On 20 August 2021, the Philippines recorded 16,797 new cases of corona virus disease-2019 (COVID-19). I was part of that statistic. It started with what I thought were allergies. I was sneezing. I had stuffy nose and a bit of cough, too. I was not too worried, then—these are my usual allergic reactions, after all. Then two nights later, I experienced chills. I tried smelling my perfume—I could still sense a hint of it, but my senses were fading. The following morning, I could no longer smell anything, which consequently destroyed my sense of taste. My cough intensified. It felt like having an asthma attack, but scarier. I had myself swab-tested, then here we are. As of this writing, I am on my ninth day of isolation.
Experiencing COVID-19 is harrowing, and it is not surprising why a considerable number of patients meet the diagnostic criteria for posttraumatic stress disorder (e.g., Bridgland et al., 2021; Janiri et al., 2021). This post, however, is not about my distress as a COVID-19 patient, but about the social support that brought my relief. As a social support researcher, it always fascinates me when I experience the subject of my academic pursuit first-hand. It puts me in a unique position of appreciating its phenomenology and at the same time, unpacking its mechanics.
Social support is an umbrella construct that refers to a set of social behaviours and interactions that provide actual assistance and embed people in a web of social relationships that are perceived to be loving, caring, and readily available (Hobfoll & Stokes, 1988). It has three distinct facets: the receipt of actual support given in the past (received social support), the perception of availability of support in the future (perceived social support), and the integration in a supportive community (social embeddedness) (Kaniasty & Norris, 2009). Of the three facets, many studies would consider perceived social support as the most important predictor of psychological relief during very stressful situations (e.g., Haber et al., 2007), as shown by its consistent negative correlations with distress. However, I argue—and this is based on both research and experience—that received social support and social embeddedness are equally, if not more, important than perceived social support because it is received social support that is being mobilised to provide REAL help and it is social embeddedness that facilitates this mobilisation. Any perception of available support in the future is but a consequence of having received support in the past and having a sense of community that may be able to provide aid in times of need.
Social Embeddedness and Support Mobilisation after my Diagnosis
I now firmly believe that I am very fortunate to be living inside the university during this pandemic, and especially when I tested positive for the disease. When our infirmary got my results, they quickly arranged for my isolation facility inside the campus, which is more convenient than staying in the local government unit’s isolation facility. They facilitated the purchase of my medicines, gave me my COVID-19 kit, provided me with clear instructions, and dealt with my case calmly. This calm and responsive provision of formal support significantly reduced my worries.
While my university was providing me with formal intervention and assistance, the community where I belong learned of my ordeal and mobilised informal assistance as well, which I deeply appreciate. For instance, upon learning my diagnosis, my flatmates helped me plan how to go about the transfer to the facility and provided me with some of my basic needs. One of our neighbours arranged for some amenities to be placed in the isolation facility (i.e., chairs, bed) to make my quarantine experience more bearable. Every other day, I would receive care packages from neighbours and colleagues, from fruits to pandesal.
In the context of quarantine, I also felt the social embeddedness through the people who checked on me daily. I would receive messages from family and friends, as far as New Zealand and the US, asking me how I am. Many of these conversations were small talk, but what makes these interactions supportive is the sense of belonging that it brings, along with the perception that I may be able to count on them when needed. This illustrates how social embeddedness influences perceived social support.
When an individual is in distress, we usually observe a spontaneous mobilisation of social support. This observation is common in the aftermath of disasters (e.g., Kaniasty, 2012, 2020). This mobilisation of support is made easy by the fact that I belong to a community—that I am socially embedded. I think the term “web of social relationships” appropriately describes this supportive facet. As in a web, when one segment vibrates, it reverberates to the rest of the web. In the same manner, when there is a signal of distress from a member of a community, it alerts the rest of the community to provide support. In this sense, social embeddedness facilitates and magnifies the provision of support.
Effectiveness of Received Social Support
Provided social support, or received social support, for me, is the sine qua non of social support. For the purposes of this post, I will refer to this facet as received social support, as this term is in reference to the recipient and not to the provider (as in provided support). As I mentioned earlier, between received and perceived social support, perceived social support is the more consistent predictor of psychological relief. On the contrary, studies on received social support often show inconsistent associations with psychological outcomes, which indicates that not every support received is effective.
But what makes social support effective? In the context of my diagnosis and isolation, I can cite some examples. For instance, when I informed my colleagues about testing positive for COVID-19, many of them offered to help even without me asking for it. The help they offered were specific as well—many volunteered to do grocery shopping for me, as they know I will not be able to do that myself. When my friend did grocery shopping for me, she chose canned goods that have easy-open lids, cognizant of the high probability that I may not have access to a can opener in the isolation facility (which is correct). When friends sent me fruits, they sent me fruits that were easy to eat. the dragon fruits came with a small knife (for peeling) and the pomelo came with salt. When I asked another friend to buy me some dishwashing paste, she also included a sponge. A friend from Manila offered to send me some lianhua, but first asked if I was comfortable taking it.
These are just some of the many gestures of support—big and small—that I would consider effective. Some researchers have teased apart these elements of received social support that contribute to its effectiveness. One of the major characteristics of effective social support is its optimal match with the need (Cutrona, 1990; Cutrona & Russell, 1990), and the support that I have received as a COVID-19 patient definitely matched my needs, allowing me to cope with the demands of the stressors effectively. For received social support to be effective, it should also be easily accessible and be provided skilfully (Rini et al., 2006; Rini & Dunkel Schetter, 2010). Skilful provision of support was evident in the details of how my friends supported me (e.g., easy-open cans, provision of knife), making sure that the support that they provide will not lead to more problems. Just imagine, if I were given canned goods that require a can opener, that would certainly make me feel more distressed and frustrated! Of course, when friends offered to help me with my needs without me asking for it, it showed that the support they offer is easily accessible.
When I received support from my friends and colleagues, it is important to note that I did not feel terrible about it. On the contrary, it made me feel good about myself, and made me think that perhaps, I am not such a terrible person to deserve such support! In fact, effective social support should also not lead to negative emotional consequences (Rini & Dunkel Schetter, 2010) and on the contrary, should make the recipient feel good about receiving support (Ishii et al., 2017). This is particularly important to note in the context of a collectivistic culture, where social harmony is given a lot of importance and social support seeking or provision may be seen as inconveniencing others. The magic of this element, in my case, was that I knew that people were going out of their way to help me, but they delivered the support so sensitively and so skilfully in a way that I did not feel like I inconvenienced them for helping me. Because of this, I felt that it was all right to ask for support.
The Importance of Social Support Seeking
I think it is crucial that individuals feel that it is all right to ask for support. While we may be in web of social relationships, it is the call for support that activates the mobilisation of support.
Testing positive for COVID-19 was most especially difficult for me, not only because I tested positive myself, but a few days later, my brother (who resides in Metro Manila) also tested positive, with more life-threatening symptoms. He had high fever, constant cough, and difficulty breathing. The problem was worsened by the fact that hospitals in the National Capital Region were running on full capacity, so we did not have much of a choice but wait and to provide him oxygen and other medications while waiting for hospital admission.
What saved his life was the fact that the (extended) family worked together, and that we had help from a lot of people. Many of our friends helped us look for hospitals or gave us information on where and how to look. The Office of the Vice President provided us with assistance, like medicines and oxygen, while waiting for any hospital vacancies. We finally were able to send my brother to a hospital through a good friend. However, these supports did not happen if we did not ask for help. Seeking for help triggers the mobilisation of support.
Hence, it is very important that one asks for help. My friend reminded me, “promise me not to hesitate to ask for help.” I think knowing that we have friends whom we can count on, and that we have a working support system, made it easier to ask for help, and to continue to ask for help.
Social support has helped me through COVID-19 and through my isolation due to the disease. The support that I get is not perfect, of course. As a spontaneous and naturally occurring intervention provided by non-specialists, supportive behaviours are not distilled and most certainly not isolated. They occur in a much wider, more complex context which may or may not contribute to its effectiveness. In addition, whiles social support buffers the effects of stressful situations, they should complement but not replace formal types of intervention (Guilaran et al., 2018).
On this ninth day of quarantine, I am still not fully well. I still have stuffy nose. I get tired easily. However, I have almost fully regained by sense of smell and taste. And with the support that I got and continue to get, I have a strengthened sense of belongingness to a very supportive community.
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