Social adjustment is an effort made by an individual to cope with standards, values and needs of a society in order to be accepted. It can be defined as a psychological process. It involves coping with new standard and value. In the technical language of psychology “getting along with the members of society as best one can” is called adjustment.
Psychologists often make use of the term adjustment to describe various types of social and interpersonal relations in society. Therefore, adjustment can be referred to as the reaction to the demands and pressures of a social setting imposed upon the individual. Social adjustment is an attempt made by an individual to address the standards, values and desires of a society so as to be accepted. It is often referred as a psychological method. It involves dealing with new standards and values. In the scientific language used in psychology, ‘ getting along with the members of society as best as one can’ is termed as adjustment.
Social skills refers to specific set of abilities including cognition , verbal and non verbal behavior that are required for effective social performance. On the other hand, social competence, is referred as overall ability of the patient to impact favourably on his/her social setting. Lastly, social adjustment is said to be the actual meeting of instrumental and affiliative desires that is regarded as the natural consequence of social competency.
Social functioning has repeatedly been found to be poorer in schizophrenia than in patients with other psychiatric problems and such functioning is a major predictor of the course and outcome of the condition (Philips, 1953, Kay and Lindenmayer, 1987). Patients with schizophrenia have pronounced deficits in social skills (Argyle, 1981; Boswell and Murray , 1981). Social dysfunction is an important feature in this disorder that has vital implications for the development, course and outcome of the illness. (Couture, Penn and Roberts , 2006). It be believed that decrement in social functioning represents an area that is different from the positive and negative symptoms (Lenzenweger and Dworkin, 1996; Lenzenweger, Dworkin and Wethington, 1991). These social deficits occur in the initial stages of the illness and anti psychotic treatments are more effective on the positive symptoms than social deterioration. Moreover, it is the social deficits themselves that usually worsen the course of the illness and may lead to a relapse.
Schizophrenia is a chronic mental condition often related to impairment of social functioning. Such losses may vary among people and all through the course of the illness. The assessment of social functioning is therefore necessary to grasp the social impact of the disorder and to estimate the influence of medications and psychosocial interventions in order to improve the social performance, either as part of analytic procedure or routine clinical follow up.
Deficits in psychosocial functioning are the hallmark characteristic in schizophrenia. It can be detected in its initial stages. Deficits include poor social interaction, difficulties in maintaining relationships with family and friends, and/or inadequate performance in the workplace.
Deficits in social adjustment is also seen in individuals with Bipolar Disorder. However, it is not as severe as seen in individuals with schizophrenia. Since individuals with bipolar disorder show extreme mood swings of mania and depression, therefore they are unable to function socially. Also, depression also plays a major role in both the disorders and therefore deficits in social functioning are present.
DEPRESSION
Depression also called major depression, clinical depression or major depressive disorder is a medical condition that causes a continuous feeling of disappointment and lack of interest. Depression affects the way the person feels, behaves and thinks. It can cause emotional and physical problems. Generally, depressed people have difficulties performing daily activities and may also experience that life is not good enough to live. Feeling unhappy or what we tend to call ‘depressed’ happens to every individual. However, people with this condition notice that their state interferes with their everyday life. Their normal functioning is undermined to such a level that both themselves and their caretakers are affected by it.
It is a false belief that depression is more prevalent among women than men. A study published in JAMA Psychiatry (August 2013 issue) showed that depression affects 30.6 % males and 33.3% females. This shows that there is no significant difference. Many people with depression never seek treatment. But majority of patients including those with most severe depression, can be treated. Medications, psychotherapies and other methods can effectively treat individuals with depression.
Depression often occurs as a symptom in schizophrenia. These days it is generally under recognized and under treated but traditionally such symptoms were the main targets of attention. Kraeplin recognized the importance of depression as a main feature in schizophrenia and identified many depressive sub types of the illness. Mayer-Gross stressed on the despair that frequently takes place as a psychological reaction to acute psychotic episodes and Bleuler regarded depression to be one among the core symptoms of schizophrenia (Advances in Psychiatric Treatment (2000)).
The significance of depression in schizophrenia has been obtained by its conceptual and operational overlap with the negative symptoms found in the disorder. Feelings of guilt and ideas of suicide may be indicative of depression. However, features like psychomotor retardation, impaired ability to concentrate, and decreased interest, pleasure, energy, or motivation can be a part of negative as well as depressive symtomatology. While a number of authors have suggested a strong link between depressive and negative symptoms of schizophrenia, others have reported considerably higher correlations between depression and positive symptoms in comparison to the negative ones (J Neuropsychiatry Clin Neurosci. 2008 ; 20(4): 431’440. ).
Depressive symptoms in schizophrenia are essential not solely because they contribute considerably to the suffering caused by the condition, whether or not ‘ positive’ psychotic symptoms are active or quiescent, but also because they increase deficits in psychological functioning and often lead to attempted and completed suicide. It is necessary to define and clinically assess such symptoms carefully since there is growing evidence that they can be treated successfully.
Nearly quarter of individuals with schizophrenia meet the criteria with schizophrenia for a depressive disorder during some time in their lives. Furthermore, depressive symptoms in schizophrenia is associated with distress especially those including loss, grief and hopelessness and can take place throughout all the stages of the condition.
Suicide is about 13 times more likely in people with schizophrenia tan the general population. Hopelessness and demoralization are indicators of increased risk of suicide.
On the other hand, in Bipolar Disorder , there are episodes of mania and depression. Depression does occur in patients with this disorder but they may not last for a very long time. Before one realizes it may shift to episodes of mania. The symptom of depression is not constant that lasts for months on end, it may probably last for days to weeks. The intensity of depression is more severe among schizophrenics than patients with bipolar disorder.
NEED FOR STUDY
According to Plato, ‘ Man is a social animal.’ We stay in a society and form viewpoints about the people around us. We make a conscious effort to behave in keeping with the norms of the society so that we can adjust with others. However, it is not easy because every individual has its own personality and distinctive organization. This organization needs to build special efforts to get along with other distinctive organizations in order to make the society a better place.
Schizophrenia and Bipolar Disorder share many common overlapping symptoms. One of the most important symptom is depression. Both are chronic disorders and may be difficult to establish a difference between them. As we know, depression is present in both these disorders. However, one would want to know the level of depression between the two populations. Furthermore, since depression is present in these populations , deficits in social adjustment would also be prominent. However, level of social adjustment between the two populations would be of interest.
Therefore, I am going to conduct a research on two most prominent features present in schizophrenia and bipolar disorder namely ‘ social adjustment and depression. This study is been conducted in order to examine the level and intensity of the above mentioned features between the two populations.
Depression and social adjustment are inter related. They are one of the most common symptoms seen in schizophrenia and bipolar disorder. Various studies have found an association between cognition and social functioning.
Research carried out by Holthausen, Wiersma, Cahn et al. (2007) found significant differences between patients with and without cognitive deficits in areas such as work and vocational functioning. It would seem that cognition is a more powerful indicator of work performance when there are cognitive deficits than when there are not. There is also evidence that neurocognitive capacity can be related to acquisition of social skills to functioning in day-to-day activities and to independent living.
A review by Green et al. (2000) of 39 published studies suggests that different types of cognitive deficits are associated with different areas of social functioning and that these cognitive deficits could individually determine the functional performance of people with schizophrenia. Specific cognitive deficits such as those in working memory, executive functioning, verbal memory and vigilance could be associated with poor social functioning and with problems in social skill acquisition.
Many studies have been conducted on social adjustment in schizophrenia and bipolar disorder. These studies have indicate that social adjustment would be lower in schizophrenia than in bipolar disorder. However, no studies have been conducted on depression in schizophrenia and bipolar disorder. Therefore, I am keen on formulating a research based on these variables.