Sense of Belonging: A VitalMental

Health Concept
Bonnie M.K. Hagerty, Judith Lynch-Sauer, Kathleen L. Patusky,
Maria Bouwsema, and Peggy Collier

Sense of belonging is a concept that has not been researched in psychiatric

nursing practice. Using a concept-analysis strategy proposed by Waker and
Avant, the authors present a detaiied description of the concept that evoived
horn a series of inductive and deductive strategies. Sense of belonging is defined
as the experience of personal involvement in a system or environment so that
persons feel themselves to be an integral part of that system or environment.
Sense of belonging has important appticabiiity for clinical use as weii as contin-
ued theory development in psychiatric nursing.
Copgrtght 0 1992 bg W.B. Saunders Company

I N AN ACCOUNT OF her experiences as a

young woman with a diagnosis of schizophre-
nia, Sylvia Frumpkin asks, “Is there no place on
concept to be identified and examined. The steps
in this process are selection of a concept and de-
termination of the aims of the analysis; identifica-
Earth for me?” (Sheehan, 1982). Psychiatric tion of the uses of the concept; determination of the
nurses hear similar statements regularly from cli- defining attributes; construction of a model case;
ents who are psychotic, depressed, anxious, or sui- construction of borderline, related, contrary, and
cidal: “I don’t fit in anywhere . . . I feel so un- invented cases; identification of antecedents and
important to anyone . . . I’m not a part of consequences; and definition of empirical refer-
anything. . . .” ents. Sense of belonging is examined here using
The impetus for these types of statements has this process of concept analysis.
been attributed to a number of psychological con- The analysis presented here is based on the au-
cepts, including loneliness, alienation, and hope- thors’ efforts to build a conceptual model of human
lessness. However, upon closer examination such relatedness using both inductive and deductive
statements appear to reflect a unique phenomenon strategies. This methodology is in concert with the
that has received little attention in the mental hybrid model of concept development described by
health literature, sense of belonging. Using a con- Madden (1990). The hybrid model consists of (1)
cept-analysis strategy outlined by Walker and a theoretical phase with literature review and de-
Avant (1988), this article presents an analysis of velopment of working definitions, (2) a fieldwork
the concept of sense of belonging and describes its phase for data collection and clinical observation,
potential relevance for psychiatric nursing. and (3) an analytic phase in which findings are
Walker and Avant (1988) presented a strategy synthesized to clarify the concept. Over a period of
for concept analysis that enables the attributes of a 2 years, we developed clinical case studies based
on observations and conducted small-group inter-
views with psychiatric nurses. Subsequently, we
From the School of Nursing and Department of Psy- initiated an integrative research review of more
chology, Univetsi~ of Michigan; and the Veteran’s Ad-
ministsation Medical Center, AM Arbor, MI.
than 2,500 articles to synthesize information per-
Address reprint requests to Bonnie M.K. Hager&, Ph.D., tinent to belonging and human relatedness. Con-
R.N., 2352 N Ingalls Building, School of Nursing, The Uni- currently, we conducted a series of four focus
uersi& of Michigan, Ann Arbor, MI 48109.
Copyright 0 1992 by WB. Saunders Company
groups with individuals having no previous psy-
0883~9417l92lO603-OOO9$3.OOlO chiatric treatment history. Analysis of the data

172 Archives of Psychiatric Nursing, Vol. VI, No. 3 (June), 1992: pp. 172-177
SENSE OF BELONGING 173

from all of these activities guided our continued belonging. Anant ( 1967) admitted that the measure
conceptualization of sense of belonging and human may have tapped dependence rather than belong-
relatedness. ing.
Anecdotal accounts of belonging are numerous
LITERATURE REVIEW
in the literature. Dasberg (1976) identified lack of
A pervasive human concern is establishing and a sense of belonging as the common denominator
maintaining relatedness to others, social institu- in the mental breakdown of Israeli soldiers during
tions, environments, and self (Berlin & Johnson, war. Every battle-stricken soldier described feeling
1989; Birtchnell, 1987; Gilligan, 1982; Wynne, cut off and uprooted, abandoned, rejected, and
1984). One component of connecting one’s self psychologically severed. Kestenberg and Kesten-
into the fabric of surrounding people, places, and berg (1988), reporting on discussion groups for
things is a sense of belonging. Maslow (1954) individuals who had been child survivors of the
identified belonging as a basic human need, rank- Holocaust, related that many child survivors felt
ing it third in his hierarchy. Anant (1966) posited that they did not belong anywhere in terms of
that belonging is the missing conceptual link in country, social group, or age. The authors noted
understanding mental health and mental illness further that belonging is an important component
from a relationship/interactional perspective. Be- of identity and object relationships. “As the child
longingness is defined by Anant (1966, p. 21) as a grows, he develops a sense of belonging not only
“sense of personal involvement in a social system to the family, but to the community, the nation,
so that persons feel themselves to be an indispen- and a cultural group.” (Kestenberg and Kesten-
sible and integral part of the system”. It is note- berg, 1988, p. 536).
worthy that Arrant emphasized an affective and Some studies alluded to belonging as a compo-
evaluative rather than descriptive perspective of nent of other constructs. Steinkamp and Kelly
belonging. Indeed, recent research on such con- (1987) equated subjective social integration with
cepts as social support and reciprocity suggested feelings of belonging and being loved. Lindgren
that individuals’ perceptions of their interactions (1990) concluded that social support “allows one
and relationships may be far more powerful deter- to believe that he or she is cared for and loved,
minants of social disruption and mental disorders esteemed and valued, and belongs to a network of
than actual network reports (Antonucci & Israel, mutual obligation’ ’ (p. 469).
1986). Building on the definition of belonging pro-
Belonging as a mental health concept has not posed by Anant, we have defined sense of belong-
been discussed or researched widely. Scant litera- ing as the experience of personal involvement in a
ture addresses the concept, and much of this is system or environment so that persons feel them-
narrative rather than empirical. In an early paper, selves to be an integral part of that system or en-
Anant (1966) wrote that belongingness implies vironment. A system can be a relationship or or-
recognition and acceptance of a member by other ganization, and an environment can be natural or
members in a group. In 1967 and 1969 reports, cultural. Through the process of concept analysis,
Anant described two studies in which the relation- we have delineated two dimensions of sense of
ships between belongingness, anxiety, and self- belonging: (1) valued involvement: the experience
sufficiency were examined. The first study was of feeling valued, needed, accepted; and (2) fit: the
conducted with 47 nursing students; the second person’s perception that his or her characteristics
study was completed with four groups of Indian articulate with or complement the system or envi-
college students who were members of four tradi- ronment. These dimensions are in concert with
tional caste groups. Although the results of both Kestenberg and Kestenberg’s (1988) notation that
studies supported an inverse relationship between belonging implies object relationships (valued in-
belongingness and anxiety and intuitively appear volvement) and identity (fit).
valid, serious methodological flaws attenuate in-
terpretations of Anant’s findings. In addition to USES OF THE CONCEPT
sampling and procedural concerns, there is no in- Walker and Avant (1988) cited the need to iden-
formation on the validity and reliability or on sam- tify as many uses of the concept as possible during
ple items of the tool Arrant developed to measure the initial stage of concept analysis. Belonging
174 HAGERTY ET AL.

should be considered from psychological, socio- sociated with that concept. The model cases pre-
logical, physical, and spiritual perspectives. Psy- sented here depict real instances of sense of be-
chologically, belonging is an internal affective or longing and include all of the defining attributes.
evaluative feeling, or perception. This could best
be described as sense of belonging; that is, a per- A retiring nurse is given a farewell party by her col-
leagues. They tell her how important she has been to
son’s experience of being valued or important to an
them and to the unit. The nurse states that she feels
external referent and experiencing a tit between overwhelmed and proud to be a part of this wonderful
self and that referent. Sociologically, belonging group of nurses. Not only does the nurse feel as though
connotes membership in groups or systems. Using she fits with this group, she experiences being valued by
this perspective, belonging can be observed and the nurses.
described through behavioral referents such as A young man, a liberal Democrat, enjoys talking with
membership in groups and social networks. These his neighbors and feels himself to be an important part of
behavioral referents are the physical signs of be- the community. His neighbors are all conservative Re-
longing. Another connotation of belonging, when publicans. They tease the Democrat but affectionately
used in the physical sense, is the possession of comment that he “keeps them honest in their views. ” In
this example, sense of belonging occurs in spite of ap-
objects, persons, or places. Spiritually, belonging
parent differences because these conflicting views are
depicts a metaphysical relationship with a being or
perceived as complementary characteristics that promote
place that exists at a universal level. fit and value.
This analysis focuses on the psychological as-
pect of belonging or sense of belonging. We pro-
ANTECEDENTS
pose that sense of belonging occurs in relation to
various external referents. These referents include Antecedents are those incidents that must occur
other persons, groups, objects, organizations, en- before the existence of the concept. We propose
vironments (both physical and social), and spiri- that the antecedents to sense of belonging are the
tual dimensions. For example, a person may ex- person’s (1) energy for involvement, (2) potential
perience a sense of belonging with animals but a and desire for meaningful involvement, and (3)
deficit in sense of belonging with people. There- potential for shared or complementary characteris-
fore, discussion of a person’s sense of belonging tics. We posit that these antecedents are vital to the
requires identification of a corresponding referent. identification of deficits in sense of belonging and
subsequent interventions. A client who is experi-
DEFINING ATTRIBUTES
encing major depression, for example, may not
Applying the framework proposed by Walker have these antecedents because of the clinical, bio-
and Avant (1988), sense of belonging occurs when chemical nature of the disorder. Thus, deficits in
the defining attributes, or characteristics of the sense of belonging in clients with major depression
concept, are evident. The defining characteristics may reflect different deficiencies than in clients
assist the clinician to identify when the phenome- such as adolescents or young adults who, from a
non is occurring. Based on the literature review developmental perspective, are actively searching
and analysis of interviews and focus group data, for belonging.
we have derived two defining attributes of sense of
belonging: (1) the person experiences being val- CONSEQUENCES
ued, needed, or important with respect to other
people, groups, objects, organizations, environ- Consequences are incidents that occur as a result
ments, or spiritual dimensions; and (2) the person of the concept. Identification of consequences al-
experiences a fit or congruence with other people, lows the researcher to begin examining relation-
groups, objects, organizations, environments, or ships between the proposed concept and resultant
spiritual dimensions through shared or comple- incidents. The proposed consequences of sense of
mentary characteristics. belonging include (1) psychological, social, spiri-
tual, or physical involvement; (2) attribution of
MODEL CASE meaningfulness to that involvement; and (3) forti-
A model case is an example of the concept under fication or laying down of a fundamental founda-
investigation and represents the characteristics as- tion for emotional and behavioral responses.
SENSE OF BELONGING 175

RELATED CASE evant to the group’s tasks, he went out with the cowork-
ers and supervisor, thinking that it would help him keep
Related cases present concepts similar to the one his job.
being examined but have different attributes, an-
tecedents, or consequences. Some concepts that INVENTED CASE
are related to but different from sense of belonging
include loneliness, alienation, attachment, and af- The invented case depicts the concept under in-
filiation. The following case illustrates loneliness, vestigation in an imaginary situation. This type of
a concept described as an emotional state with un- allegory allows the researcher to examine if the
pleasant, negative connotations. Loneliness im- antecents, attributes, and consequences of the con-
plies a need for another person or group that has cept can be illustrated in a non-reality-based situ-
been disrupted and is discussed in the context of ation.
absence or loss (Copel, 1988; Welt, 1987; Weiss, The toy clown was so excited about being brought
1974; Fromm-Reichmann, 1959; Russell, Cut- home from the store by the little girl. He could now be
rona, Rose, dz Yurko, 1984). with other toys. He had new batteries and could play
games all day and all night. After arriving home, the
Marie moved to a town where she knew no one. The
little girl put him in her room and went off to dinner. The
fiit several weeks she spent much of her time unpacking
toy clown looked around and saw all of the other toys:
and finding her way around. She did spend tune with her
balls, dolls, stuffed animals. Each one was so different,
new neighbors and coworkers, all of whom seemed to
but they were all toys for the little girl to play with.
really enjoy her company. Yet Marie felt very alone,
“Welcome,” said the talking doll. “Another toy for us
unhappy, and isolated without her friends and family.
to play with. We’re glad to have you here. The more the
Marie’s experience with the new neighbors did not nec-
merrier!” The toy clown smiled and knew that he was
essarily relate to fit and valued involvement, but rather
truly home.
to the loss and disruption of relationships with family
and friends.
EMPIRICAL REFERENTS
BORDERLINE CASE
Empirical referents are those observed phenom-
This type of case illustrates only a portion of the ena that show the presence of the concept. For
defining attributes of the concept. Below are two sense of belonging, the empirical referents would
borderline cases. The first presents the experience be (1) statements from the person that he or she
of being valued but not fitting, and the second feels valued, needed, or important with respect to
describes fit but negates being valued. other systems or environments; and (2) statements
from the person that there are shared or comple-
Ann joined a sorority and knew that the other mem-
mentary characteristics that promote a sense of fit-
bers valued her participation. However, all of the
women were from wealthy families and had had very ting with other systems or environments.
different lives than Ann, who grew up on a farm. At These empirical referents reflect the experien-
times, AM wondered if she really belonged in the so- tial, affective nature of sense of belonging. Behav-
rority . ioral observations must be used with caution be-
Mary joined a sorority that her mother and two sisters cause participation, activity, and proximity do not
had belonged to in college. Her mother made yearly necessarily constitute sense of belonging as de-
financial donations to the sorority. Mary knew that she fined in this analysis but are more aligned with
fit in with the women even though she knew that many belonging as defined sociologically. As evidence
of them did not like her or value her presence.
by David in the contrary case presented above, it is
CONTRARY CASE
possible for people to go through the motions of
belonging without incorporating the critical attri-
The contrary case illustrates a situation in which butes of the concept. This is an important factor to
none of the defining attributes of the concept are consider in working with clients who appear to be
present. actively involved but who describe internal expe-
David worked with a group of people who went out riences of deficits in sense of belonging. Thus,
every Thursday night for pizza. Even though David was behavioral observations may be suggestive of
often ignored, did not feel valued by his colleagues, and sense of belonging but cannot be considered defin-
felt that his specific computer skills were not really rel- itive measures.
176 HAGERTY ET AL.

RELEVANCE TO PSYCHIATRIC NURSING This analysis represents an initial effort to de-

velop conceptual foundations for sense of belong-
Analysis of concepts relevant to psychiatric ing as an important mental health phenomenon.
nursing allows us to develop and advance the con- Continued analysis of the concept and develop-
ceptual foundations on which we base our practice. ment and testing of empirical measures will be
Through identification of phenomena, definition of necessary for further refinement. Psychiatric
concept attributes and characteristics, and genera- nurses, as well as nurses in other specialities, pro-
tion of theory, psychiatric nurses will be able to vide care daily for clients whose sense of belong-
reframe and augment practice approaches from a ing is an issue. Theory generation and subsequent
tested, scientific perspective (Hall, 1988). Theo- clinical application will assist nurses in maximiz-
retical analysis of the characteristics of sense of ing their impact on the client’s well-being.
belonging allows researchers and clinicians to dis-
cuss the phenomenon and to develop further a base ACKNOWLEDGMENT
of knowledge on which to build relevant applica- The authors acknowledge the Office of Vice-President
tions with clients. for Research and the School of Nursing Biomedical Re-
We assert that sense of belonging has important search Committee for their support of this project.
applicability for clinical use. Clients can be as-
sessed for the extent to which they show sense of REFERENCES
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SENSE OF BELONGING 177

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