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Published in final edited form as: Psychiatr Rehabil J. 2012 Dec;35(6):441–446. doi: 10.1037/h0094577

Valued Social Roles and Measuring Mental Health Recovery: Examining the Structure of the Tapestry

Marcia G Hunt 1, Catherine H Stein 2
PMCID: PMC4037131  NIHMSID: NIHMS563732  PMID: 23276237

Abstract

The complexity of the concept of mental health recovery often makes it difficult to systematically examine recovery processes and outcomes. The concept of social role is inherent within many acknowledged dimensions of recovery such as community integration, family relationships, and peer support and can deepen our understanding of these dimensions when social roles are operationalized in ways that directly relate to recovery research and practice.

Objective

This paper reviews seminal social role theories and operationalizes aspects of social roles: role investment, role perception, role loss, and role gain. The paper provides a critical analysis of the ability of social role concepts to inform mental health recovery research and practice.

Method

PubMed and PsychInfo databases were used for the literature review.

Results

A more thorough examination of social role aspects allows for a richer picture of recovery domains that are structured by the concept social roles. Increasing understanding of consumers’ investment and changes in particular roles, perceptions of consumers’ role performance relative to peers, and consumers’ hopes for the future with regards to the different roles that they occupy could generate tangible, pragmatic approaches in addressing complex recovery domains.

Conclusions and Implications for Practice

This deeper understanding allows a more nuanced approach to recovery-related movements in mental health system transformation.

Keywords: social role theory, mental health, recovery, severe mental illness

The concept of mental health recovery has become central to changes in United States mental health policy and practice at both the state and national levels (Anthony, 1993; Davidson, O’Connell, Tondora, Styron, & Kangas, 2006; Davidson et al., 2007). During the past decade, increased attention has been given to the definition and measurement of recovery in order to support mental health system transformation and facilitate recovery outcomes research. This process lead to the acknowledgment that both the concept of recovery and recovery measurement are complex— in part because of the multiple components related to recovery (Davidson, Lawless, & Leary, 2005; Resnick, Fontana, Lehman, & Rosenheck, 2005). For example, the Substance Abuse and Mental Health Services Administration (2006) developed a consensus statement on mental health recovery defining recovery as “a journey of healing and transformation” that includes 10 fundamental components: self-direction, individualized and person-centered, empowerment, holistic, nonlinear, strengths-based, peer support, respect, responsibility, and hope. Other components or domains that have been the focus of mental health recovery research include community integration, family relationships, living arrangements, mental health symptoms, navigating social services, optimism, safety, social networks and supportive relationships, and spirituality (Baxter & Diehl, 1998; Davidson et al., 2001).

The sheer number and breadth of components that currently define the tapestry of mental health recovery makes systematic examination of recovery processes and outcomes difficult. Inherent in many recovery elements, the larger concept of social roles acts as a barely visible underlying structure, a kind of warp in the weave of the tapestry. Despite being hidden, this structure allows consumers, practitioners, researchers, policymakers, and citizens to better visualize the richness and multifaceted nature of mental health recovery. For example, discussions of social roles are inherent in writings about community integration (Anthony, 1993; Davidson et al., 2001; Ridgway, 2001), literature on family relationships (Janzen & Muhajarine, 2003; Stein, Mann, & Hunt, 2007), and studies of peer support for adults with mental illness (Barber, Rosenheck, Armstrong, & Resnick, 2008; Goldberg & Resnick, 2010; Sells, Black, Davidson, & Rowe, 2008). However, the notion of valued social roles for adults living with a mental illness is typically relegated to a subordinate position in discussions of mental health recovery despite studies that have shown a relationship between a greater number of valued social roles and higher levels of well-being and less psychological symptomotology (Spreitzer, Snyder, & Larson, 1980; Thoits, 1991). Moreover, there is relatively little discussion regarding operationalization and measurement of the construct of social roles in the context of mental health recovery beyond describing a social role as being a member of a social group or joining in an activity described as “social” such as a book club. As noted below in the description of role theories, the word social in this context is used to connote a focus on beliefs/behaviors in relation to a social context rather than whether or not one “socializes” as part of a role. This article reviews seminal social role theories and operationalizes aspects of social roles thought to relate directly to mental health recovery research and practice. This article provides a critical analysis of the ability of social role concepts to contribute to effective ways to facilitate and support recovery for individuals and inform mental health systems transformation.

Social Role Theories

Role Theory

Seminal social role theories focus on individuals’ beliefs and behaviors in relation to their social context—holding the individual/social context interplay at the core of the construct. In early writings, Biddle (1979) described role theory as “the study of behaviors that are characteristic of persons within contexts” (p. 4) and role as “phenomenon-patterned human behaviors.” The notion of grouping behaviors to define a role is the basis for the study of social roles. Not only do both the behavior and its context define a role, but behavior and context have a reciprocal relationship, each affecting the other. Biddle further described roles and role theory, saying that roles are linked to societal functioning and to social position or status. He explained this concept of social linkage by proposing that behaviors within roles are “contextually bound” and are thus “embedded within social systems” (Biddle, 1979, p. 6). In other words, the roles we hold as members of society help us define who we are relative to others while helping society understand and shape its own hierarchical structure.

Normalization

Role theory, broad and descriptive, lacks overtly stated implications for social application, policy, or practice. Nirje’s (1999) principle of normalization was one of the early practical applications of role theory. Bengt Nirje’s experiences with the plight of intellectually disabled children in Sweden informed his notion that people’s role attributes and expectations can impact the lives of marginalized members of society and led him to articulate the normalization principle in 1969. The normalization principle sets forth general guidelines advancing parity in access to resources for marginalized people, specifically those with intellectual disabilities. This principle was intended to help shape policy and to change the way society addressed the problems of this marginalized group.

Similar experiences in Wolf Wolfensberger’s life led him to redefine the normalization principle in 1972 and again in 1982 with a colleague, Tullman (Thomas & Wolfensberger, 1999). These redefinitions expanded idea of normalization to include all conditions or disabilities of devalued or marginalized people, highlighted an argument against the embedded notion of “normal” and stated that the principles of normalization were rooted in the idea that marginalized people lacked socially valued roles the socially assigned attributes associated with those valued roles.

Social Role Valorization

The combination of concepts and principles from role theory and normalization allowed for the development of the concept of social role valorization (SRV) (Wolfensberger, 1983)—making explicit connections to role theory and shifting the focus from promoting “normal” opportunities and life circumstances to promoting social roles that are collectively valued. Putting the emphasis on “valorization” or, more simply, value, SRV is characterized by the availability of social roles, the socially constructed values and expectancies related to roles, and the effect that holding a role has on the individuals’ perception of his or herself. Social role valorization specifically addresses the impact of social roles and their collectively assigned attributions upon individual’s access to resources. As an example, if someone holds a role that is thought to have positive value—such as “student”—the attributes associated with the role (e.g., goal-directed, contributing to society, educated) are associated with the person and can impact the person’s access to resources (e.g., summer jobs, loans, movie discounts). This is in contrast to socially devalued roles (e.g., mental patient) that can increase the likelihood that those holding this role will be subject to negative experiences including fewer resources and many forms of stigma, abuse, and neglect.

Life Course Perspective and Valued Social Roles

An important aspect of valued social roles not explicit in role theory per se relates to the expected developmental timing of roles. The life course perspective reflects the notion of normative timing of developmental milestones and metrics of individual, social, or family, and historical or contextual time, as they relate to the life of an individual or family (Aldous, 1990). In other words, there is inherent social comparison with respect to timing of social roles that can vary the importance of a role to an individual depending on the age of that individual. Both individuals and families experience expectations for events (e.g., marriage, childbirth, leaving home as an adult) that are linked to the chronological age of the individuals and family members (Aldous, 1990; Hill, 1970; Olson, Lavee, & McCubbin, 1988), and these events can be linked to specific valued social roles. For example, in mainstream culture in the United States, the “average person” expects to complete a secondary education by age 18, have a spouse by about age 25, be well established in a career by middle age (approximately age 40), and retire from work at about age 65 (United States Census Bureau, 2000); these milestones correspond with valued social roles such as student, worker, spouse, parent, and retiree. Perception of the importance of any role is tied to chronological milestones. For example, if a person is age 30 and not partnered, given that the average age of marriage is 25, he or she may feel that the role of “spouse” is more important or salient in his or her life at this moment than the role of “student” or “retiree.” Thus, the notions of meeting or missing developmental milestones and holding and not being able to hold corresponding valued social roles are important aspects informing the operationalization of the construct of valued social roles and the use of the construct in research.

Operationalizing the Construct of Valued Social Role

Initial Steps

Operationalizing the construct of social roles involves categorizing roles, noting specific behaviors that exemplify the role, and finally, recognizing the value or “status” of the role. Social roles can be divided into broad categories, such as relationships, work, education, sports, community participation, religious roles, or residence-related roles, and so forth (Thomas & Wolfensberger, 1999). Most people view themselves and are viewed by society as filling different roles due to the multifaceted nature of their lives. For example, someone can be a worker, a parent, a religious devotee, and a political activist. Describing people as holding multiple roles begins to reflect the complexity of individuals’ self-concept as determined by their perception of the roles they hold.

A second step in operationalizing the construct of valued social role relates to the number of requirements, positions, or behaviors that need to be exemplified for a person to be seen as holding that particular social role. According to Thomas and Wolfensberger (1999), if a person exemplifies only a few key behaviors attributed to a particular role, both the person and the larger society perceive them as holding or filling that role. In other words, if a person has a child and has some contact with that child, they will typically see themselves as a parent and will typically be seen by society as a parent. Similarly, if one lives in a neighborhood, he or she usually perceives his or herself and are usually perceived by others as being a member of the community in that area, whether or not he or she belongs to a block watch committee, knows many neighbors in the area, or participates in local events.

A third step involves recognizing the value or status related to different social roles. Social roles are perceived as differentially valued by individuals and by society (Thomas & Wolfensberger, 1999; Wolfensberger, 1983, 2000). For example, the role of worker typically holds higher status than the role of disabled person. It is argued that since the value or worth that society places on particular roles differs from role to role, society also differentially values persons holding or representing various roles. Differential valuation of roles has important implications when applying the concept of expanding access of valued social roles to marginalized populations in society, including those with serious and persistent mental illness. concept, psychological adjustment, and coping strategies is critical to formulating change, particularly for marginalized groups.

Aspects of Valued Social Roles

Initial steps

The operationalization and measurement of the complex construct of valued social roles are critical for further empirical studies. Studies of social roles typically have one measure of social role, role occupancy. Role occupancy most often involves counting the number of predetermined roles filled by a participant (e.g., parent, married partner, worker, caregiver) (Janzen & Muhajarine, 2003; Weich, Sloggett, & Lewis, 2001). Studies typically use this measure to investigate the impact of the number of social roles held at one time or the impact of multiple social roles or loss of social roles on psychological distress (Baruch & Barnett, 1986; Harris, Morley, & Barton, 2003; Lee & Powers, 2002). These studies are often focused on work–family roles such as worker, parent, or marriage/partner roles. Occasionally, other variables associated with these social roles are included such personality characteristics related to fulfilling a role (e.g., assertiveness), job insecurity, or specific domestic responsibilities. Although role occupancy is a helpful measure when focusing primarily on the number of social roles filled by participants, measures of role occupancy do not allow for research focusing on the aspects of social roles themselves. The approach we have taken is to go beyond a focus on number of roles to the aspects of roles—including role investment, role perception, role loss, and hope for future role gain.

To more thoroughly describe a role beyond occupancy, several questions arise including, How important is the role to the person filling it? Is this a role they wish to become more invested in … or less invested in? How similar are they to others also filling this role? And particularly when thinking about roles within the lives of people with serious mental illness, Has this role changed as a result of an important event such as the onset of the illness? Beginning with these questions and including research findings from social role theory and the life course perspective, four role aspects were chosen as representing the most salient issues for marginalized populations including people with severe and persistent mental illness. These are described below. Table 1 shows the application of role aspects to two role categories: parent and worker.

Table 1.

Application of Role Aspects Using Two Role Categories

Step Parent (relationships category) Worker (income/employment category)
Step 1: Role categorya
Step 2: Key behaviorsa Spend leisure time with children
Assist with daily activities		 Seek help from boss or supervisor
Worry about work performance
 Aspect: Role occupancy Are any of the key behaviors applicable?
 Aspect: Role investment How often does the person participate in key behaviors?
How does the person feel this compares to others the same age?a
Step 3: Status or value indicators
 Aspect: Role loss Has participation in key behaviors changed since a seminal event (e.g., onset of serious mental illness)?
 Aspect: Hope for future role gain Does the person hope to do more of these key behaviors in the future? … or less of in the future?
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a

Indicates that, by definition of selection/construction, item inherently includes the developmental timing/life course perspective of valued social roles.

The concept of role investment is identified in a number of areas of social role literature. Research by identity theorists supports the notion that people both differentially value social roles and organize roles within a hierarchy (Thoits, 1983, 1991; Wells & Stryker, 1988). One implication of this hierarchical structure is that people can then have different levels of investment in the various roles that they hold. As noted above, not all requirements or expectations of a role need to be filled for a person to be seen as holding that particular social role. Thomas and Wolfensberger (1999) implied that social role investment may be measured by a few key behaviors seen as representing a particular role. For example, to hold the role of autonomous householder, key behaviors may include shopping for groceries and cooking meals for oneself, doing housework, laundry, and paying bills. Someone who participates in all of these behaviors can be seen as more invested in the autonomous householder role than someone who does only laundry. Despite its seeming straightforward nature, role investment is a complex concept as the word investment seems to imply a level of importance or salience. It is important to note the difference as people may not have access to resources or role-related opportunities—particularly to more valued roles if one is marginalized— or one may simply enact key behaviors, requirements, and so forth for reasons other than feeling that the role is particularly salient or important. Role perception, the notion of whether or not one is fulfilling a particular role in the same way as one’s peers, is closely linked to the literature on the life-course perspective of social roles. Being off-time or off the life-course trajectory— noted by peer comparison—relates to one’s self concept and feelings of self-esteem (Aldous, 1990; Cohler, Pickett, & Cook, 1996; Cook, Cohler, Pickett, & Beeler, 1997; Pickett, Cook, & Cohler, 1994; Stein & Wemmerus, 2001). Additionally, accepted age-related milestones for important life events (e.g., high school graduation, marriage) help locate oneself in the context of a socially determined life. With respect to roles, this perception of oneself in relation to others can add to the understanding of the impact of lack of access to valued social roles. For example, if one perceives that his or her peers are finding marriage/life partners while he or she is in a significant relationship, he or she is less likely to feel off the life course or less marginalized with respect to that particular role—regardless of whether or not an objective measure of peer concordance supports this assessment. Conversely, a relatively negative comparison with peers may generate a greater feeling of marginalization and off-timedness, regardless of any objective evidence.

Role loss has been primarily researched in the context of laterlife issues (Barefoot, Mortensen, Helms, Avlund, & Schroll, 2001; Chambre, 1984; Myers, 1999) and typically means the loss of a role rather than a decrease of importance or investment in that role. Studies have shown that role loss is correlated with decreases in well-being and greater psychological symptomotology (Barefoot et al., 2001; Faria, 1983; Huppert & Whittington, 2003). A typical example is the loss within the role of independent self that may occur when one moves into a nursing home after an unexpected illness. From a life-course perspective it is important to note that there are expected and unexpected losses at all ages—and that some losses within roles may be welcomed and could positively affect well-being.

An example of an expected younger-age role loss occurs within the role of parent when a child leaves home to start his or her own life or go to college. Although the parent does not stop being a parent, there is likely a decrease in “typical” parent behaviors when a child is living at home. Thus, a loss in role does not necessarily mean the role itself has ended, behaviors may have merely changed or decreased. An example of a negative role loss due to nonenactment would be the desire to be a father but never having children. Finally, an example of a potential positive role loss within the worker role could be semiretirement if someone has a decrease in work hours as a goal.

Linked with role loss is hope for future role gain. Studies have shown that holding a greater number of valued social roles is related to reports of higher levels of well-being and less psychological symptomotology such as depression and anxiety (Menaghan, 1989; Spreitzer, Snyder, & Larson, 1980; Thoits, 1991). These and similar findings bring together the related notions of gaining social roles and the desire to increase investment in social roles in the future. According to Thoits (1991), gaining valued social roles is linked to reported improvements in well-being. A desire to become more invested in or to hold more valued roles in the future may stem from a desire to increase feelings of wellbeing, social worth, and self-esteem.

These aspects—role investment, role perception, role loss, and hope for future role gain, and the embedded nature of the lifecourse perspective within these aspects—indicate the complexity of the construct of social role. Accounting for the complexity of the construct of social role becomes particularly important when attempting to understand, operationalize, and measure the construct of social role.

Conclusion

Valued Social Roles and Recovery

The construct of social role is critical in the examination of the experiences of marginalized people, including people with serious mental illness, and the systems that serve them. Key to such an examination of marginalized groups is the idea of role devaluation. Thomas and Wolfensberger (1999) noted that both individuals and classes (societies) can socially devalue a person, event, or role. If the devaluation is by an individual—for example, one person telling another that he or she is “worthless” because she or he is unemployed—the person being devalued is less likely to be at risk for emotional damage since a single person’s opinion can be emotionally put aside. However, if the devaluation is from a class of people or society in general—for example, perceiving that someone is of lower status due to his or her unemployment—the person being devalued can no longer simply avoid the devaluer or ignore their opinion, as it is not a single voice, but a chorus. Class or societal devaluation allows few, if any, ways to escape from the devaluation. This becomes a vicious cycle with the marginalized person having access only to devalued roles—and increasing his or her marginalization by holding only lower valued roles. By acknowledging the social construction and differential valuation of social roles, we acknowledge that marginalized populations are at greater risk for continued devaluation and marginalization. Operationalizing and defining aspects of social roles is an important step toward decreasing this risk and is crucial for recovery and system change.

Implications for Research and Practice

As recovery-related movements in mental health move forward to transform systems, attempts to define, operationalize, and measure the concept of recovery would be well served by a closer look at the aspects of social roles. By providing the underlying structure and shape, the construct of social role defines many other recovery domains. Accepted and defined dimensions of recovery such as social relationships or community integration are linked with the construct of social role, calling for better and more self-sustaining ways of promoting valued social roles, encouraging natural supports, and helping consumers take more control in their recovery. A more thorough examination of the aspects of social roles can facilitate a fuller description of the meaning particular roles have to individuals—filling a need for empirical research regarding social role and recovery, particularly beyond the notion of role occupancy. In other words, if researchers, practitioners, and consumers themselves develop a richer picture of social roles and related recovery domains structured by an individual’s social roles, this could allow interventions or programs to specifically target an area for change. For example, in the development of a program intending to increase consumers’ level of community integration, understanding which behaviors link to feelings of investment in the role of community member and comparison of this investment relative to peers would allow several different types interventions to be developed. These interventions might include educating or exploring specific behaviors and how they impact feelings of integration or partnering participants with peers who report feeling high levels of integration. Regardless of the specific intervention, understanding these aspects of social roles—and ultimately measuring them—could help target interventions and supporting policy. For people who typically have been marginalized by society, a closer examination of social roles provides a view of the structure within the tapestry of mental health recovery that could generate tangible, pragmatic approaches in addressing complex recovery domains such as community integration—and may also reveal other patterns in the larger fabric of our society that demand our attention and concern.

Contributor Information

Marcia G. Hunt, Veterans Affairs New England Mental Illness Research, Education, and Clinical Center and Yale Medical School

Catherine H. Stein, Bowling Green State University

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