Mind Body Seminar: March 1977

Contemporary medical care is a valuable but incomplete approach to health. More and more the individual is being recognized as the primary health care resource and individual behavior and lifestyle as the principal determinants of health. A new trend toward self-care is emerging, transforming the traditionally passive patient into an active, informed, and effective participant in health care. This symposium will explore the promise, prospects, and varied forms of self-care which range from lay-initiated to professionally controlled, from personal change to political reform, from therapeutic interventions to health-promotive activities, and from practical techniques to new directions in health policy.

FACULTY

JAMES F. FRIES, M.D., is Associate Professor of Medicine at Stanford University School of Medicine and National Director of the American Rheumatism Association Medical Information System. His research interests include medical decision analysis, the application of computer science techniques to clinical decision making, and the development of algorithmic guidelines for patients, physician’s assistants and physicians. He is author of Systemic Lupus Erythematosus and coauthor of Take Care of Yourself: A Consumer’s Guide to Medical Care.

LOWELL S. LEVIN, Ed.D., M.P.H., is Associate Professor of Public Health at Yale University School of Medicine. He has recently organized an information and resource center for research related to self-care and health education, has coauthored a book Self-Care: Lay Initiatives in Health and is preparing a book on an assessment of social iatrogenesis.

SHERYL K. RUZEK is a Ph.D. candidate in Sociology at the University of California, Davis and has recently completed a dissertation entitled The Women’s Health Movement: Finding Alternatives to Traditional Medical Professionalism. She is a research associate and member of the Advisory Board of the Center for the Study of Women, Institute for Scientific Analysis, San Francisco and is author of Women and Health Care, an annotated bibliography.

DAVID S. SOBEL, Program Director for The Institute for the Study of Human Knowledge, is a Fellow in the Health Policy Program and is completing his medical training at the University of California, San Francisco School of Medicine. He is coauthor of An Everyday Guide to Your Health: Holistic Approaches in Ancient and Contemporary Medicine. He is serving as program coordinator for this symposium.

CARL E. THORESEN, Ph.D., is Professor of Education and Psychology, Stanford University, where he is a Fellow of the Stanford Boys Town Center for Youth Development. He is also founder and Executive Director of Learning House in Palo Alto, a residential social learning treatment facility for disturbed children. Recent books include Counseling Methods, Behavioral Self-Control, Self-Control: Power to the Person, and How to Sleep Better.

DAVID WERNER, a biologist by training, has fostered the development of a primary health care network run by villagers in a remote mountain area of western Mexico. He has authored a villager’s medical handbook, Donde No Hay Doctor, which is being used throughout Latin America and is now being translated for use in Africa and Asia. He has just completed a study of 40 rural health care programs in Central and South America.

IRVING K. ZOLA, Ph.D., is Professor of Sociology at Brandeis University and a member-director of Greenhouse, Inc., a counseling center in Cambridge, Massachusetts. He has written about the growing sociopolitical power of the medical sector, cultural factors in health and illness behavior and self-treatment. His most recent book is a socioautobiography entitled A Question of Invalidity which deals with the problem of having a physical handicap in an essentially healthist society.

PROGRAM

Saturday, March 19

9:00-10:30
THE DETERMINANTS OF HEALTH
David S. Sobel
Recent changes in contemporary health problems have highlighted a striking paradox. Although we place our faith (and resources) in professional medical care, our health is largely determined by factors which operate outside the medical domain. A new strategy is required to address the current health problems – one which acknowledges the critical importance of individual lifestyle and behavior and equips individuals to become active agents in their own health care.

10:45-12:15
THE MEDICALIZING OF AMERICA
Irving K. Zola
Medicine is becoming a major institution of social control, nudging aside, if not incorporating the more traditional institutions of religion and law. This is an insidious and often undramatic process accomplished by “medicalizing” much of daily living and making medicine and the labels “healthy” and “ill” relevant to an ever-increasing part of human existence. However, a counter-process of “demedicalization” as evidenced in the self-care movement is also developing.

2:00-2:45
THE DIMENSIONS OF SELF-CARE
Lowell S. Levin
Self-care is a process in which a lay person functions effectively on his or her own behalf in health promotion and disease prevention, detection, and treatment at the level of the primary health resource in the health care system. Self-care is a universal attribute of all cultures and has historically accounted for the vast proportion of all health care. The recent resurgence of interest and programs to enhance self-care skills as a substitute as well as supplement to professional health care raises critical medical, social, economic, and political issues.

2:45-3:45
THE WOMEN’S HEALTH MOVEMENT:
SELF-HELP GROUPS
Sheryl K. Ruzek
Women’s self-help groups offer a growing alternative to the traditional medical model and professionalism. The origins, aims and practices of these programs emphasize the importance of lay control, demystification, reduced costs, shared expertise and social support systems. The sociopsychological and political implications of this type of self-care will be presented along with the benefits and possible hazards of self-help gynecology from the perspectives of both lay participants and health professionals.

4:00-5:00
WHERE THERE IS NO DOCTOR
David Werner
A remarkable adventure in rural primary health care is taking place in the mountains of western Mexico. Villagers are learning modern medical skills, both preventive and curative, and strengthening their own traditions of self-care. The result is a more effective coping with their own health problems and lessening of dependency on outside professional resources. These villagers can change our ideas of what is possible for self-care in both developed and developing countries. Slides will illustrate the lecture.

Sunday, March 20

9:00-10:30
A CONSUMER’S GUIDE TO MEDICAL CARE
James F. Fries
A new strategy of personal health care is emerging based on individual responsibility for health maintenance by a more effective, critical and autonomous consumer. Guidelines, in the form of decision-trees, have been developed to help the individual evaluate symptoms, apply home treatments, and decide when, or when not, to interact with the health care system. Unambiguous information is now available to the consumer to reduce unproductive medical encounters, dispel mystery, and provide a means of freeing the individual from professional domination.

10:45-12:00
SELF-CONTROL: POWER TO THE PERSON
Carl E. Thoresen
The concept of self-control has a long and confused history having been viewed until recently as a stable personality trait, often referred to as willpower, which some people possessed and others unfortunately lacked. A cognitive social learning view by contrast suggests that self-control can be thought of as learnable skills used to alter one’s behavior and can be applied to solve problems such as sleep disorders, obesity, headaches, smoking, and career decisions.

1:45-2:15
SELF-HELP GROUPS: LAY ORGANIZATION
FOR HEALTH CARE
Lowell S. Levin
Self-help or mutual aid groups are small groups organized voluntarily by “peers who have come together for mutual assistance in satisfying a common need, overcoming a common handicap or life-disrupting problem, and bringing about desired social and/or personal change.” It is estimated that there are over 500,000 such groups in the U.S. often providing health-promotive services not available from the professional system.

2:15-4:15
WORKSHOPS I AND II
Films and discussions with the speakers and invited representatives of various self-care groups.

4:30-5:00
PANEL