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On friendships, loneliness, and the life of an international PhD student

I wish I knew how lonely life can be as an international PhD student. It is not because I would have wanted to avoid studying overseas; given a chance to do it all over again, I would still do it again. It would have, however, made me prepare better for what is to come.

I have been studying here in New Zealand for more than two years now. Along the way I have met a few good friends, most of them international students as well doing either a master’s or a doctorate. Last weekend, my closest mate for two years went back to Vietnam after (near) completion of his master’s degree. It left me with such profound loneliness.

I knew the PhD journey is a lonely one. I have known the fact, even at the onset, that the PhD usually involves solitary work. I was prepared for this part of the process. I knew that I can work independently. I was not, however, prepared for the other source of loneliness—being left behind when friends finish their degrees and go back to their home countries.

This is even harder because of the fact that I am an international student. As a social support researcher, I have learned that being embedded in a caring social network is a good predictor of positive psychological outcomes. Loss of social integration may have a negative impact on one’s well-being.

As international students, most of us have uprooted ourselves from our social networks back home. We are forced to establish new connections in the host countries, and more often than not, our newly established connections have less densities than those back home. I have to say not all of us are skillful enough to gravitate towards communities, or make people gravitate towards us to create new communities. The pressure of wanting, but not having, these supportive communities also makes matters worse.

Network density is one thing. Network quality is another. I am selective of people I call “friends.” I am glad that during my stay here in New Zealand, I have met and formed really good relationships with some people. Some of these friendships I am so proud of, and I will treasure them for the rest of my life. The downside, however, of having just a few friends is that when one leaves, a significant void is created. My friend left a huge one.

Studying overseas may appear fun (it is fun, really) but it is also filled with so much challenge. I am lucky to have come here under a generous scholarship program—I do not have to worry so much about financial matters (I still do, but not so much). However, a lot of international students worry about that, on top of adjusting to a new culture, new climate, new language, new system of doing things, and new people. Having a strong social support network would buffer the stress brought about by these adjustments. The problem is that more often than not, the support system that is needed is still in the works during those times when you needed them the most.

Again, this is where I am a bit lucky, I must say. I started the PhD journey with friends who are on the same boat—international students under the same scholarship program. During our two-week orientation in Palmerston North, we started a bond that has endured physical distance when postgrad life began (as we transferred to our respective campuses), and even beyond postgrad, as, one by one, they left to go back to their respective countries. Although we lived far apart, it was comforting to know that we were not alone in this journey.

Yet, in spite of this, I still felt the loneliness of living away from friends. I had to travel two hours to Palmerston North to enjoy the weekend with friends, or travel to Auckland via bus on a 12-hour trip to enjoy my time with mates in the north. I could just imagine how much harder it is for others who started their journey with zero social network.

I am still lucky, for I have found a very good friend while doing PhD overseas. In some contexts, PhD—or postgrad, generally—could be too competitive that real friendships are scarce. Thankfully, this is not the case in my uni. Yet for us international students, especially for those like us who are obligated to go back to our home countries, there is always the nagging fact that one day you will have to leave the Country—and leave your friends behind (or them leaving you first, as in my case). It stays in the background. It nags silently, but nags, nevertheless. So while I am glad to have formed good friendships here, I knew at the back of my mind that one day, they will leave, and I will leave as well. We know for a fact that nothing lasts forever, but the transience of things–of time spent together–is highlighted in our experience.

Perhaps it is the temporariness of us being together that has made me treasure more these relationships that we have formed. As my friend would put it, the consciousness of the “finitude” of time makes us [me] value these relationships really well. I know too well that my time here in New Zealand is limited. I could have decided to not form relationships at all, because it is pointless. However, I am glad I did. It made my stay in this country more meaningful. Furthermore, my friends have helped me endure the loneliness of working on my research alone. To be fair, PhD life is not always a lonely life. In fact, my PhD journey has been punctuated by a number of very happy moments, some of which I consider one of the happiest in my life, thus far.

Of course, the inevitable trade off of having these strong attachments is that when the people you are strongly attached to leave, they leave you in distress. I reckon they feel equally distressed to leave you as well. Had I known this to be a part of life as an international PhD student, I would have prepared myself better. But then again, I guess I could never really have prepared for anything like this. Perhaps I could have focused more on friendships even during my first year. But who knew?

It is a little funny though, but I am actually glad that I feel sad about my friend leaving—it confirms how meaningful our friendship is for me. He has a better, more appropriate term for this: companionship. The journey, after all, is only as good as the company.

Depressed elephant in the emergency services staff room

Responding to emergencies and disasters is a tough job that requires both physical and psychological readiness. At times, however, the highly stressful nature of emergency response work stretches one’s capacity to cope, which may result to psychological distress. Support from friends, family, and co-workers may help. Or can it?

Emergency responders need help.

People working in emergency services face very stressful situations on a regular basis, which can exact a psychological toll on emergency responders. The New Zealand Medical Association recognises that in spite of the rewarding nature of their work, daily stressful events can wear doctors down (New Zealand Medical Association, n.d.). Compounding exposure to traumatic events is also shown to increase the risk for posttraumatic stress disorder (PTSD) in rescue workers (Berger et al., 2012). These effects may be long-lasting. For instance,  a significant number of 9/11 police officers still experienced PTSD symptoms more than 10 years after the attacks (Cone et al., 2015).

For a long time, little attention has been given to the psychological effects of working in emergency response. Recently, however, news about doctor suicide (e.g., “Three of my colleagues have killed themselves. Medicine’s dark secret can’t go on,” 2017) and police and firefighter PTSD (e.g., Evans, 2017) have placed attention on the mental health concerns of people in  high risk occupations, along with the inadequacies of measures in preventing these tragic outcomes. The problem is further complicated by some organisational cultures that consider help-seeking as a sign of weakness (e.g., Henderson, LeDuc, Couwels, & Hasselt, 2015)—something which is not valued in emergency response circles. Constant and cumulative exposure to horrible events and the reluctance to seek help is a recipe for psychological disaster.

Yet in spite of these conditions, some emergency responders survive and even thrive. This brings to light the fact that behind the highly stressful nature of the profession, working in emergency services can be very rewarding and can bring out the best in people. We now know that individuals—including emergency responders—can be resilient in the face of adversity (Bonanno, 2004, 2005; Bonanno, Brewin, Kaniasty, & La Greca, 2010) and we are now starting to identify these resilient factors. Studies on New Zealand police officers point to social support as one of these factors that decrease psychological distress and increase resilient outcomes (de Terte, Stephens, & Huddleston, 2014; Stephens, 1997).

There are ways of helping the helpers.

As a psychologist in the Philippines, I have had my share of providing psychological support to both survivors and responders in the aftermath of emergencies and disasters. In the course of my work, I had a troubling but unsurprising observation: there are usually no mental health services available for responders. They are usually left take care of themselves and/or take care of each other, perhaps because they are expected to be fine, or maybe because of the lack of resources, or both. Some responders get informal support from co-workers, friends, and family, to get through these very stressful times.

This illustrates the value of social support in emergency response. The highly stressful nature of responding to emergencies puts the responders at risk of a wide range of negative psychological effects. In addition, emergency response organisations usually lack the resources to help responders cope with these occupational hazards. Yet even with these difficulties, we find responders who, not only have lower psychological distress, but also experience personal growth. For some responders that I have talked to, having supportive relationships is an important component of staying afloat in their profession.

In fact, social support is found to be one of the most reliable factors that buffer the negative effects following a traumatic event. For instance, firefighters with high social support are found to have fewer suicidal thoughts compared to those with low social support (Carpenter et al., 2015). Emergency responders during the 9/11 attacks with high social support  were found to have low levels of PTSD (Bromet et al., 2016). Social support is a major factor in psychological recovery after emergencies and disasters (Hobfoll et al., 2007).

Social support is but one of the many other ways of helping people working in emergency services. There are, however, several reasons why social support should be seriously considered as a form of intervention. First, social support occurs naturally. In the aftermath of emergencies and disasters, people rush to help others (Kaniasty & Norris, 2009). This includes helpers helping other helpers. Second, people who have better social support also have better psychological outcomes than those with poor social support. Third, social support is not necessarily contingent to traumatic exposure. Supportive relationships happen with or without horrible experiences, before and after catastrophic events. In other words, social support is both proactive and reactive—a protective factor and an intervention. Think of it as proper nutrition to prevent illness and to quickly recover from it.

There are ways of helping emergency responders. Social support has the potential of being one of the more effective and sustainable ways of doing so.

But it’s not as simple as it sounds.

Helping is simple. Effective helping is another story.

In my work as a psychological services provider and as a researcher, I have heard stories of how social relationships have helped emergency responders. I have also heard of how some relationships brought them down. In fact, one does not need to be in this kind of job to realise this. Think of a time when somebody helped you and you ended up feeling worse. Even with the best of intentions, supportive behaviours may not be effective, and may even cause harm, if not done properly.

Not all supportive behaviours and interactions end up supporting the people they intend to help. This is because social support has different facets (see Kaniasty & Norris, 2009), with each facet having a unique contribution to psychological outcomes. Receiving actual support is one of these facets. The receipt of actual support influences the perception of availability and quality of support, which is another facet. The third facet is being part of a community which may be able to provide support in times of need.

Social support also comes in different forms. It may come in the form of information, such as giving advice. It may be in the form of providing emotional warmth, such as giving words of encouragement. It may also be in the form of practical support, such as helping with certain tasks. It could range from providing a listening ear to lending money, or by just being there. These different forms of support have different effects. These effects depend on whether the support matches the need (Lakey & Cohen, 2000).

What, then, are the forms of support that match the needs of emergency responders?

The complexity of social support does not end there. The effectiveness of social support may also depend on who provides the support. For instance, family members can be very effective in providing support to emergency responders; however, some responders report being reluctant to share their experiences with family members, as they do not wish to expose them to the gruesome elements of their profession. People in the workplace are in a very good position to empathise and provide emotional and practical support, but some organisational cultures do not facilitate support-seeking behaviours. In fact, seeking for help, particularly in the mental health aspect, may even present itself as an occupational liability.

Who, then, can provide effective support for emergency responders?

The use of social support is also observed to vary across cultures. Some researchers observed European Americans to use social support more than Asians and Asian Americans as a way of coping (Taylor et al., 2004). European Americans were also observed to prefer emotional forms of support while Asians seem to go for informational types of support (Chen, Kim, Mojaverian, & Morling, 2012). There are not many studies comparing how social support works across different cultures, but there seems to be a pattern among collectivistic and individualistic culture orientations. For example, collectivistic societies, such as those in Asia, are characterised by a close-knit social structure that values relationship harmony. This is both good news and bad news. The good news is that the tight social structure allows for the provision of support even before one asks for it. This also happens to be part of the bad news. Some unsolicited forms of support may cause more distress. The other bad news is that because social harmony and order is held with high regard, people in collectivistic societies may be reluctant to ask for help as help-seeking may be viewed as inconveniencing other people. Receiving support may also be associated with outcomes other than relief. In the Philippines, for examples, receiving help from others may result to utang na loob (a deep form of indebtedness associated with one’s sense of being), which arguably may lead to strengthening of interpersonal relationships or psychological distress.

Will these cultural differences come into play in emergency response work?

We should study how to help properly.

One thing is clear: social support is effective but its effectiveness is not absolute. It depends on several conditions, such as the type of support provided, the person providing the support, and who receives the support. We need to find out what conditions work best for emergency responders. This is where my current research comes in.

We already know that perceptions of social support are beneficial for emergency responders. The problem with a lot of social support research is that they do not move past studying perceptions of support. From the perspective of someone who provides psychological services, these are missed opportunities for knowing how to best utilise social support in order to effect psychological change.

Knowing what forms of actual support are effective and what forms are ineffective in reducing psychological distress and increasing psychological adjustment and personal growth is crucial. By knowing the elements of support that work and those that do not, we will be able to design programs and other interventions that focus on these effective supportive elements. This is especially important in emergency and disaster response. Emergencies and disasters usually challenge resources, and with limited resource, knowing which elements of support work will aid in prioritising efforts where it matters most.

Social support may be effective and highly sustainable, but it is not an infinite resource. Social support deteriorates, especially after disasters. Knowing the effective elements of social support means being able optimise its effectiveness by increasing provision of supportive elements that works and decreasing those that don’t.

Finding out the best way to help emergency responders is complex, but the reason behind it is simple: we need help our emergency responders the best way possible so that they may be able to help us the best way possible.

My research is still on-going. If you are an emergency services worker, such as a police officer, military personnel, firefighter, ambulance driver, EMT, paramedic, physician, nurse, emergency or disaster worker, search and rescue worker, or an allied professional in New Zealand or in the Philippines, support this research by answering the questionnaire.

If you think you need help, do not hesitate to contact these hotlines:

Lifeline (New Zealand): 0800 543 354

Hope Line (Philippines): (02) 804-HOPE (4673)

 

References

Berger, W., Coutinho, E. S. F., Figueira, I., Marques-Portella, C., Luz, M. P., Neylan, T. C., … Mendlowicz, M. V. (2012). Rescuers at risk: A systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Social Psychiatry and Psychiatric Epidemiology, 47(6), 1001–1011. http://doi.org/10.1007/s00127-011-0408-2

Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we undersestimated the human capacity to thrive after extremely adverse events? American Psychologist, 59(1), 20–28. http://doi.org/10.1037/0003-066X.59.1.20

Bonanno, G. A. (2005). Resilience in the face of loss and potential trauma. Current Directions in Psychological Science, 14(3), 135–138. http://doi.org/10.1111/j.0963-7214.2005.00347.x

Bonanno, G. A., Brewin, C. R., Kaniasty, K., & La Greca, A. M. (2010). Weighing the costs of disaster : Consequences , risks , and resilience in individuals , families , and communities. Psychological Science in the Public Interest, 11(1), 1–49. http://doi.org/0.1177/1529100610387086

Bromet, E. J., Hobbs, M. J., Clouston, S. A. P., Gonzalez, A., Kotov, R., & Luft, B. J. (2016). DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11). Psychological Medicine, 46(4), 771–783. http://doi.org/10.1017/S0033291715002184

Carpenter, G. S. J., Carpenter, T. P., Kimbrel, N. A., Flynn, E. J., Pennington, M. L., Cammarata, C., … Gulliver, S. B. (2015). Social support, stress, and suicidal ideation in professional firefighters. American Journal of Health Behavior, 39(2), 191–196.

Chen, J. M., Kim, H. S., Mojaverian, T., & Morling, B. (2012). Culture and Social Support Provision: Who Gives What and Why. Personality and Social Psychology Bulletin, 38(1), 3–13. http://doi.org/10.1177/0146167211427309

Cone, J. E., Li, J., Kornblith, E., Gocheva, V., Stellman, S. D., Shaikh, A., … Bowler, R. M. (2015). Chronic probable PTSD in police responders in the world trade center health registry ten to eleven years after 9/11. American Journal of Industrial Medicine, 58, 483–493. http://doi.org/10.1002/ajim.22446

de Terte, I., Stephens, C., & Huddleston, L. (2014). The development of a three part model of psychological resilience. Stress and Health, 30(5), 416–424. http://doi.org/10.1002/smi.2625

Evans, M. (2017). Emergency service workers suffering post-traumatic stress following terror attacks and Grenfell fire. Telegraph. Retrieved from http://www.telegraph.co.uk/news/2017/07/23/emergency-service-workers-suffering-post-traumatic-stress-following/

Henderson, S., LeDuc, T. J., Couwels, J., & Hasselt, V. B. Van. (2015). Firefighter suicide: The need to examine cultural change. Retrieved from http://www.fireengineering.com/articles/print/volume-168/issue-12/features/firefighter-suicide-the-need-to-examine-cultural-change.html

Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., … Ursano, R. J. (2007). Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry, 70(4), 283-315-369. http://doi.org/10.1521/psyc.2007.70.4.283

Kaniasty, K., & Norris, F. H. (2009). Distinctions that matter: Received social support, perceived social support, and social embeddedness after disasters. In Y. Neria, S. Galea, & F. H. Norris (Eds.), Mental health and disasters (pp. 175–200). New York: Cambridge University Press.

Lakey, B., & Cohen, S. (2000). Social support theory and measurement. In S. Cohen, L. G. Underwood, & B. H. Gottlieb (Eds.), Social Support Measurement and Intervention: A Guide for Health and Social Scientists (pp. 29–52). New York: Oxford University Press.

New Zealand Medical Association. (n.d.). Health and wellbeing. Retrieved from https://www.nzma.org.nz/about-nzma/nzma-structure-and-representatives/councils/dit-council/health-and-wellbeing

Stephens, C. (1997). Debriefing, social support and PTSD in the New Zealand police: Testing a multidimensional model of organisational traumatic stress. Australasian Journal of Disaster and Trauma Studies, 1997(1).

Taylor, S. E., Sherman, D. K., Kim, H. S., Jarcho, J., Takagi, K., & Dunagan, M. S. (2004). Culture and social support: who seeks it and why? Journal of Personality and Social Psychology, 87(3), 354–362. http://doi.org/10.1037/0022-3514.87.3.354

Three of my colleagues have killed themselves. Medicine’s dark secret can’t go on. (2017). Stuff. Retrieved from http://www.stuff.co.nz/world/australia/89276565/three-of-my-colleagues-have-killed-themselves-medicines-dark-secret-cant-go-on

 

Musings from my PhD Confirmation

Today, I was confirmed as a PhD candidate. At last, I am officially (no longer provisionally) a PhD candidate! (yay!) after nine months of hard work. It was also nine months of learning. Intense learning, I may say. Some thoughts:

  1. I started out thinking I knew what I wanted to know. But as I went along — after literally hundreds (or thousands, no?) of journals skimmed through and read — I realised I had to know it more. Doing a PhD is, in itself, a good exercise of humility. It made me realise how much of the world I do not know, how much there is to know, and how much of it is beyond my capacity to know. I now know, by heart, that it is impossible to know everything about the topic I am investigating, and I am not here to save the world. I am just doing a PhD. I just hope it will make a difference, but realistically, I expect it will not change the world.
  2. They say the PhD is a lonely journey. To a certain extent, it is. You work on it alone. You read the articles alone. You write the manuscripts alone. But it does not necessarily have to be a lonely journey. It helped that I have a community of fellow PhD students who, more or less, have the same struggle. Misery loves company, they say.  Knowing that there are others around you who have more or less the same experience as you have makes the burden more light, and the journey less lonely.
  3. Never underestimate the relationship that you have with your supervisors, especially your main supervisor.  I am so lucky to have found a main supervisor who provides an excellent balance of challenge and support on what I do, and who believes in my capacity more than I believe in myself. Takeaway: choose your supervisors wisely.
  4. Sometime ago, I read this somewhere: “it takes a village to make a thesis,” which is a play on “it takes a village to raise a child.” Truly, make no mistake of thinking that it is only you building that thesis (unless you really are alone in doing that — abandoned by the rest of the world). Initially, I thought it was just me. But no. This thesis is, and ideally is, my work with plenty of help from my supervisors and other helpful friends.
  5. It is hard work. Period. Some people may be talented enough to work “less hard” than others, but generally, PhD is hard work. As such, it is usually coupled with frustration. I have had months when I felt like a total loser, when I felt like I was not progressing and that I am failing myself. But I guess most PhD students go through that phase — that “what am I doing with my life” phase, and that eventually, you will get that “I am doing something awesome with my life” answer.

I am lightyears away from that degree, but it is always comforting to know that I am a step closer to it. The last nine months were an intense period of learning. I know the next two or so years will be equally challenging, but I am ready for it — with a (little) help from my friends.

One Ring to Finish PhD

As a PhD student in the middle of Middle Earth, I thought I would get myself a replica of the One Ring from The Lord of the Rings, as a PhD commitment ring. The ring has the following inscription:

One Ring to rule them all, One Ring to find them,

One Ring to bring them all and in the darkness bind them.

1000px-one_ring_inscription-svg

One Ring to rule them all. A rule is a line gauge (also called “ruler”), a device that measures distance or length. The PhD journey starts with knowing what you want to measure and how you can measure them. Measure them (the variables), all of them.

One Ring to find them. This is, of course, data gathering. I will find them (my data).

One Ring to bring them all. After finding your data, you have to bring them all (together) — data collation, analysis, and write up.

…and in the darkness bind them. Of course, this refers to the final stage: the binding of the dissertation.

The One Ring captures the entire PhD journey. So yep, I am getting myself one.

NZPsS Conference 2016

I recently presented a paper, Social Support among Disaster First Responders: A Review of Literature, which I did with my PhD supervisory team: Dr Ian de Terte (Massey University, Wellington), Prof. Krzysztof Kaniasty (Indiana University of Pennsylvania, USA), and Prof. Christine Stephens (Massey University, Palmerston North), at the New Zealand Psychological Society (NZPsS) Annual Conference at Massey University, Wellington last 1-4 September 2016.

Social support is considered one of the key components of psychosocial recovery after disasters. Most studies, however, focus on the survivors, and we wanted to know what the literature says about social support in those who help the disaster survivors. Interestingly, very few studies explicitly investigated this area, and a considerable number of these studies also had methodological issues on top of the inherent issues surrounding disaster mental health research, and disaster research as a whole. These issues include having no comparison or pre-disaster data, the problem of isolating effects of social support variables, and the use of non-standardised measures.

nzpss-ad

There is also the lack of research on received social support. Majority of the studies measured perceived social support. From an interventionist perspective, we argue that although it is important to know appraisals of the quality and availability of support (perceived support), what we can control and provide is the actual support (received support); hence, it is important to know the effectiveness of received social support and how it relates to psychosocial consequences.

This was my first conference presentation in New Zealand and it did not disappoint. It had some of the most interesting presentations and engaging discussions that I have listened to thus far.

A copy of the presentation slides may be downloaded here: [pdf]