Macrosocial change, the health professions, and a scientific basis for cooperation with other professions and groups in the public sector.

Michael Macpherson
Psycho-Social and Medical Research (PSAMRA) Berlin FRG


Based closely on a paper accepted by the Scientific Committee and presented during the Second European Conference on Traumatic Stress - Prevention, Coping and Treatment. Noordwijkeerhout, Netherlands 1990. Modified 1993 and 1998.

People the world over are aware of events and processes such as war and the threat of war, pollution, and destruction of the environment or oppression of one group of human beings by another. The problems, faced by all of humanity, appear to require much innovation in research by academics and increased cooperation by them with colleagues, officials, politicians and other citizens. The involvement of people in macrosocial change may be direct, as in war or political oppression, or indirect, as illustrated by the fear of nuclear power plant accidents among young people and the threat posed by depletion of ozone from the earth's atmosphere. The stress-related, psychosomatic and sociopathic components of macrosocial change, should they be identified, would fall into the area of responsibility accepted by medical scientists and those working in health care. When human interactions with macrosocial events and processes become stressful then the term macrosocial stress may be used.

This essay has several purposes. It will show the importance of macrosocial change for the health professions by mentioning some relevant events and circumstances in the macrosocial sphere and by reporting on some initiatives which health professionals and their societies have made. Some problems involving the macrosocial sphere, which have been referred to in such terms as "This web of global problems" (Peres de Cuellar, former Secretary General of the United Nations Organisation)(Cuellar 1987) or "global crisis" obviously have complex causality and are not amenable to solution by any single group of scientists or professionals. By showing how macrosocial change can be included in the bio-psycho-social model of health, behaviour and disease a theoretical basis for investigation and prevention of harm will be illustrated. Given the "web of global problems" the necessity for intensified interdisciplinary cooperation among academics and better cooperation of them with people and groups in non-academic sectors of public life is probably widely accepted although seldom put into practice. In the essay I will propose that a bio-psycho-social model which, as it arguably must, includes the macrosocial sphere, can provide a theoretical basis for new forms of human cooperation in scientific and prophylactic initiatives to protect human well-being, to both help improve the quality of everyday life and increase the chances of survival of life on this planet.

The universities and other institutes of higher learning have been accused of ignoring or being helpless to respond to vital problems such as the destruction of our life-supporting environment by large-scale technical, industrial and agricultural activity, by ongoing wars and the threat of all-destructive nuclear, biological and chemical war. Global and societal problems such as widespread starvation and curable or avoidable disease, oppression of minorities and women and other abuses of basic human rights have, it is argued, been neglected. A development of the psychosomatic approach to health offers insights into how these academic sins of omission may be corrected. The psychosomatic tradition has contributed to introducing the concept of a bio-psycho-social theory which can improve our approaches to studying behaviour, health and disease and which provides guidance for protecting human well-being. Bio-psycho-social theory is scientifically based and therefore underpins, can provide support for older concepts of wholism. It can lead to a view of the human being not only as a passive subject of disease or misfortune but also as an actor in and integral part of her or his environment. When we consider social interactions, this environment includes the microsocial (partner, family, friends, colleagues) and extends to the macrosocial (the global, international, state, national and cultural" plus political constellations, groups and processes). Macrosocial events, circumstances and processes (shortened to macrosocial change) can obviously interact with or intrude into people's everyday lives, often through the mass-communication media. Sometimes the intrusion can be more direct, such as when nuclear missiles, originating in global or international processes, are stationed near people's homes. Other threats, such as those of a corrupt political system or of racial discrimination, may be more subtle.

The consideration of macrosocial change has become a widely but by no means universally accepted responsibility of health professionals. A few examples of practice, research and scientific conferring will be given.

The medical and psychosocial care of victims of oppression requires a detailed and sensitive awareness of the circumstances of the social or political conflict involved. Examples of this type of practice are the special units for victims of war, of prisoner of war and concentration camps which are to be found in the Netherlands, the United States and Israel. Centres for the care and rehabilitation of victims of torture, usually politically motivated, have been established in Denmark, Paris and London and one is proposed for Berlin. Robert Jay Lifton, in his famous study of the survivors of the atomic bombing of Hiroshima, showed lucidly how macrosocial change can lead to long term human stress (Lifton 1967). For many years, until Lifton's work in the 1960s, the psychological suffering and social isolation of these survivors, the "hibakusha", had been neglected by health professionals.

The effects of war and other forms of violence on human beings have been subjects of medical study and concern for centuries. The periodic modernisation of the medical curriculum is an obvious necessity. During the 1980s, aspects of human ecology and polemology (the study of conflict) were introduced into the curricula of some medical schools and universities, an example being the military applications of nuclear technology and its psychological implications. Distinguished medical journals have recently published articles on the physical and psychosocial implications and effects of modern war and the World Health Organisation has commissioned (1987) an authoritative report "The effects of nuclear war on health and health services" which includes a section entitled "The psychological aspects of nuclear threat and nuclear war: analogies from disaster research"(World Health Organisation 1987).

It is correct that prophylactic aspects, aiming to show how conflict and harm to human health and environment may be avoided, are emphasised in medical polemology, especially in teaching students. Had this science of peace and conflict resolution been more widely studied (for instance, as proposed in the early 1980s and before by physicians (f. Uebersetz.: Mediziner) and their organisations) then subsequent conflicts such as outright war in the Middle-East and Jugoslavia might have been mitigated or avoided.

Major conferences of health scientists and health professionals have devoted substantial parts of their programmes to aspects of macrosocial change and its meaning for human life and well-being. The 17th European Conference on Psychosomatic Research, Marburg, Federal Republic of Germany, 1988, was entitled "Physician in the 21st Century: new paradigms to cope with specialisation and to promote health". A symposium, "Social stress and psychosomatic health", held during the Marburg conference, covered topics such as psychosomatic disease during the Nazi occupation of the Netherlands, the psychosocial consequences of a serious accident in the London Underground railway, the psychic and behavioural effects, in Germany, of the Chernobyl nuclear power plant disaster. Thus, in Marburg, developing a psychosomatic tradition, research about human involvement in both macrosocial and smaller scale events was presented. At the World Congress for Mental Health in New Zealand, 1989, a major session, "Global Issues", addressed social and health aspects of changes and threats to the geo- and biosphere. Topics included international research about the socio-political fears of adolescents and the social effects of ozone depletion and climatic changes.

The study of macrosocial change and its relationship to human health, coping and behaviour is part of a developing body of documentation, analysis and research which may be referred to as "the human dimensions of global change". As well as the natural and man-induced physical phenomena of global change, as studied by natural scientists, intensified research and effective public education about the the human involvement in producing such change and human psychic and behavioural responses to it are needed. Human interaction with global change can be classified under the term "macrosocial".

Beginning in 1980 the group and networks associated with Psycho-Social and Medical Research carried out research and promoted public debate into certain critical "human dimensions of global change".We have studied in fields such as

"the human costs of nuclear war" ( Macpherson 1983" Howe & Macpherson 1984),

"political, macrosocial and environmental perceptions, coping strategies and political behaviour" (Macpherson, Boehnke, Fromberg 1990" Boehnke, Macpherson, et al 1989a" Boehnke & Macpherson 1989b),

"trauma of political oppression: towards collective healing" (Macpherson 1992),

"democratic systems and citizen politics, with reference to environmental change" (Macpherson 1996, 1997a, 1997b).

Towards the end of the 1980s an international group in which natural, social and medical scientists were represented made proposals for an ambitious project on "the human dimensions of global change". The proposers, who report to the Secretary General of the United Nations, write "Dramatic, threatening, and possibly irreversible changes in the environment result from past and present human activities. Such change leads to serious impacts on human conditions, with the risks of compromising prospects for life in the future. (We have) therefore resolved to initiate a research programme to investigate both the human causes and consequences of global environmental change. The objectives of the research programme are: to improve scientific understanding and increase awareness of the complex dynamics governing human interactions with the total earth system" to strengthen efforts to study, explore and anticipate social change affectinng the global environment...". One of their aims is "To foster a global network of scientists and other concerned parties, and to encourage this network - in collaboration with other relevant research initiatives - to engage in research directed towards the dynamics of human interactions with the global ecosystem.".

The success of projects which address the human dimensions of global change would be expressed in the reversal of dangerous global trends and in the prevention of conflict and catastrophe.

The above examples of practice, conferring and research show that some health professionals have begun to treat the complex interactions of human 1ife with macrosocial processes as belonging to their field of professional concern. Most scientists and other informed citizens would accept that, given the complexity and scale of the problems faced, better and greater cooperation among different academic, professional and societal groups is urgently needed.

Some practical consequences of macrosocial change for health professionals and their potential cooperation partners (e.g. colleagues of various disciplines, academic and professional organisations, other institutions and public citizens) are as follows:
1. For the successful practice of, for instance, occupational medicine, learning about the conditions in factories and other places of work is an obvious and accepted necessity. By analogy, life, health and disease in the modern world can only become adequately understood by taking all relevant aspects of the human environment into account. Consequently, education and postgraduate training for health professionals must include learning about the interactions of human beings with both their global (macro-) as well as more local (micro-) environment.

2. Research is needed to provide better understanding of the psychic (mental), psychosomatic and social ramifications of macrosocial change. For example, the complex interactions of health, coping, behaviour, micro- and macrosocial environments are poorly understood. Clearly, interdisciplinary cooperation is essential here.

3. Macrosocial change is a proven and potential cause of human stress. Thus, in following their duties to promote health, to prevent, diagnose and treat disease, health professionals must more intensively consider, investigate and intervene in the macrosocial sphere. Again, new forms of cooperation are needed.

4. A multi-country, multidisciplinary research and public education effort is required in order to reverse destructive trends in local and global environments, in war, human suffering and starvation. Health professionals can and should play vital roles in helping to initiate and to carry out this work.

In conclusion, the bio-psycho-social model of behaviour, health and disease leads us to question paradigms, or established ways of thinking and behaving, which limit our fields of inquiry to isolated systems. For instance, considerations of health and disease as problems only of the individual ("patient") are put into question. Neither microsocial nor macrosocial factors in her or his life may be neglected. Investigative, therapeutic and prophylactic approaches to health can no longer ignore the social or physical environment. As well as the social "atmosphere" at work or in the family, climatic changes such as the anthropogenic "greenhouse effect", the threat of violence or war , the person's relationships in a multicultural society must be considered. Changes in the geosphere, in relationships between countries, inter-cultural conflicts, have all been produced by collective human actions and can be improved by corrective human behaviour. (This "corrective" behaviour may have better chances of success if it expresses the ideals of caring and healing, often attributed to the nursing and medical professions, diffused through societies.) The relationships of these latter events and circumstances in the macrosocial sphere to microsocial processes and individual human lives can scientifically be considered in the bio-psycho-social model. For example, changes in the geosphere may be treated as dependent or independent variables interacting with human life: e.g. with aspects of thought, behaviour, health and disease. Limits to investigation or research set by academic disciplinary boundaries need to be set aside in order that we have a chance of finding solutions to macrosocial problems. Restrictions to therapeutic or preventive interventions imposed by custom or convenience in the practice of health care are put into question. Effective - therapeutic or prophylactic - intervention, whether at the micro- or macrosocial levels, becomes a matter of individual and collective will, of finding ways and means, of experiment, innovation and cooperation, all of which may be guided by bio-psycho-social insights into what will benefit our fellow human beings.

References

Boehnke K., M.J. Macpherson, M. Meador, H. Petri. (1989a) How West German adolescents experience the nuclear threat. Political Psychology 10(3), 419-443.

Boehnke K. & M.J. Macpherson (1989b) (The influence of nuclear threat on political involvement - literature overview and intercultural comparison.) Zum Einfluß atomarer Bedrohung auf das politische Engagement- Literaturübersicht und interkulturelle Vergleichsstudie. In K. Boehnke, M.J. Macpherson & F. Schmidt (Hg.), Leben unter atomarer Bedrohung. Probleme und Ergebnisse internationaler Forschung. Heidelberg: Asanger.

Cuellar, J.P. de (1987) Annual Report of United Nations Secretary General.

Howe T. & Macpherson M.J. (1984) Childhood and adolescent perceptions of war and the threat of nuclear war. Association for child psychology and psychiatry- Newsletter, 6(2), 21-24.

Lifton, R.J. (1967) Death in Life: Survivors of Hiroshima. New York: Simon and Schuster.

Macpherson M.J. (1983) Psychological aspects of the nuclear war threat: The development of a research agenda. In S. Farrow & A. Chown (Eds.) The Human Cost of Nuclear War. Cambridge, U.K.: MCANW, 154-159.

Macpherson M.J. (presenter), K. Boehnke & E. von Fromberg. (1990) Macrosocial stressors and youth: a longitudinal questionnaire study in the Federal Republic of Germany. Lecture in the symposium "Macrosocial stressors, family and education" organised by M. Macpherson during the 2nd European Conference on Traumatic Stress, Noordwijkerhout, Netherlands, September.

Macpherson M.J. (1992) Working through the trauma of political oppression.
http://www.snafu.de/~mjm/verg-b.html

Macpherson M.J. (1996) Citizen participation in politics and the new communication media. (With reference to environmental change) http://www.snafu.de/~mjm/CP/cp.html

Macpherson M.J. (1997a) La participación ciudadana en política y los nuevos sistemas de communicación. Psichologia Política, No.14 (May), 77-119. Resumen: http://www.snafu.de/~mjm/res.html

Macpherson M.J. (1997b) Citizen politics and the renewal of democracy. Published as "On-line Democracy: Citizen politics and the media". Bulletin of the European Institute for the Media (Düsseldorf) Vol. 14, No.4, December, pp.3,4,16.
(With reference to environmental change and with WWW links to initiatives in Europe, south and north America, Asia) http://www.snafu.de/~mjm/CP/cp2.html

World Health Organisation (1987) Effects of Nuclear War on Health and Health Services. Second edition, Geneva.

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Dr. Michael Macpherson,
Integral Studies,
Guildford and Berlin

e-mail: mm@iniref.org

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