Analysis – social functioning

Man is a social animal – and Covid-19 has driven that truism home! When introducing yourself at a party, a wedding dinner, or any other social event where you meet people who do not know you, you will always present your self in two ways. You are likely to start by explaining your relationship to the host or some other relevant person. You are then likely to give some information about yourself in terms of relevant roles, usually one or more of your work or vocation, your interests, or your relationship to another person with you.

You are very unlikely, at any point, to describe yourself in terms of your performance of activities such as dressing or washing, doing domestic chores, or doing more complex activities such as constructing and Ikea flat-pack successfully! Yet, in rehabilitation, we will often describe patients in terms of their (in)dependence in activities. That is better that in many healthcare settings where people are (still) often described first by their diagnosis: “This is Simon Brooks, a 57 year old man admitted two days ago with a stroke affecting his right side.“. Occasionally the word, man, might be replaced by his job, engineer.

Depressingly, when I visited medical wards regularly (up to 2016) to see patients for rehabilitation, it was not uncommon, on asking about family, visitors and housing situation, to discover that no-one knew anything. And these patients had often been in hospital two or more weeks. I sincerely hope that there is more awareness of the importance of social functioning now.

The essential message is, give much greater attention to the social situation, roles, relationships, and functioning within social networks than you may have done so far.

The graphic illustrates how social functioning can be analysed, including a simple categorisation of the five main areas of social functioning to consider. As is being recognised, loneliness is perhaps both an important aspect of social functioning, and it is also a potential good single outcome measure; measures exist, including a three item one.

As in all other analyses, the graphic shows how each domain of the biopsychosocial model of illness may have an impact of social function, and that the relationship can be positive or negative – see influence of pathology, where having a diagnosis may lead to active social function in disease-specific organisations.

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