COVID‐19, systems thinking and the ecology of disease: A focus on the family

Abstract

In his successful essay Spillover, David Quammen explains that the potential for infectious diseases is everywhere: any change of an ecosystem that modifies the interactions among organisms may trigger novel infections. This immediately recalls Ludwig von Bertalanffy General Systems Theory, where a system is described as a pattern of organized relationships among elements, and any change of the elements or their relationships may affect the whole. Systems are powerful constructs and metaphors for understanding human functioning and the biopsychosocial dimensions of disease, as originally theorized by Engel. Indeed, each level of such biopsychosocial dimensions can be described as a system made of subsystems and included in wider, integrated wholes. Systems are open to change and must display adaptability to survive. This is true for cells, organisms, families, and societies. It is also true for health care institutions whose scope is that of confronting with changing profiles of morbidity in society and a globalized world. With its multiple demands, the COVID-19 pandemic is a challenging stress test for the health care system. Under the pressure of a rapidly and widely expanding menace, the current situation confirms that all the biopsychosocial dimensions of disease are closely interconnected as parts of the same complex reality. The basic tenets of systems thinking thus can serve as guiding principles for an accurate analysis of such complex reality and the ecology of individual lives. For human beings, this includes family relations, social networks, societies, and the cultural milieu, not forgetting the nonhuman environment. In many societies, family relations have a special role, providing reciprocal support and mediating the relationships between individuals and larger groups. In turn, families are constantly influenced by the dynamic interplay of their members and by sociocultural variables. The pandemic reveals such strong ties between family processes and social dimensions. As suggested by Jay Lebow, the current situation has led to an “international experiment about family life.” Such an experiment regards the definition and selection of close contacts with whom to maintain constant interactions, the chance (or not) to use virtual connections, family strategies for coping with co-occurring problems, such as work loss, pre-existing relational problems (domestic violence, caregiving for people with medical conditions or mental health issues), and loss of social resources. How to preserve and recreate family rituals in these circumstances that have a remarkable impact on daily habits and special ceremonies—including funerals—is another relevant theme. There is also accumulating evidence that this pandemic, such as other global crisis, is having a more severe impact on fragile and underserved groups, shedding new light on inequalities and social injustice. The pandemic sheds new light also on other pre-existing problems of specific populations, such as the long-lasting limitations in the social participation of people living with disabilities in many countries. For instance, our study on a sample of Italian patients undergoing neurorehabilitation programs revealed that such patients—somehow—were “already in lockdown.”