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The family today
PUBLIC
HEALTH
The Journal of the Society of Medical Officers of Health Vol. LXXX
July 1966
No. 5
THE FAMILY TODAY IN taking as its theme various aspects of family health, this year's Annual Symposium broke new ground and highlighted some interesting problems. Broadly speaking, it set out to ask what are the social service needs of the family today and how these can best be met. From the start it was very reasonably assumed that the family, while it is ~till that organ of society which has been developed to take the major share of c:tring for the child in his years of immaturily. cannot be asked to undertake responsibilities beyondits scope, and that the bringing up of children in the twentieth century is a matter for partnership between the family and the community. It is not possible to set down any rigid guiding lines tbr that partnership, since there is such a wide range of variation between families, but for that very reason there is a need for understanding people and agencies who wilt help the family to asses6 its problems and work out the way in which the partnership should operate in the particular case. The speakers in the opening session, John and Elizabeth Newson, have for some years been studying family patterns and behaviour from an angle which is unfamiliar to the health services, and their picture of the changes in the health and social service approach which have taken place in the past thirty or forty years was most enlightening. The moralistic-authoritarian approach of the last century has long been viewed with a mixture of amusement and deprecation, but the medical-authoritarian approach of the nineteen-thirties was no less authoritarian even though it was more down to earth. There is no inherent vice in authority, provided that it knows when to moderate its tones, but it tends too easily to set into a dogmatism. He who speaks with authority because he really knows is, one hopes, likely to modulate his voice as he comes to know more. He who dogmatizes because he thinks he knows may easily become a misleader instead of a leader. The most dangerous teachers and advisers, however, are those who take refuge in dogma because they are afraid that they do not know. It is indeed tempting to draw a parallel between the progress of child care in the past half-century and the progress of religion over a somewhat longer
210
PUBI,.IC tll!.\l.,lll \:OL. I.XXX NO 5
period. Certainly one has seen much of the ellk'cts of defensive dogmatism with the degeneration of once purposeful practices into rituals without much meaning. Sooner or later this is follmved by a questioning of their value, and it is but a short step fi'om rejecting the ritual itself to rejecting the essential values w,hich lie behind it. In child xvdt'are ~Yo!'kan agnostic phase is being l~llowed hy a downright atheistic one, with the picture made rather more padaetic by the ~;t,,' in which a sceptical generation still seems to find some comfort in certain clinic rituals, even to a point at which these are demanded by the consumer against the considered advice of the progre,,~ivc doctor and nurse! There is nothing new in this kind of phenomenon. Ju~;I a~ il is bad for human beings to be held on too tight a rein all the time. so it is dangerou,, for ti~em to have no fixed points fromwhich to take their hcarings':when lhev arc xenturing out into the unknown. There is much scope for argument as t(, ~hcther a permissive home atmosphere in early childhood does or dt~s not conduce to sociai and emotional instability in adolc.,cence. On the one hand it is true that a generation of adolescents apparentl'r sho~ing an unusual amount of in,,tability ha,, been brought up during the yea:, in ~hich the doclrine ~q" pcrm!s-,ivencss has been vigorously promuh...,ated. On the other hand. it is no le,;s true lha! the ad~lescent of today is exposed to social pressures outside the home of a ~arietv and an intensity without precedent. Some instability in adolescence is normal, and oilc might ~ie~ the preternaturally sober young person with a degree of disquiet. There are dt.mlo ~ in the public health service who are o.ld enough to ha~e ~alched several :mcccssive crops of youngsters gr,:)x~ing up and can recall hm~ many of llmse ,wet whom grey heads were shaken in despair came through in the end ~o stability and responsible parenthood and citizenship. We are glad that those contributor.,, to the symposium who were specially concerned with adolescence were not too pessimistic in general. The)' were prepared to see most of the common errors of youth as part of a process of learnine by experience, and te accept as a commoF~ failing the refusal of human being~ of all ages to prolit tull.~, by the mi~take~, which their predecessors have made. if the years of adolescence may be taken as the years of social birth, then it is probably logical to think of analgesia as better than antesthe.,,ia as a routine measure--the pains are not to be eliminated but they may be rendered tolerable. Professor Mays had some ingenious suggestions to make to this end. As with the pains, so with the risks; if they can be brought within the individual's capacity for survival they' may in the end do good rather than harm. But there are undoubtedly certain risks which are unacceptable. The phenomenon of widespread drug-taking, beginning even in the school years, is a new and frightening thing. Presumably it is only one of many aspects of youthful behaviour which are essentially symptoms of a feeling of one or other kind of inadequacy, btlt it is a special one. Sartorial eccentricity, row:liness, vandalism, and general lack of consideration for others would all seem, from past experience, to be
I I)I I ( ) R I A I .
211
transient and to leave no ill-effects in later life in the majority of cases. Drugtaking, however, can lead to habit-fbrming and thence to true addiction, and ma.v d,~ permanent ph.w,ical as well as emotional damage. Dr Glatt's paper* is ,me I~articulmly w~rthv of scrit~us ~tudy as a specially clear survey of the situatic,n. l h c treatment ~,I"addiction will ha~.e to be undertaken, an~l~ no doubt, there n',,~l bc legal and other action !,,~reduce the risk of drugs get!i~g into the ;~r~.,rzg hztrJds. Basically, h~:~wevc~,~c arc faced with symptoms of a sickness to youth ~ithin a socict~ which is hy no means healthy. In helping tile other vull~crablc er,~ups within the community, public health I.~as cot~ccrncd it~,clf I~ol,]J with ,aiding tile iodividual and with modifying the ,~ci:~l cnvir~mtlcnt. The fall in the i~ffant mortality rate has been due to prosi~,i{~n I,.~r the carc ~',f the individu~d infa!~t, to the education of parents, to therapeutic "tdvz,ncr but perh:q~, m,~st of all to social progress -in those field,, ~tlch as hot,sing, which ha~c obvious l'ealth connotations, and those ~hich arc indirectly involved il~ hcallh, like the promotion of full employment . and the devclopmc~:t of social sccvrity. "l-he elderly--the vtdnerable group pro,crating tile 171~,,1 t, rgc~lt challenge of the last decade--are benefiting not only fr,~n~ gcri:tlric clinics and the don~cslic help service but from the gradual coming t,f it new ~ocial and ccont,rnic outh,~,l,z. The adolescents are the i;ew challenge tit tl~t' c~'rc ~f the ~uh~crable. "lhc llcx~ aMuencc of society, which has brought [~,',IlI~.C good t~) the very y~ung and to the old, would seem to have been one of the nceativc inflt~c~lcc.~prt~ducing the present "'teen-age malaise," and for this :rod o~her rr ~t is tikcl 3 that the ~olution ~f this problem is not easily to be found on t~:z~ttitional linch. A solution must, nevertheless, be sought, and we hope that the sympo.,,ium ha~ made a useful conlribution by effectively calling lhc 'tllt, n t i ~ of ptlbJic he;~lth
* to be published in Septem[yer
HEALTH
The Journal of the Society of Medical Officers of Health Vol. LXXX
July 1966
No. 5
THE FAMILY TODAY IN taking as its theme various aspects of family health, this year's Annual Symposium broke new ground and highlighted some interesting problems. Broadly speaking, it set out to ask what are the social service needs of the family today and how these can best be met. From the start it was very reasonably assumed that the family, while it is ~till that organ of society which has been developed to take the major share of c:tring for the child in his years of immaturily. cannot be asked to undertake responsibilities beyondits scope, and that the bringing up of children in the twentieth century is a matter for partnership between the family and the community. It is not possible to set down any rigid guiding lines tbr that partnership, since there is such a wide range of variation between families, but for that very reason there is a need for understanding people and agencies who wilt help the family to asses6 its problems and work out the way in which the partnership should operate in the particular case. The speakers in the opening session, John and Elizabeth Newson, have for some years been studying family patterns and behaviour from an angle which is unfamiliar to the health services, and their picture of the changes in the health and social service approach which have taken place in the past thirty or forty years was most enlightening. The moralistic-authoritarian approach of the last century has long been viewed with a mixture of amusement and deprecation, but the medical-authoritarian approach of the nineteen-thirties was no less authoritarian even though it was more down to earth. There is no inherent vice in authority, provided that it knows when to moderate its tones, but it tends too easily to set into a dogmatism. He who speaks with authority because he really knows is, one hopes, likely to modulate his voice as he comes to know more. He who dogmatizes because he thinks he knows may easily become a misleader instead of a leader. The most dangerous teachers and advisers, however, are those who take refuge in dogma because they are afraid that they do not know. It is indeed tempting to draw a parallel between the progress of child care in the past half-century and the progress of religion over a somewhat longer
210
PUBI,.IC tll!.\l.,lll \:OL. I.XXX NO 5
period. Certainly one has seen much of the ellk'cts of defensive dogmatism with the degeneration of once purposeful practices into rituals without much meaning. Sooner or later this is follmved by a questioning of their value, and it is but a short step fi'om rejecting the ritual itself to rejecting the essential values w,hich lie behind it. In child xvdt'are ~Yo!'kan agnostic phase is being l~llowed hy a downright atheistic one, with the picture made rather more padaetic by the ~;t,,' in which a sceptical generation still seems to find some comfort in certain clinic rituals, even to a point at which these are demanded by the consumer against the considered advice of the progre,,~ivc doctor and nurse! There is nothing new in this kind of phenomenon. Ju~;I a~ il is bad for human beings to be held on too tight a rein all the time. so it is dangerou,, for ti~em to have no fixed points fromwhich to take their hcarings':when lhev arc xenturing out into the unknown. There is much scope for argument as t(, ~hcther a permissive home atmosphere in early childhood does or dt~s not conduce to sociai and emotional instability in adolc.,cence. On the one hand it is true that a generation of adolescents apparentl'r sho~ing an unusual amount of in,,tability ha,, been brought up during the yea:, in ~hich the doclrine ~q" pcrm!s-,ivencss has been vigorously promuh...,ated. On the other hand. it is no le,;s true lha! the ad~lescent of today is exposed to social pressures outside the home of a ~arietv and an intensity without precedent. Some instability in adolescence is normal, and oilc might ~ie~ the preternaturally sober young person with a degree of disquiet. There are dt.mlo ~ in the public health service who are o.ld enough to ha~e ~alched several :mcccssive crops of youngsters gr,:)x~ing up and can recall hm~ many of llmse ,wet whom grey heads were shaken in despair came through in the end ~o stability and responsible parenthood and citizenship. We are glad that those contributor.,, to the symposium who were specially concerned with adolescence were not too pessimistic in general. The)' were prepared to see most of the common errors of youth as part of a process of learnine by experience, and te accept as a commoF~ failing the refusal of human being~ of all ages to prolit tull.~, by the mi~take~, which their predecessors have made. if the years of adolescence may be taken as the years of social birth, then it is probably logical to think of analgesia as better than antesthe.,,ia as a routine measure--the pains are not to be eliminated but they may be rendered tolerable. Professor Mays had some ingenious suggestions to make to this end. As with the pains, so with the risks; if they can be brought within the individual's capacity for survival they' may in the end do good rather than harm. But there are undoubtedly certain risks which are unacceptable. The phenomenon of widespread drug-taking, beginning even in the school years, is a new and frightening thing. Presumably it is only one of many aspects of youthful behaviour which are essentially symptoms of a feeling of one or other kind of inadequacy, btlt it is a special one. Sartorial eccentricity, row:liness, vandalism, and general lack of consideration for others would all seem, from past experience, to be
I I)I I ( ) R I A I .
211
transient and to leave no ill-effects in later life in the majority of cases. Drugtaking, however, can lead to habit-fbrming and thence to true addiction, and ma.v d,~ permanent ph.w,ical as well as emotional damage. Dr Glatt's paper* is ,me I~articulmly w~rthv of scrit~us ~tudy as a specially clear survey of the situatic,n. l h c treatment ~,I"addiction will ha~.e to be undertaken, an~l~ no doubt, there n',,~l bc legal and other action !,,~reduce the risk of drugs get!i~g into the ;~r~.,rzg hztrJds. Basically, h~:~wevc~,~c arc faced with symptoms of a sickness to youth ~ithin a socict~ which is hy no means healthy. In helping tile other vull~crablc er,~ups within the community, public health I.~as cot~ccrncd it~,clf I~ol,]J with ,aiding tile iodividual and with modifying the ,~ci:~l cnvir~mtlcnt. The fall in the i~ffant mortality rate has been due to prosi~,i{~n I,.~r the carc ~',f the individu~d infa!~t, to the education of parents, to therapeutic "tdvz,ncr but perh:q~, m,~st of all to social progress -in those field,, ~tlch as hot,sing, which ha~c obvious l'ealth connotations, and those ~hich arc indirectly involved il~ hcallh, like the promotion of full employment . and the devclopmc~:t of social sccvrity. "l-he elderly--the vtdnerable group pro,crating tile 171~,,1 t, rgc~lt challenge of the last decade--are benefiting not only fr,~n~ gcri:tlric clinics and the don~cslic help service but from the gradual coming t,f it new ~ocial and ccont,rnic outh,~,l,z. The adolescents are the i;ew challenge tit tl~t' c~'rc ~f the ~uh~crable. "lhc llcx~ aMuencc of society, which has brought [~,',IlI~.C good t~) the very y~ung and to the old, would seem to have been one of the nceativc inflt~c~lcc.~prt~ducing the present "'teen-age malaise," and for this :rod o~her rr ~t is tikcl 3 that the ~olution ~f this problem is not easily to be found on t~:z~ttitional linch. A solution must, nevertheless, be sought, and we hope that the sympo.,,ium ha~ made a useful conlribution by effectively calling lhc 'tllt, n t i ~ of ptlbJic he;~lth
* to be published in Septem[yer