Magazine article Clinical Psychiatry News

'Weak' Ties Matter to Our Patients

Magazine article Clinical Psychiatry News

'Weak' Ties Matter to Our Patients

Article excerpt

Hurricane Katrina, the war in Iraq, and the Southeast Asian tsunami are disasters that are likely to have immense consequences--for all of us--if we do not have a plan for the recovery efforts. We cannot plan properly if we fail to understand environmental displacement in its ecological and sociological terms.

People who lose their homes, familiar buildings, and streets suffer, irreconcilably, because we are all linked to our near environment in profound ways. But it is the rupture of social bonds that has the broadest impact.

I have coined the term "root shock" for the consequences of environmental displacement, because it is as devastating for a human being as being pulled from the ground is for a plant.

When communities get disrupted, two types of social ties get broken: strong ties and weak ties. Strong ties are the bonds to our families as well as to our religious or ethnic groups. Weak ties are the bonds we have with our more casual friends, neighbors, and acquaintances, such as the corner newsdealer.

Surprisingly, it is the weak bonds that tend to become irreparably broken and may have the greatest consequences. Individuals who have been displaced seek out their family, their close friends, and their church, and work to reestablish these strong bonds. But in a disaster, people may never find out what happened to the guy who sold them the newspaper every day or the coworker down the hall, making it impossible to reestablish those linkages.

Paradoxically, it is the weak ties that get people jobs, link them to the political system, and cross racial and ethnic barriers.

When strong ties emerge, without the weak ties to keep people together across groups, often hostility will surface. Indeed, hostility becomes an important behavior that helps to manage the frayed social situation.

In refugee camps, for example, people may fight over food, and this is not just because of hunger. Such behaviors communicate the new social order, but do so at great cost to individual and group health.

Groundbreaking work on how social organization changes when social bonds are broken was conducted by social psychiatrists examining community disruption during and after World War II. A central thesis to come out of that work was that highly integrated social order produced good health for people of all social classes, while disintegration undermined the health of all. In fact, poor people in an integrated community were found to have better health than rich people living in social disintegration.

A recent article in the Journal of the American Medical Association seems to bear on this point. The article compared health status in England with that in the United States, where we spend twice as much per capita on medical care (JAMA 2006;295:2037-45). It found that health is better in England, so much so that the working class in Britain is better off than the wealthy here. The authors of the paper suggest that "social determinants," such as the circumstances in which people live and work, are the explanation, and I would suggest that it has to do with the relative levels of social integration in the two nations.

My own work has examined these issues by looking at the urban renewal projects of the federal government, begun in 1949. These projects were billed as an effort to redeem blighted and dysfunctional neighborhoods, but in reality what they became was an effort to remove African American ghetto neighborhoods from their proximity to downtown locations. Two-thirds of the 2,532 urban renewal projects conducted under the program were done in predominantly African American neighborhoods. …

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