Social causes of illness

Press, 11 August 1979, Page 10

Social causes of illness

Social Causes of Illness. By Richard Totman. fravenir Press, 1979. 256 pp. $15.15 (hardback); $11.30 (paperback).

(Reviewed by Ralf Unger). Psychosomatic illness — physical symptoms caused by psychological factors without the presence of a discernable physical dis-< ease — is extremely com-< mon, not only in doctors’ surgeries and hospitals, but in the community’s everyday miseries of life. In this book a social psyvi.jlogist links the development of such disabilities to the difficulties which people have in living in association with oneanother.

In a survey of the history of medicine, Dr Totman concludes that the major and most expensive part of medical technology applied today appears to be used much more for the satisfaction of the health professions, than for the benefit of the coni sumers of health care.

Improvement of health in the past, when looked at realistically, has been brought about by social factors rather than medical measures, which have made quite a marginal contribution, according to Dr Totman.

The physical aspects of a disease, the organic manifestation, may be quite a late stage in an

underlying dysfunction following particular types of life experiences. Here he calls upon the “cognitive dissonance” theory which he parai phrases as: “After a person has made a decision he will tend to justify itHe is under a kind of teni sion which he seeks to rei duce by finding or coni cocting reasons for what he did.” From this the author argues that the psychological factors which contribute to the risk of illness are not simply in physical attributes of people’s environments such as noise, or the stresses of fast, -modern urban life. Blame must also attach to personal

social factors, such as bereavement, residential moves, and retirement. People are looking all the time for consistency of response in the world about them. If this breaks down, symptoms are likely to appear.

People have ideal life situations in mind; if these are suddenly disrupted, and people are brought back to reorganise their psychological defences, they are vulnerable to psychomatic disorders. Personal commitment is somehow related in a crucial way to mental health and to the absence of possible physical symptoms. Thus, the way in which the individual relates to society and sustains a sense of personal identity and worth is crucial.

If a person’s involvement in various classes of activitity declines, such as does in retirement, the likelihood of his . becoming ill increases correspondingly. Broadly, the hypothesis is based on a social readjustment rating scale first designed by HolmesRahe. This, in 1972, had a good deal of publicity as a means of indicating various point scores for important events in a person’s life such as the death of a spouse, a son or daughter leaving home, jail, trouble with a boss, and so on. These could then be added up to predict the risk of the person’s psychological disturbance.

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