Social Constraints on Disclosure and Adjustment to Cancer

Abstract

This article introduces the concept of social constraints on disclosure, puts it in a theoretical framework, and examines how it can affect adjustment to major life stressors using the exemplar of cancer. Cancer is a leading cause of death and disability worldwide. It is often life threatening, disfiguring, and unpredictable; hence, it can undermine people's basic and often positive beliefs and expectations about themselves, their future, and social relationships. For many people with cancer, it is important to come to terms psychologically with the illness -to make sense of or somehow accept the reality of it. People often do this by thinking about different aspects of the disease and its implications for their life, but also through socially processing, or talking about, their cancer-related thoughts, feelings, and concerns with others. When people experience social constraints on their disclosure of cancer-related thoughts and feelings, it can adversely affect how they think and talk about their illness, their coping behaviors, and psychological adjustment. In addition to discussing mechanisms and consequences of social constraints on disclosure, we discuss some of its determinants and future research directions.You seldom listen to me, and when you do you don't hear, and when you do hear you hear wrong, and even when you hear right you change it so fast that it's never the same.-Marjorie Kellogg, 1922Kellogg, -2005 Whenever we are compelled by others to regulate, restrict, or modify our thoughts, actions, or feelings, we are experiencing social constraints. From a sociological perspective, social constraints are objective, external circumstances, such as others' manner of acting, thinking, and feeling, which shape an individual's manner of acting, thinking, and feeling (Durkheim, 1982). Social constraints can be direct and coercive, as when police carry out laws through force, or indirect, as when individuals are shunned by neighbors for dressing or speaking in a particular way. This paper adopts 314 Social Constraints and Cancer a more social-psychological perspective on social constraints. According to this perspective, social constraints are the product of social facts -the actions, thoughts, and feelings of others -and individuals' psychological construal of those facts. Within the field of health psychology, the construct of social constraints is relatively new but is beginning to receive more attention as a predictor of stress, coping, and adjustment processes. This article examines social constraints on disclosure in the context of one major life stressor where it has been studied a good deal: coping with cancer. It is quite common for people to want to disclose thoughts and feelings related to cancer (Davison, Pennebaker, & Dickerson, 2000). If emotional disclosure is not possible or somehow discouraged, how does this influence coping, cognitive processing, and emotional reactions to cancer? Because cancer can be life threatening, disabling, and disfiguring, cancer survivors can experience difficulti...

Comparing Standard Versus Prosocial Internet Support Groups for Patients With Breast Cancer: A Randomized Controlled Trial of the Helper Therapy Principle

“…Patients with cancer can sometimes feel constrained in talking about their cancer-related concerns and fears because they do not want to upset others. 2,38 Similar social constraints may arise in a breast cancer support group. In trying to be supportive toward others in the prosocial intervention, women may have felt a need to suppress their own negative feelings and increase their expression of positive feelings.…”

“…2 Internet support groups (ISGs) can increase access to psychosocial support, yet trials of cancer ISGs have yielded mixed results. 3 Thus, there is a need to enhance the effectiveness of cancer ISGs to better serve patients.…”

New frontiers in couple-based interventions in cancer care: refining the prescription for spousal communication

“…Successful adaptation involves actively assimilating or accommodating the illness into these schemas through cognitive processing, which involves efforts to perceive the illness as less harmful or threatening (e.g. acceptance, reappraisal), and social processing, which involves disclosing fears and concerns as a means of soliciting partner support and facilitating engagement in active coping strategies [35,36]. However, disclosing feelings to a partner can be challenging.…”

“…Another reason why individuals may refrain from discussing cancer with their partners is that they perceive them as critical, unreceptive or uncomfortable with the topic. The objective social conditions and individuals' construal of those conditions that lead them to refrain from or modify their disclosure of cancer-related thoughts, feelings or concerns are known as social constraints; and research has shown that social constraints place individuals at higher risk for psychological and relationship distress [36].…”

Trying to Be Perfect in an Imperfect World: Examining the Role of Perfectionism in the Context of Chronic Illness

“…Yet, she very insightfully illustrates how the benefits from this strategy were short-lived and ended up resulting in long-term consequences by causing her greater pain and a prolonged recovery period. Further, she points out how her false façade ironically caused her greater frustration and stress not only from causing her poorer health, but also because it created social constraints (i.e., perceiving that others are unreceptive to emotional self-disclosures; Lepore & Revenson, 2007). In other words, she was so successful at hiding her pain and discomfort that when she finally had to admit that she needed to rest and could no longer meet the situational demands, her family could not understand why because she appeared "fine" before.…”