Fostering Ontological Security through Social Affiliation: Implications for Recovery

Objective. The concept of ontological security was originally developed to explain how persons with schizophrenia lack a sense of trust, continuity and security in their lives (Laing, 1960). Although expanded by Giddens (1990) to understand the challenges of all individuals living in modern society, the theory of ontological security has been primarily applied to research on the benefits of having (and owning) a home (Hiscock et al., 2001). Padgett extended the theory's application to understand the importance of ‘home' for adults with mental illness who transitioned from long-term homelessness to their own apartment (2007). This paper builds upon earlier work to examine: a) whether and how the social environment operates as a source of ontological security for newly housed homeless adults with serious mental illness; and, b) how if at all social environmental factors enhance mental health recovery.

Methods. This report analyzed in-depth interviews with 41 participants who took part in the New York Services Study, a qualitative study of new enrollees at programs for homeless adults with serious mental illness and co-occurring substance abuse. Qualitative analyses used ‘template' coding (Crabtree & Miller, 1999) in which a priori concepts were applied to the qualitative data to examine whether and how participants' descriptions of their social relationships were linked to four conditions of ontological security defined by Dupuis & Thorns (1998): (a) constancy, (b) daily routines, (c) sense of control, and (d) identity construction. Following template procedures, coded excerpts associated with these conditions were analyzed to determine their fit with the over-arching theory and their connection to recovery indices such as improved mental functioning, control over substance abuse, and a sense of hope and well-being.

Results. Participants' descriptions of their social relationships were consonant with the four dimensions of ontological security but the latter needed to be redefined. These dimensions were re-conceptualized as (a) constancy: relationships with uninterrupted contact (or dependability and reliability even in the absence of contact); (b) daily routines: relationships in which others facilitate the fulfillment of daily activities by providing instrumental assistance, or that offer social affiliations that make routines more meaningful; (c) control: relationships where one has a say over the terms of the relationship or feels free to be oneself; and (d) identity construction: relationships with individuals with whom one shares commonalities or that one views as positive role models. The pursuit of ‘social ontological security' both facilitated and inhibited recovery since social contacts could be negative (e.g., drug-users, exploitive, abusive partners) as well as positive.

Conclusions/Implications. This study found that consumers' relationships contribute to a sense of ontological security in several positive ways, but that the benefits of having such security can sometimes hinder consumers' ability to change negative relationships or move forward in recovery. Recognizing the complex linkages between ontological security and recovery can shed new light on the importance of social relationships and help service providers better assist consumers as they negotiate their changing relationships within a recovery process.