Nursing and Social Change

Monica F. Baly

• Publisher: Routledge
• Year: 2002
• eBook ISBN: 9781134853052
• Edition: 3
• Topic: Medicina
• Subtopic: Atención sanitaria

Nursing and Social Change is essential reading for nurses who wish to understand how their profession had developed from its earliest beginnings to the present day. Now in its third edition the book has been completely revised to take into account the challenges facing nurses. Ten new chapters include contributions from senior members of the nursing profession who have been closely involved in the most recent health service reorganisation and the radical changes to nurse education.

Students and practitioners will find Nursing and Social Change invaluable as a comprehensive source of reference which offers a unique combination of scholarship and readability.

Chapter 1

Social change and attitudes to care

Not to know what took place before you were born is to remain forever a child.

Cicero

Nursing has developed as a response to changing social needs. As the structure of society alters, so new demands for health care arise; new habits and customs alter the disease pattern while changes in the size and composition of the population create fresh problems for sanitation and community living. These changes are continuous and tend to accelerate as knowledge accumulates, but they are not only perpetual, they are also erratic. In some periods development seems so slow that variations in the structure of society are almost imperceptible, at other times circumstances combine to produce change so quickly that the whole social basis of society alters in one generation, and with these rapid changes come new ideas about ‘rights’ and responsibilities, and indeed the whole social purpose. It was not coincidental that the ideas of the so-called Enlightenment, the precursor of the French Revolution, should have occurred in the same broad spectrum of time as American independence, Thomas Paine’s Rights of Man and the change in much of Europe from an agrarian to an industrial society.

There is considerable controversy among social scientists about what is crucial to, and above all what initiates, social change. Marxists believe the key factor to be the technology of production, and Marx himself argued that productivity was the primary determinant of all social organisation and that the philosophical, religious and political ideas and values by which men have interpreted society were secondary and derivative—a theory Marx described as ‘the material conception of history’. However, other sociologists such as Max Weber have denied the purely Marxian dialectic and have argued that ideas, particularly religious ideas, have had profound consequences for social change. Weber himself and other historians confidently asserted that there was a strong relationship between seventeenth-century Puritanism and the rise of capitalism,¹ while Halévy claimed that in the late eighteenth century working-class conversions to Methodism saved England from a revolution similar to that in France.²

Within these two schools of thought, the economic and the history of ideas, there are many sub-divisions, and, depending on their bias, sociologists stress different aspects in what they believe to be the most significant force for fostering change. Some emphasise the importance of changes in communications and the far-reaching effects of printing in the fifteenth century, or the fact that the ‘take-off into growth’³ occurred when man could at last travel faster than a horse. Again, demographic change is always linked in a complicated way with social and economic change; sometimes as with the depopulation of much of Europe in the late fourteenth century it seems to cause economic change, whereas at other times, as in the nineteenth century, it appears to be both a cause and a consequence of social change.

Other candidates for social change are the scientific revolution, war and racial conflict, the use and abuse of power, the effect of the mass media in moulding public opinion and the power of pollsters and sociologists to bring about change by self-fulfilling prophecies and what is sometimes known as ‘the definition of the situation’.⁴ If sociologists announce that nurses leave because of harsh discipline there is a tendency for nurses, and their relatives, to look for harsh discipline and see it even in the simple restraints required for communal living. In the study of history it is important to remember that what men believe to be true is often as significant as what is true.

Although opinions differ as to what is fundamental to social change there is no doubt that the pattern of society changes, and as it does so it produces new health needs in the community. Whether society attempts to meet these new health needs and whether it meets them with any degree of success depends on a variety of factors which include religious attitudes and beliefs, cultural patterns, economic resource together with population change, the state of knowledge and the way in which health care is organised and delivered.

RELIGIOUS ATTITUDES AND BELIEFS

Primitive belief

Primitive man attributed disease and epidemic to evil spirits, which he sought to drive out by means of magic. The early myths about the birth of Asclepius and his connection with snakes and the underworld and the fact that worshippers who sacrificed at his shrine would be cured through the agency of dreams has an obvious psychological significance in what Freud called ‘the collective mind’.⁵ Often illness and misfortune were thought to be due to the breaking of a taboo or the failure to perform a ritual, and this could only be expiated by the correct sacrifice, and in many parts of the world there are still taboos and rituals about pregnancy, childbirth and death, indicating our debt to the collective unconscious.

Particularly important in the study of mental ill health is the age-old idea of suffering as a result of sin; moreover, as in the Oedipus myth, the gods could inflict punishment even when the sin was not consciously committed. Linked with this was the idea of symbolic appeasement, where the sins of the community could be laid on a sacrificial animal, usually the goat, who became the ‘scapegoat’,⁶ or in Christian symbolism, the lamb. Other societies and cults believed that evil could be transferred to an animate or inanimate object of which the effigy was the most familiar, including a model of the afflicted part of the body. By burning the image, or sticking pins in it, the ‘evil’ was destroyed. The apparent ability of some persons to assist in this transference of evil led to witchcraft, devil doctors and sorcerers who ran a profitable trade until the Church in its endeavour to root out heresy connoted witches with the devil himself and ordered their burning.

Anthropomorphic religion

This was the stepping-stone between primitive magic and the monotheistic religions. With social growth men moved away from primitive belief and animism, and in the more sophisticated societies these spirits were translated into anthropomorphic gods and goddesses. Now, as Frazer suggests, ‘more thoughtful men were looking for a truer theory of nature and were questioning the efficacy of magic’.⁷ In Greece the period is strikingly illustrated by Homer and the early classical playwrights; but while the Olympian hierarchy brought some order to the chaos of primitive belief, because it incorporated so much primeval superstition it became impossibly complicated. Behind every sophisticated Greek myth there lies an older, darker and deeper configuration. Confusion led to questioning, for while it was possible to blame disaster on vague spirits, it was less easy for intelligent men to accept the irrational behaviour of person-alised gods who threw thunderbolts at will. By the fourth century BC the observant had begun to notice a causal relationship between disaster and physical phenomena, and some, like Aristophanes, began to ridicule the Olympians and their deeds. It was this same spirit of questioning and scepticism that produced the new approach to disease exemplified by Hippocrates and Aristotle (see Chapter 2). At the same time Socrates (469–399 BC) and his disciple, Plato (427–348 BC), were laying the foundations of logical thought and encouraging deductive reasoning. Plato, by connecting knowledge with ideas of virtue and love, and in his new conception of ‘God’ and the relationship of religion with morality, exercised a great influence on subsequent philosophers and paved the way for Christianity, which in some ways he helped to shape.

Christianity

By the time Paul and Barnabas brought Christian teaching to Asia Minor in the first century AD there was already fertile soil for the seed. Christianity appealed to the philosophers in the Greek tradition as a rational system of thought, and at the same time commended itself to the poor and humbleminded. With its roots in older Hebrew and Hellenistic thought it had, as Gilbert Murray pointed out, ‘a strange subterranean power with a new humanity and intense feeling of brotherhood and incessant care for the, poor’.⁸

Christianity was an important influence on attitudes to suffering soon manifest in new movements for the care of the sick, such as the appointment of deacons and deaconesses to administer charity and to visit the sick in their homes, a movement many subsequent reformers sought to emulate. Much of the Gospel is about attitudes to the poor, the sick and the disabled, and the Good Samaritan who bound up the wounds is the ideal for the Christian to copy. Curiously enough, however, the early Church was ambivalent in its attitude to suffering; the early Christians had a profound Messianic faith which meant that they viewed this transitory life as of little consequence and only to be endured as a passport to the life and the world to come. Did not Lazarus, whose sores were licked by the dogs, rest on the bosom of Father Abraham? Not only did this engender a passive attitude to sickness, it was also antipathetic to any enquiry into the cause of disease, and as the Church put forward more extreme dogma, enquiry became equated with heresy, a sin calling for excommunication. Moreover, it must be remembered that cure in the Gospels was always apparently achieved by a miracle; cure therefore was in the hands of God, and all men could do was to assist by faith and prayer. So it came about that the first religion to be based on compassion and brotherly love discouraged scientific understanding, and while ideals of care were promoted their effect was hampered by the lack of knowledge.

The Reformation and the evangelical revival

However, attitudes to care and ‘good works’ may vary within a major religion, and Christianity in its chequered path has produced a wide range of beliefs, dogmas and schisms which have at times resulted in bitter controversy and war. In the sixteenth century two main faiths emerged, each determined to conquer the Christian world, and in the terrible conflict that followed many of the attitudes of compassion fostered by the earlier Church passed into oblivion—a sad characteristic of religious and ideological warfare. As the strife subsided the philosophies of the different faiths showed themselves in different attitudes to care. The Catholic Reformation, with its doctrine based on faith and works, saw an upsurge in corporate care and the founding of a number of new orders with practical concerns in the world, many of which were concerned with nursing the sick. The Protestants, on the other hand, with their insistence on ‘justification by faith alone’ and personal ‘election’ tended to emphasise individual and family duty, and there arose what has been described by sociologists as the Protestant ethic, where, it is alleged, there is a congruence between the ascetic Protestant and the value attitudes this produces in certain personalities. Although the pattern of behaviour has its roots in religious belief, it is in fact acted out in attitudes to work, wealth and philanthropy, and this is seen as underlying many of the charitable endeavours of the eighteenth century, including the endowing of hospitals.

As the more extreme attitudes of Calvinistic predestination and dissent modified in the eighteenth century, many Protestants adopted new attitudes based on evangelical teaching, and groups like the Wesleyans and the Quakers with their human and social concerns began to flourish. These attitudes coincided with the scientific thought of the period, which was largely engendered by the Nonconformists, who, because they were excluded from the universities by the Test Act, had established their own superior schools which had a bias towards the practical and to industry, in which so many eminent Nonconformists were interested. Thus, Protestant philanthropy, yoked to science and rational thought, paved the way for a new attitude to illness which was to come to fulfilment in the following century.

Islam

By contrast with Christianity, Islam, also a religion based on the duty of man to God and his neighbour, exhorted man to enquire. Islam, in turn, produced a number of sects and mystical philosophies many of which reflected what it had absorbed from its conquered territories, including the Greek medical writings from the library at Alexandria. For a few centuries after the death of the prophet, Mohammed (AD 632), Islam led the world in medical knowledge. Adopting the methods of Hippocrates and Galen, the Arabs advanced the idea of disease entities and organised a hospital system where treatment was free and patients were nursed according to thei...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• List of illustrations
• List of contributors
• Acknowledgements
• Preface to the third edition
• 1 Social change and attitudes to care
• 2 Change and care before the Reformation
• 3 The sixteenth-century transition
• 4 New approaches to care
• 5 The growth of hospitals in eighteenth-century England
• 6 The deserving and the undeserving poor
• 7 Those of unsound mind
• 8 Local government and sanitary reform
• 9 The influence of Florence Nightingale
• 10 Nursing reforms extended
• 11 Towards a health service
• 12 Registration and the growth of nursing organisations
• 13 Social change and nursing in the inter-war years
• 14 The legacy of the Second World War
• 15 The National Health Service
• 16 Adapting nursing to new demands
• 17 New demands on nursing
• 18 Who will nurse the patients of tomorrow?
• 19 New problems for old in the community
• 20 Mental health nursing—origins and developments
• 21 Health at work
• 22 Nurses as managers
• 23 Nursing education—‘Reports are not self-executive’
• 24 Nursing research
• 25 The road to reorganisation
• 26 Nursing, economic change and industrial relations
• 27 The health problems of the world
• 28 International and inter-regional organisations
• Epilogue
• Index