that
are labeled as single-gender (e.g., “women’s group,” “men’s group”),
and they should practice the use of gender-inclusive language (Out &
Equal Workplace Advocates, 2018).

Contemporary research indicates that group composition may be

more complex than once thought. But in the group work literature
there is still strong support for Yalom’s (1995) observation that for
“long-term intensive interactional group therapy,” heterogeneous
groups appear to be better (p. 255). Yalom is speaking here of
homogeneity or heterogeneity of psychological problems.
Homogeneous groups are generally not beneficial for long-term
psychotherapeutic work that involves personality change, because
they tend to remain at superficial levels and don’t challenge
individuals’ behavioral patterns and dynamics as much as
heterogeneous groups. Homogeneous groups, on the other hand, are
often better for “support or symptomatic relief over a brief period” and
“for individuals with mono­symptomatic complaints or for the
noncompliant patient” (Yalom, 1995, p. 255). Homogeneous groups
tend to build commitment more quickly, offer more immediate support
to members, and have better attendance and less conflict. And given
the research cited earlier, there are good reasons to consider
composing groups by race and ethnicity to allow for more intensive
exploration of common problems.

An interesting research finding is that the heterogeneity/homogeneity

issue takes on less importance the briefer and more structured the
group. Compositional issues are more significant in groups that are
less structured and that focus on group interaction (Yalom, 1995). In
the sexuality and gender group, the homogeneity of sexual
orientation and recovery from addiction provide the safety and
support to explore the heterogeneous aspects of the group.

For task or work groups, heterogeneity has been shown to positively

influence group productivity. Keck and Tang (2018) found that all-
male task groups are more likely than task groups with gender
diversity to be overconfident in their decision-making and having only
a few females in the group can change that dynamic. Among the 42
student project groups examined in one study, racial-ethnic diversity
was positively associated with group efficacy (Sargent & Sue-Chan,
2001). Another study of work groups assessed diversity by race, age,
gender, and functional background in their contribution to quality of
innovation (the usefulness of an idea or the impact it might have on a
business) and quantity of innovation (the number of new ideas the
group produces) (Cady & Valentine, 1999). These four dimensions of
diversity had no significant impact on quality of innovation. There
were significant differences in quantity of innovation, however. As
gender diversity increased, the number of new ideas decreased, and
conversely, when racial diversity increased, the number of new ideas
increased. Another study found that increasing the dimensions of
diversity in work group membership mitigates the negative effects of
tensions between majority and minority group members based on a
single trait such as gender or race (Valenti & Rockett, 2008).

Social Justice Issues in Social Work Groups

As social group workers think about group composition, they do so in

the contexts of an increasingly diverse society and a profession
committed to the promotion of social justice. At the most basic level,
that means social group workers will recognize the equal rights of all
people in their communities to access social work groups. Promotion
of social justice may, at times, mean the development of groups that
are homogeneous on an important identity dimension, where people
can speak about common experiences, receive social support, and
develop solidarity. Such groups can lead to empowerment, and social
group workers can support self-advocacy while also advocating for
the group when appropriate.

At other times, promotion of social justice will mean being intentional

about having a group that is heterogeneous on important social
identity issues, while being homogeneous on group purpose. In
developing such heterogeneous groups, the group worker should
avoid having a token member of a marginalized community group
(the Noah’s ark principle). When working with heterogeneous groups,
the group worker must work to ensure that all members have a voice
and are treated with dignity and respect, paying particular attention to
power dynamics that members bring into the group from the world
beyond the group. It is important for social workers to consider the
potential for social work groups to create a safe place to discuss
topics of diversity, oppression, and privilege that are avoided in most
places of human interaction. For example, Richards-Schuster and
Aldana (2013) describe one program that fosters youth dialogues on
race and ethnicity. This type of program is a great opportunity for
social workers to promote social justice. Additionally, group workers
should continuously strive to improve their cultural responsiveness by
“systematically examining culture, identity, acculturation, privilege,
and oppression within a process approach to resolve a lack of
understanding and create cultural empathy” (Ibrahim, 2010, p. 272).

Ortega and Garvin (2019) developed a conceptual framework of

social justice and small groups, which includes several overarching
components: the purpose for the group (e.g., goals and objectives,
desired outcomes and the potential for unintended negative
outcomes that foster injustice); organizational and community
contexts (e.g., organization’s locale, policies, management style,
culture; community norms and values, culture); and sociohistorical,
historical and political contexts (e.g., political structures, economic
influences, social policies, symbols and rituals).

Ortega and Garvin’s (2019) conceptual framework also focuses on

the composition, roles, and subgroups of the group and how they
may privilege certain subgroups and create hierarchical processes
within the group. The group’s culture, including its values, norms, and
symbols, can be expressions of what is meaningful to group
members; however, dominant values, norms, and symbols can then
create dominant meanings, which could possibly marginalize
nondominant meanings. Group processes, or the ways in which
group members interact, can be influenced by dominant methods of
interpersonal interactions, and can also be an area where differences
are inhibited. Social workers’ and clients’ attitudes and behaviors can
also impact social justice within groups, including when micro-
inequities are present in group and privileged positions are
unquestioned. Positive intra- and interpersonal dynamics, on the
other hand, can create synergy and connections between members.
Finally, in their model, Ortega and Garvin stress that groups can
proactively infuse social justice into their functioning by engaging in
such practices as exploring organizational and community contexts
and their influence on the purpose and processes of the group,
decentering dominant meanings and interactional practices and
bringing marginalized meanings and practices to the center,
questioning privileged positionalities in the group, attending to
boundaries, and approaching the group with humility and critical
consciousness.

A helpful book with a section on social justice in the practice of social

work with groups is Sullivan et al. (2003). Group examples included in
this section include hip-hop music therapy groups for teens,
Indigenous/First Nations talking circles, groups at a food bank for
parents of young children, and groups for children who have
experienced sexual abuse.

Critical Thinking Questions 11.2

We live in an increasingly diverse world. What experiences have you

had with small groups that were heterogeneous in race/ethnicity
and/or in gender? What did you see as the benefits and challenges of
heterogeneity? In what ways could you explore with group members
how privileged values, norms, and behaviors are being centered in
group while nondominant ones are being marginalized?

Basic Group Processes

To be effective, group workers need tools for understanding the group

processes in which they participate. Group processes are those
unique interactions between group members that result from being in
a group together. How people behave in groups is of interest to us
because we spend much of our time in groups, and groups have a
strong influence on our behaviors.

Theories of Group Processes

The fields of social psychology and sociology have been in the

forefront of empirical research on group processes. Five of the major
theories of group processes are discussed in this section:
psychodynamic theory, symbolic interaction theory, status
characteristics and expectation states theories, exchange theory, and
self-categorization theory. Each one helps us understand, among
other things, why and how certain members of a group develop and
maintain more power than other members to influence the group’s
activities.

Psychodynamic Theory

You were introduced to the psychodynamic theoretical perspective in

Chapter 2. When applied to small groups, psychodynamic theory
“focuses on the relationship between the emotional unconscious
processes and the rational processes of interpersonal interaction”
(McLeod & Kettner-Polley, 2005, p. 63). It is assumed that
understanding the emotional processes in a group is essential for
accomplishing the group’s task. The psychodynamic theoretical
perspective is especially important to therapy groups where
understanding emotional processes is the central task of the group,
but some group leaders argue that it is an important perspective for
increasing the effectiveness of any type of group. Small groups can
be challenging because they satisfy our need to belong, and yet they
also arouse our fears about social acceptance and social
competence (Geller, 2005).

McLeod and Kettner-Polley (2005) identify three broad assumptions

of psychodynamic theory for understanding small groups:

1. Emotional, unconscious processes are always present in every

group.
 2. Emotional, unconscious processes affect the quality of
interpersonal communication and task accomplishment.
3. Group effectiveness depends on bringing emotional,
unconscious processes to group members’ conscious
awareness.

Group leaders in a psychodynamic therapy group would look for

opportunities to assist group members to identify how their
interactions within the group may mirror their patterns of interactions
with others outside of the group; in other words, the group experience
becomes a microcosm of members’ lives outside the group. For
example, a female-identifying group member who tends to defer to
the opinions of male-identifying group members and who is afraid to
confront them may be demonstrating a general theme in her life of
being intimidated by male-identifying individuals because of childhood
experiences of severe physical abuse by her father. Black (2019)
suggests that group therapy is a good milieu for addressing issues of
insecure attachment and disrupted emotional self-regulation. Abdel-
Malek (2021) recommends a group psychodynamic approach to
mediation interventions.

Symbolic Interaction Theory

In Chapter 4, you read about symbolic interaction theory and how it is

used to understand the self. This theory is also used to understand
what happens in small groups. According to symbolic interaction
theory, humans are symbol-using creatures. We make meaning of the
world by interacting with others through symbols—words, gestures,
and objects. Some small-group theorists find it helpful to think about
the small group as a place where symbols are created, exchanged,
and interpreted and to think about individual and social change
happening as meanings are made and changed through the use of
symbols (Frey & Sunwolf, 2005). In fact, they think that a group is
itself a symbol used to describe a relationship people understand
themselves to have with each other. Group members create a sense
of being a group through their symbolic actions with each other,
through their language and their behaviors over time. Groups may
use such symbols as metaphors, stories, and rituals to communicate
and build cohesion. Barker and colleagues (2020) suggest that
emotions are symbolic resources in learning groups. In their symbolic
interaction, group members build a culture with its own symbols and
meanings. The symbols provide group identity and stimulate
commitment to struggle with the tensions of group life.

The symbols used in a group, and the meaning made of those

symbols, are influenced by the environments in which the group is
embedded (Frey & Sunwolf, 2005). Group members are also
members of other groups and bring symbolic meanings with them
from these groups. This may lead to tension and conflict in the group
as members struggle to develop shared meaning about who they are
as a group, what their goals are, and how they will operate as a
group.

An example of symbolic interaction within a group is a ritual

developed by the chapter author and a cofacilitator for a support
group for incarcerated survivors of intimate partner violence. At the
beginning and end of each session, the group would light five candles
and recite five affirmations related to the group’s theme, loving and
healing ourselves: “I am worthy of a good life,” “I am worthy of
positive friendship,” “I am a loveable person,” “I desire inner healing,”
and “I will recognize the good things about myself and others.” The
lighting of the candles symbolized bringing to awareness the inner
strength and healing power of each woman in the group.

Status Characteristics and Expectation States Theories

In the tradition of the critical perspective discussed in Chapter 2,

status characteristics and expectation states theories are used to
understand the creation and perpetuation of social inequalities—
social injustice—in social settings such as small groups (Kalkhoff et
al. 2020; Melamed et al., 2019). Status characteristics and
expectation states theories propose that the influence and
participation of group members during initial interactions are related
to their status and to expectations others hold about their ability to
help the group accomplish tasks (Bianchi & Shelly, 2020). Status
characteristics are any characteristics evaluated in the broader
society to be associated with competence; they may be either specific
or diffuse. Let’s look first at an example of a specific status
characteristic. Joan and Bob are both members of a task force
formed in a housing project community to increase healthy social
interactions among the children and beautify the grounds. Joan, who
is known to be artistic, makes a suggestion that the group involve
children in painting murals on communal buildings and then hold a
contest for the best mural. Bob, who is not known to be artistic,
suggests that the group solicit volunteer contributions from local
artists who would donate paintings and other artwork to display on
the inside of buildings. It can be expected that group members will be
more willing to go along with Joan’s idea than with Bob’s because of
Joan’s greater perceived expertise in artistic matters. Their
performance expectations —predictions of how well an act will
accomplish a group’s task—are influenced by this specific status
characteristic.

In the sexuality and gender group, Beverly carries some influence.

She has attended group sessions for almost 3 months and is one of
the core members who come to the group consistently. As an
influential member, she is expected to articulate and enforce the
group’s rules and to assist new members in acclimating to the group.
Group members expect Beverly to share her insights about the
coming-out process and recovery from addiction, and they perceive
her as a knowledgeable person, especially when discussing issues
faced by African American lesbians.

Now let’s look at an example of a diffuse status characteristic. In the

sexuality and gender group, Beverly is perceived as a knowledgeable
person regarding coming out and the unique issues faced by African
American lesbians. But in another setting, the color of Beverly’s skin
might negatively influence how she is perceived by other people. In
the United States, race is a powerful dimension of social stratification,
and many people hold implicit status beliefs about racial groups that
they assume are shared by others (Evans et al., 2020; Melamed et
al., 2019). Stereotypes about African Americans may cause other
people to question Beverly’s interests, skills, or values. Such
stereotypes are the basis of diffuse status characteristics whereby the
power and prestige of group members are correlated with their status
in the external world, regardless of their specific characteristics
relative to the task at hand.

For example, if people expect that someone using a wheelchair is

incapable of playing basketball for a charity fundraiser, then they will
act as if a person using a wheelchair is unable to play basketball.
They may disqualify that person from playing, thereby demoralizing
the individual with the disability and preventing the person from
contributing to the success of the fundraiser.

Gender is an influential diffuse status characteristic in our society. In

mixed-gender groups, male-identifying persons have greater
participation and influence than female-identifying persons, and
people with traditionally masculine personality traits are likely to
exhibit more dominant behavior (Karpowitz et al., 2012; Toosi et al.,
2012). Individuals who identify as nonbinary may find it challenging to
identify a group in which their nonbinary identity will be acknowledged
and affirmed (Out & Equal Workplace Advocates, 2018). In same-
gender groups, gender is not an initial status differential; instead,
members develop expectations of each other based on other status
characteristics, such as education, race, or experience. Regardless of
gender, a person’s perceived ability also affects performance
expectations. For example, a female-identifying person may be
perceived as incapable of handling a complex mechanical problem in
a work group, but she may be able to develop influence if she shows
she can accomplish the task successfully (Schneider & Cook, 1995).

One assumption of status characteristics and expectation states

theories is that people rely on their stereotypes in the absence of
proof that those characteristics are irrelevant. In the psychological
literature, this phenomenon is often referred to as “self-fulfilling
stereotypes” (Snyder, 2014). In our example of assumptions people
may make about persons using wheelchairs, the burden of proof
would be on the persons using wheelchairs to demonstrate that they
could indeed play basketball, thus establishing the inapplicability of
others’ assumptions about the disability.
Exchange Theory

Sometimes in coming-out groups, those who have been out for the
longest time have implicit power over those newly out, the “baby
dykes.” A “let me show you the ropes and tell you what this is about”
attitude can be used to gain power and influence over another person
and to create dependency: “You need me to help you understand
what you are getting yourself into.” But social power can also be used
in a positive way in a coming-out group, as when those who have
been in the lesbian community for a long time offer support and
information to others with the intention of providing mutual aid. To
understand power as a social commodity, we can look to exchange
theory (D. Brown et al., 2014; Lovaglia et al., 2005), which assumes
that human interactions can be understood in terms of rewards and
costs.

According to exchange theory, social power is what determines who

gets valued resources in groups and whether those resources are
perceived as being distributed in a just manner. Conflicts within the
group often revolve around power issues among members—those
who want the power in the group, those who have power and don’t
want to give it up, and those who don’t want others to have power
over them. Some researchers have used exchange theory to
understand the relationships between group leaders and group
members (H. Li et al., 2020).

Groups are particularly vulnerable to conflicts over power because

social power arises within the context of the group itself rather than
being an innate quality of an individual. Power not only determines
the distribution of group resources but also influences people’s
expectations of others’ abilities, even when the power results from
structural conditions and not from innate personal ability (Lovaglia,
1995). Emotion also has an impact on perceived power and
influence, regardless of status. If a person has negative emotions
toward a high-status person, the power of the high-status person will
lessen (Lovaglia, 1995).
Power differences among group members can create status
differences but don’t necessarily have to. Group members may rate
more highly the abilities and influences of high-power members,
which may in turn influence expectations for high-power members,
but negative feelings toward high-power members may mitigate their
influence.

The exercise of social power often brings with it a concern about

justice, fairness, and equality. Most of us would agree that power
should not be exercised to the special benefit or detriment of some
group members. However, justice is a relative rather than absolute
term. Any two persons may have quite different ideas about what
constitutes justice. For some, justice would be an equal distribution of
resources; for others, justice would be an equitable (but not
necessarily equal) distribution.

How persons evaluate the equity of a situation depends on such

factors as cultural values, self-interest, the situation, the relationships
between those affected, and personal characteristics (Hegtvedt,
1994). People tend to operate more from self-interest in impersonal
conditions than when they have personal bonds with others. The
status of the person for whom justice claims are being considered
also affects the definition of justice, the perception of injustice, and
the resolution of injustices. In addition, what may be perceived as fair
on an individual level may be perceived as unfair when viewed from a
group perspective. For example, suppose a group member is in crisis
and asks for extended time in the group. The other five group
members agree to give the person an extra 10 minutes because of
the crisis. This extension, however, requires each group member to
give up 2 minutes of their floor time. Giving one individual an extra 10
minutes may not seem like much, but that one action has a cost for
five other group members. And what if one group member decides
that they have a pressing issue to discuss and does not want to give
up the 2 minutes? How the group would resolve this dilemma relates
to its spoken and unspoken guidelines for handling matters of justice
within the group.

Self-Categorization Theory
Self-categorization theory builds on social identity theory, which, as
discussed in Chapter 5, is a stage theory of socialization that
articulates the process by which we come to identify with some social
groups and develop a sense of difference from other social groups.
Self-categorization theory expands social identity theory by
suggesting that in this process, we come to divide the world into in-
groups (those to which we belong) and out-groups (those to which we
do not belong) (Sewell et al., 2022). We begin to stereotype the
attributes of in-groups and out-groups by comparing them with each
other, with bias toward in-groups. When we encounter new group
situations, we are more likely to be influenced by in-group members
than by out-group members (Haslam & Reicher, 2015). We give more
credence to those similar to us than to those different from us,
particularly when situations are conflicted or unclear. Doing so is
consistent with our categorization schemes, but it also helps us
maintain distinctive and positive social identities (Abrams et al., 2005;
Hogg, 2005). So, in this approach, we are influenced in group
situations by members of our in-groups, whether or not they hold high
status in society.

An example of this is Katie, a member of the sexuality and gender

group, who was raised in an evangelical Protestant church. Katie
struggled with her sexuality and what she was taught in church about
homosexuality. Katie received approval from her counselor to go into
the community on a day pass so that she could accompany her
sponsor to a Metropolitan Community Church service. She
immediately “felt at home” there. She felt she had found a place
where both her sexual orientation and faith could be affirmed—a
place where she could belong.

Researchers have studied the impact of both status characteristics

and self-categorization on social influence in group settings,
recording who agrees with whom and who defers to whom. They
have found that group members are influenced by both status
characteristics and social identity. More specifically, they found that
group members are more highly influenced by high-status members
who also belong to the in-group than by either a low-status in-group
member or a high-status out-group member (Kalkhoff & Barnum,
2000).

Critical Thinking Questions 11.3

The psychodynamic perspective on groups proposes that emotional

processes in the small group affect the effectiveness of the group.
Some proponents of this perspective argue that dealing with the
emotional processes in the group is important in any type of group,
not just therapy groups. What do you think about this argument? How
important are emotional processes to mutual aid groups,
psychoeducational groups, self-help groups, and task groups? Can
you think of an example where unconscious emotional processes
interfered with task accomplishment in a task group of which you
were a member?

Group Development

To understand the unique nature of groups and why they are effective
in helping people, we need to examine the ways groups develop over
time. Two common ways of viewing group development are by the
stages the group passes through and by the processes that facilitate
the work of a group. This section provides a brief overview of stage
theories and models and then discusses an example of the analysis
of processes that facilitate the work of groups.

Stage Theories and Models

A variety of scholars have attempted to delineate the life cycle of

small groups. Both progressive stage models and cyclical models
have been proposed (Coyne, 2014). Progressive stage models
propose stages that are sequential, with each stage building
successively on accomplishments in prior stages. Cyclical models
suggest that groups may move back and forth in group processes in
a cyclical rather than linear manner (Donigian & Malnati, 2005). Most
small-group scholars recognize that groups do not always progress in
a linear fashion but find progressive models to be helpful when
thinking about group development. Researchers who focus on the
stages of group development have reached no consensus as to how
many stages there are, the order in which they appear, or the nature
of those stages. Table 11.3 displays four progressive models
commonly cited in the group work literature. Note, however, that
controlled experiments investigating group stages are rare. Most
theories of group stages have been developed by observing patterns
and changes in groups, usually after the group has disbanded.
Because most of the stage theories have been based on studies of
time-limited, closed groups, they may not be applicable to open-
ended or ongoing groups.

Table 11.3

Most progressive stage theorists agree, however, on some basic

principles: Groups don’t necessarily move through each stage in
order, groups may revert to an earlier stage, stages are not distinct
entities but may be a blend or combination, the group’s development
is influenced by the leader and the members, and groups do not need
to reach the most advanced developmental stage in order to be
effective (Coyne, 2014).

Small group. This exercise class is an example of a small group that

comes together to accomplish a goal: fitness.

© iStockphoto.com/Tomaz Levstek

Process Models

If stage theories are inadequate for explaining how groups develop,

what are we to use instead? The chief alternative is process models,
which identify what goes on in groups and how those processes
affect group members and their interactions. The advantage of
process analysis is that it focuses on the interactions among group
members rather than creating norms for development.

A good example of a process model is that developed by Irvin Yalom,

one of the best-known group psychotherapists. Yalom and Leszcz
(2005) describe 11 factors that shape the functioning of therapeutic
groups. These factors are listed and defined in Table 11.4 .

Table 11.4

Some of Yalom’s therapeutic factors may operate to a degree in

groups other than therapy groups. For example, universality and
imparting of information are two of the mutual aid processes
described earlier in this chapter. In addition, certain factors may be
more significant at particular stages of group development than at
others. One study of 12 time-limited outpatient psychotherapy groups
found that the development of cohesion varied according to the stage
(or phase) of psychotherapy (Budman et al., 1993). For example, in
the earliest stage of the group, members sharing issues about their
lives outside the group built cohesion; however, too much focus on
the therapist during this stage tended to be counter-cohesive. In the
sexuality and gender group, several therapeutic factors are evident at
different times. When group members feel they can trust each other,
catharsis and interpersonal learning are likely. When new members
attend the group, they often desire to experience an instillation of
hope, universality, imparting of information, and development of
socializing techniques.

Pels and Kleinert (2022) present a process model of task groups that
they call a group flow theory. They suggest that when a group is in
flow, all group members seem to know what needs to be done and
their behavior is coordinated and harmonized toward the goal. Pels
and Kleinert (2022) describe 10 processes involved in group flow:
clear group goal, close listening, complete concentration on the task,
being in control of group actions and group environment,
subordinating individual egos to the group, equal participation, shared
knowledge, constant and clear communication, keeping the
conversation moving forward, and recognizing the possibility of
failure.

Group Dynamics

The overall development of the group is overlaid with patterns of

interactions that can be characterized as group dynamics —such
issues as how leaders are appointed or emerge, which roles
members take in groups, how communication networks affect
interactions in groups, and how groups develop cohesiveness.

Formal and Informal Leadership

Formal leaders are appointed or elected to lead the group by virtue of
such characteristics as their position in the organization or community
and their interest or expertise in relation to the group’s focus. Informal
leaders may emerge in groups where no formal leader exists or
where formal leaders are established. In the latter case, a group
member may feel more comfortable in a helper or leader role than as
a client in the group, thereby mimicking the actions of the formal
leader. Using video-recordings of naturally occurring workplace
interactions, Van de Mieroop et al. (2020) found that “doing
leadership” is not something done only by formal leaders. They found
that informal leadership is negotiated in subtle ways, through talk but
also through such nonverbal behavior as gaze and use of space.

Both formal and informal group leaders have a two-pronged focus:

the individuals in the group and the group as a whole. Task-oriented
leaders facilitate problem solving within the context of the group;
process-oriented leaders , also known as social-emotional leaders or
relationship-oriented leaders, identify and manage group
relationships (Myers & Anderson, 2008). Any given leader usually
fluctuates from one role to the other, although people tend to be
either more task oriented or more process oriented. Leadership of
virtual groups and teams can be an especially complicated endeavor
because of such factors as the geographic dispersion of members
and the potential for unevenness in members’ ease and comfort with
technology (Hunsaker & Hunsaker, 2008). In one study, Breevaart &
de Vries (2021) found that participants preferred relationship-oriented
leaders, but leadership style preference is related to personality traits
of the members.

In natural groups, leaders may be formal or informal. A friendly

softball game at the diamond on a Saturday morning may evolve into
a complex hierarchy of leaders and followers as various activities are
negotiated—who is on what team, who bats first, how long the game
will last, who will decide batting order, and so on—and such process
issues as team morale and cohesiveness are promoted.

Leaders of formed groups also take on various roles, depending on

the purpose and structure of the group. A facilitator of a group for
children with ADHD is a formal leader who may provide structured
activities, support, and guidance for the children. Similarly, the leader
of a one-time debriefing group may provide support and information
to rescue workers after a fire. Informal leaders of formed groups
might include a person who evolves into a leadership role in a work
group assigned to some project.

Groups often have co-leaders, or one appointed leader and one or

more group members who serve as self- or group-appointed co-
leaders. At times, co-leaders may offer the group a nice balance of
facilitation styles, with one person having a more process-oriented
style and the other person having a task orientation. Good
communication and processing skills between co-leaders is essential
to effective group leadership.

Gender, class, and race influence leadership (both who takes

leadership and the perception of leaders by group members). Status
differences based on gender influence the behaviors of both male-
identifying and female-identifying group members, including their
reactions to male-identifying and female-identifying group leaders
(Karpowitz et al., 2012; Toosi et al., 2012). Both male-identifying and
female-identifying individuals tend to respect male-identifying
leadership more quickly and easily. Male-identifying persons in a
female-led group tend to challenge the leader(s) and expect female-
identifying leaders to be more nurturing than male-identifying leaders.
Complex member-to-member and member-to-leader interactions
around gender identity and status may also take place in groups that
are inclusive of, and/or led by people who are transgender (dickey &
Loewy, 2010).

Persons of color may distrust white leaders “from the system” (Davis,
1995, p. 49), because such leaders ma