The History, Concepts and Theories of Self-Help Groups: From an International Perspective

The first people in history to demonstrate the power of self-help groups were alcoholics. Alcoholics Anonymous was started in 1935 to help "hopeless alcoholics" recover from alcoholism, something the medical profession had been unable to do. The power of self-help groups to help people suffering from other problems was not widely recognized until after World War II.

In the 1960s, civil right movements began to evolve in many developed countries, as people became aware of their collective power. These power-to-the-people movements provided avenues for the development of the self-help group movement (Vattano, 1972). In Japan, people who had come to enjoy a free society welcomed "the peak of circle movements" in 1955 (Ôsawa, 1976), and, influenced by Western civil right movements, they promoted the establishment of similar movements.

In the 1970s, the emphasis moved from mass movements to small group movements in some countries. In Germany, people began to be more interested in their ordinary lives than in political abstractions (Moeller, 1978) while in Japan, people with disabilities and chronic illnesses started to spend more energy on activities within their local communities rather than on political actions against the central government (Osa, 1991, pp. 43-45; Tsuda, Kida, Yamada, & Saitô, 1977, pp. 62-67). Moreover, by mid-1970s welfare states were being challenged by criticism of their rising public expenditure and inefficiency, while international economic growth rates were declining due to rising oil prices (George & Page, 1995, pp. 8-10).

Then in 1976 a strange coincidence occurred. In North America, two edited books (Caplan & Killilea, 1976; Katz & Bender, 1976) and two journal issues (Borman & Lieberman, 1976; Riessman, 1976) written by social scientists appeared which featured self-help groups. In Japan that same year, a voluminous edited book on "small grassroots groups" was published with detailed reports on various groups, including self-help groups for people with disabilities (Shisô no Kagaku Kenkyûkai, 1976). In 1977, in the UK, and in 1978, in Germany and Belgium, research books on self-help groups were published that were clearly influenced by the studies in North America (Brankaerts, 1983; Moeller, 1978; Robinson & Henry, 1977) and in 1979, Japanese psychologists published a book on self-help groups, and introduced the studies of North America to Japanese readers (Murayama & Agari, 1979).

In the 1980s, self-help support systems such as self-help clearinghouses, which provided information and referral services linking the public with the groups and assisted groups to develop, were established in North America and Germany (Matzat & Estorff, 1989; Oka, 1992; Wollert, 1987). In our opinion, it was at this point that these countries and Japan went their different ways. Although Japan had as many self-help groups as North America and Germany, it has never established any self-help clearinghouses with paid staff. Even today, Japan has only a few volunteer-based self-help clearinghouses and paid-staff-based clearinghouses catering to a limited client base, such as a women's clearinghouse (Oka, 1994a).

Another characteristic trend of the 1980s was the development of international networks of self-help supporters. In 1980, the Regional Office for Europe of the World Health Organization established a Copenhagen-based working group on self-help and health. This resulted in an international report on self-help (Hatch & Kicbusch, 1983). In 1983, another international report was published which covered self-help groups in countries, including the UK, Germany, the US, Canada, and New Zealand (Pancoast, Parker, & Froland, 1983). As a result of this internationalization and other factors, in 1992 an international conference in Ottawa, Canada, attracted people not only from North America but also from Europe and East Asia. Two years later, the conference research committee (a Canadian, American, and an Israeli) edited a book published with papers from the conference including ones from Eastern Europe, Japan, Israel, and Hong Kong (Lavoie, Borkman, & Gidron, 1994).

In the 1990s, a new trend appeared: online self-help groups (Madara & White, 1997). Going on-line has contributed to the self-help group movement in the following ways: first, the Internet has made it much easier for people to communicate with each other especially those who are separated by great distances. International interactions have increased (our co-authorship, for example, would be impossible if we were unable to use the Internet), and people with very rare and special needs, who naturally live great distance from each other, can now easily form groups. Second, by using searching engines, people can easily find out if groups they would like to participate in exist as long as they have web pages.

Although self-help groups have been formed in both the developed and developing countries, research about them has mainly taken place in Western Europe and North America. One of the widely known definitions of self-help groups is a product of a national workshop on self-help and public health that the US Surgeon General convened in 1987. At that workshop, a consensus of delegates provided the following definition of self-help groups: They are

self-governing groups whose members share a common health concern and give each other emotional support and material aid, charge either no fee or only a small fee for membership, and place high value on experiential knowledge in the belief that it provides a special understanding of a situation. In addition to providing mutual support for their members, such groups may also be involved in information, education, material aid, and social advocacy in their communities. (Surgeon General Workshop, 1988, p. 5)

Although both definitions of self-help emphasize health problems, we should note that the members of some self-help groups share circumstances other than health concerns. They may be single parents, for example, or members of sexual minorities or ethnic minorities who conduct social advocacy for their so-called "cultural rights. They should have " the right to define themselves, and to name themselves, to give voice to their experiences as valid" (Borkman, 1999, p. 62). These cultural rights are related to "the liberating meaning perspectives", as mentioned below.

As well as self-help groups, there are also "support groups" and it is important to understand the difference between these two. Although some authors have called support groups "professionally-led self-help groups", the terminology has now been standardized so that support group means a group in which the ultimate responsibility for group management lies not with group members but with supporting professionals (Kurtz, 1997), although participants may also share their experiences and support each other. This differentiation may be vital for Japanese professionals because many Japanese authors seem to have confused the two. Self-help groups are, in theory, member-owned and independent from professional control, however, this does not mean that they do not have relations with them. On the contrary, successful self-help groups work in close cooperation with related professionals.

Another important development has been the "self-help agency", which "provides services in exchange for fees but relies primarily on the experiential knowledge of self-helpers" (Borkman, 1999, p. 19). In Japan the number of self-help agencies is growing rapidly. Many of them are called "Independent Living Centers" for people with disabilities, where paid staff help people who have disabilities to live independently outside residential institutions and without parental care. Although some self-help groups are working in cooperation with self-help agencies, the leaders of self-help groups are not paid and all of the groups' services are provided free of charge.

Extensive discussion about self-help groups has continued since the 1970s, and many theories about them have evolved. Because there is insufficient space in this journal to discuss them all, we will introduce some of the more important views and research trends.

First, the "helper-therapy principle". This was coined by Riessman (1965, p. 27) and asserts that "while it may be uncertain that people receiving help are always benefited, it seems more likely that the people giving help are profiting from their role." People who are suffering from their own difficulties find that their painful experiences can help others in the same boat, thus enabling them to realize the humanitarian or existential meanings of their experiences. Additionally, people can deepen their understanding of their own problems by helping others in similar circumstances.

Second, "experiential knowledge." In early studies of self-help groups, it was asserted that a dichotomy existed between professional and non-professional help (for example, Riessman & Gartner, 1976), with non-professional help consisting of a jumble of self-help and lay help. Instead, Borkman (1984) proposed a trichotomy of helping perspectives: professional, lay, and experientialist. According to Borkman, what differentiates lay people and members of self-help groups is "experiential knowledge." This theory implies that it takes considerable time for new-born self-help groups to become fully-fledged unless "experiential knowledge" developed by other groups is made available to them, because "experiential knowledge" is developed by accumulating the experiences of many people who have undergone various aspects of the common difficulties. This theory concurs with an assumption of Oka (1999) that "continuous activity" is one of three essential foundations of self-help groups, the others being "common experience" and "spontaneous participation."

The third idea focuses on the special perspective of the problem or predicament and its resolution that self-help groups develops that are different from medical or professional views of their problem. Antze (1976) called it "ideology" and Kennedy and Humphreys (1994) used the term "worldview." Borkman (1999) expanded on these ideas to emphasize that the alternative perspectives are "liberating meaning perspectives," that is, they are less likely to be stigmatizing, and more likely to be constructive, positive, and view the members in a dignified and respectful manner than professional perspectives. This idea is also related to "emancipation from suppression", which Oka (1999) proposed as one of "the three basic processes and qualities of self-help groups", the others being "sharing" and "individual independence." Professionals are often unaware that their technical perspectives are stigmatizing, dehumanizing, or implicitly negative about living with the condition. Qualitative research, rather than quantitative or conventional research, is needed to explore these perspectives.

The fourth idea is based on the view of self-help groups as voluntary organizations, not as a form of therapy or treatment. Borkman (1999, p. 17) states that "the social science literature on self-help / mutual aid has taken a disproportionately therapeutic and individualistic perspective, focusing on such questions as how individuals are benefited by their participation in a group."

The advantage of the voluntary action perspective is that it more clearly distinguishes self-help groups from government-controlled or professionally-controlled groups or health foundations that are set up for people with a problem like diabetes but diabetics do not control the organization -- professional managers, or health professionals or government types control the organization. The voluntary action perspective also focuses on organizational issues such as leadership, leader burnout, lack of members willing to contribute to maintaining the organization, problems recruiting or retaining members, etc. which the treatment and therapy perspectives does not. The voluntary action perspective also points to questions of how do self-help groups contribute to society, to building social capital or to changing professional practices.

Despite many cultural and historical obstacles (Oka, 1994b), Japan is undoubtedly an area in which self-help groups are very active and successful, however very little is known outside of Japan about the research that has been done on Japanese self-help groups. Because many aspects of Japanese culture are quite different from Western cultures, the studies of self-help groups within Japan would contribute significantly to the clarification of those features that remain in common despite cultural differences.