Both to share some reading in the spirit David suggested, and to continue
with the debate about the importance of us attending to the material vs the
non material world (those debates about the usefulness and redundnacy of
postmodern thinking and working), here is what Richard Wilkinson wrote
recently that might be pertinent. This is why I do not accept arguments that
our over involvement in theorising about the nonmaterial world is unhelpful
to what we are seeking to achieve in com psy when working alongside those in
poverty and in distress in our communities:
[p.60]
When I first became interested in the social gradient in health some
twenty-five years ago, I, like most researchers working on this problem,
assumed that the health differences we saw between different occupational
classes resulted from differences in material living standards. (As
mentioned in chapter 1, studies had shown that differences in health-related
behavior - differences in drinking, smoking, exercise, and so on - failed to
account for the bulk of the health differences.) Most of us assumed our task
was to identify what aspects of the differences in material living standards
contributed to which diseases. But what has become clear from numerous
studies over the years is the surprising success of psychosocial variables
in explaining differences in morbidity and mortality. Variables such as a
lack of a sense of control, depression, hopelessness, hostility, lack of
confidence, lack of social support, bad social relationships, stressful life
events, family conflict, stress at work, social and material rewards from
work that fail to match work effort, bereavement, being single or divorced
rather than married, and job and housing insecurity all seemed to produce
poor health.
[p.61]
The shift in emphasis from individual psychology to the social patterning of
psychological life reflects the fact that epidemiological studies of health
and health inequalities often collect data from many thousands, sometimes
tens of thousands, of people. The interest is inevitably in the broad
patterns rather than the individual differences. But at the same time the
broad patterns tell us more about individual sensitivities. When we see, for
instance, that levels of stress hormones in middle age are related to birth
weight, or-as in the last chapter-that levels of violence and the quality of
social relationships in a society are related to the degree of inequality,
we are learning about processes which affect individuals. Often they are
processes we may be blind to until we see the evidence in data comparing
large numbers of people.
So, for instance, [p.62] things such as air pollution, infectious
microorganisms, poisoning, and vitamin deficiencies are all capable of
harming our health even if we are totally unaware of them: they are
therefore classified as material factors having a direct effect on health.
But job or housing insecurity affects your health only if you are aware of
it.
Despite individual differences, mental states are rarely independent of the
practical world. Instead they are perceptions of it and attempts to make
sense of one's situation in it. Sometimes an emphasis on psychosocial
influences on health is criticized for seeming unrelated to the practical
reality of people's lives: what is at stake is, however, their experience of
life, and the easiest way to change that is to change the practical reality.
But to know what to change we need to know the way people's worlds are
subjectively constructed and experienced, and that is why the psychosocial
is crucial. The growing understanding of the biological pathways through
which [p.63] stress affects health has provided us with one more major new
pathway through which the environment can affect health. It is no longer
just a matter of what we ingest or inhale, or how we use our bodies; it is
also a matter of our feelings and subjective experience of life.
Wilkinson, R. (2005). The impact of inequality: how to make sick societies
healthier. London: Routledge. pp.60-63.
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