Robert Straus

Behavioral factors and denture status.

The experiences and impressions for most of the 64 patients who entered the project in 1968 reveal that the opportunity to obtain new dentures, prepared according to the best available technology by highly skilled dentists and dental laboratory technicians, has had an identifiable impact on each of the several behavioral variables for which changes were predicted before the study began. There has been general improvement in self-image, confidence, and relaxation, and these changes often were associated with perceived improvement in fit of dentures, ability to eat, ability to talk, and general health. Although some patients experienced serious health problems during the 6 year study period, neither were these attributed to nor did they appear associated in any way with denture status. The patient population, in general, was very cooperative. Fifty-three patients stayed with the study for 6 years. Most kept their appointments and followed the instructions and advice of their dentists on all matters but one--that of removing their dentures at night. In explaining why they did not remove their dentures at night, most of the patients gave evidence of a high degree of sexual symbolism associated with teeth and denture status.

Departments and Disciplines: Stasis and Change: Significant multidisciplinary activity requires a redistribution of power within universities

Because I believe that the departmental power base of universities has been a major factor in resisting inevitable and continuing changes in the disciplinary boundaries of research and teaching, I predict that significant changes in the nature of departments are inevitable. Departments will either permit, or even seek, a realignment of their spheres of control over disciplinary activity or they will lose the power of control over basic academic decisions and rewards. To the extent that society at large expresses resistance to change, the status quo of departments may have a temporary lease on life. On the other hand, societys current disenchantment with academia may make radical internal change seem vital to the maintenance of public support, and even the survival of universities, and thus hasten changes in either departmental structure or departmental power. Within universities, resistance to such change is generally supported on the assumption that academic freedom will be threatened. Obviously, all change involves some risk, but a very significant limitation to academic freedom already exists in the pressures that many departments exert on members to restrict their intellectual activity to fit the departmental mold. Departments can regain their important role in fostering both academic freedom and academic responsibility for excellence if they will redefine their discipline-oriented identities and realign their priorities to include cross-disciplinary inquiry and teaching and greater responsiveness to the responsibilities and expectations of the university and society.

Behavioral science in the medical curriculum.

This paper will begin with some brief commenta on the history of the behavioral sciences in medical education. Consideration will then turn to a specific program at the University of Kentucky in Lexington where a new Medical eenter,l activated in 1960, includes a basic science department devoted to &aching and research in the behavioral ~icences.e*~ Much of ?the paper will be directed to questions frequently wised with respect to programs of behavioral science in medicine: “What do you teach?” “How do you go about it?” “What is its impact?” It is customary to think of the fast-growing role for the behavioral sciences in medical education and research as a relatively new development. This development is new in the organizational sense and new in term of scientific sophistication in the behavioral sciences. However, before recent developments in the biological and physical sciences e&abIished a biophysical bat& f s r medical science, and before the disciplines now known as behayioral sciences were classified as disciplines at all, much of medical practice was concerned with humanistic aspeots of life, illness, and death. Medical literature of the mid-nimtemth century included some classical studies of epidemiology, and t h e were papers which discussed the relatiomhip between specific heal& problems and swh modes of living as occupation, housing, family structure, prevailing attitudes and customs, and other considerations which would now be classified as anthropdogy, psychology, economics, M sociology. The late Henry E. Sigcrist has stressed the relationship between the nature of medicine in different societies and the prevailing social and economic characteristics of the society as well as the technical means available to medical science at a particular time. “. . . h e position of the physician in society, the~tasks assigned to him and the rules of conduct imposedupon him by Society chaaged in every period. The physician was a priest in Babylonia, a craftsman in wxient Greece, a cleric in the early and a scholar in the later Middle Ages. He became a scientist wigth the rise of the natural sciences, and it is perfectly obvious that the requirements put upon the physician and the tasks of medical education wre diiZerent in all these periods.’“ Majur developments in the bidogical and physical sciences in the lattw part of the 19th and early 20th centuries led to medicine’s preoccupation with biophysical bases of health and disease. Basic discoveries in the natUrai sciences drastically altered the theories and techniques of medicine. This period witnessed such dramatic developments as the alleviation of human misery through anesthesia, ,the reduction of infant and maternal mortality and of mslssive epidemics through asepsis and chemotherapy, and the perfedion of countless lifesaving surgical techniques. It is hardly surprising that this era is characterized by a major focus OB the purely organic aspects of disease and on the treatment of specific biological and physical factors, with which medical advances were directly identified. The current rawgent interest in psychological, social, cultural, and econolltic aspects of illness and health care which is reflected in medical education, community health programs, and hospital planning appears to stem from geyeral distinct, but related, developments. Throughout history medicine has been concerned with the adaptation of man

PUBLIC ATTITUDES REGARDING PROBLEM DRINKING AND PROBLEM EATING

The assignment to discuss public attitudes about problem drinking aqd problem eating poses the problem of deciding how to conceptualize a topic which encompasses four such fundamental and complex phenomena as eating, the drinking of alcoholic beverages, public attitudes, and social problems. The task is further complicated when we realize that the problems associated with both eating and drinking are numerous and extraordinarily diverse, and, furthermore, that attitudes toward routine eating or drinking are often in sharp contrast to attitudes regarding the consequences of overeating, undereating, or inappropriate drinking. These attitudes may vary sharply according to the age and sex of those who hold them or of those involved in problem eating or problem drinking, and they are influenced by such diverse factors as medical, economic, ethnic, religious, educational, political and recreational values and beliefs . The late social psychologist, Kurt Lewin, has written that eating habits “are part and parcel of the daily rhythm of being awake and asleep; of being alone and in a group; of earning a living and playing; of being a member of a town, a family, a social class, a religious group, a nation; of living in a hot or cool climate, in a rural area or a city, in a district with good groceries and restaurants or in an area of poor and irregular food supply. Somehow, all these factors affect food habits at any given time.” (Lewin, 1951). Although eating is one of the few really fundamental forms of human behavior and is concerned with the fulfillment of a basic human need, there is enormous variation in the eating habits of societies around the world, and the eating habits of any given society may be subject to continuing change. The use of alcoholic beverages is not quite as basic or quite as universal as eating, but customs involving alcohol consumption are found in almost all societies and can be traced to the beginnings of recorded history. Drinking customs, like those of eating, vary widely among different societies and within societies, are influenced by a broad range of social forces, and are also subject to continuing change.

Health, Society, and Social Science

Throughout the United States and elsewhere in the Western world since World War II, there has been a grow ing interest in medicine. As early as the 1930s, popular accounts of scientific developments began to interest lay readers in medical care and innovation. The significant involvement of social and behavioral scientists in medical education and research began a decade ago and has increased rapidly. It has become apparent that the understanding of health and disease requires a holistic frame of reference in which the psychological, social, and cultural aspects of human behavior are appropriately related to the biological nature of man and the physical environ ment in which he lives. Emphasis upon the holistic approach to medical science and upon comprehensive health care has moved medicine to seek the services of social scientists, notably in connection with public health, preventive medicine, and psychiatry. And, as conceptualization and methodology in the social sciences have matured, social scientists have increasingly tended to interest themselves in applied fields and have come to grasp the significance of health and medicine as a major focus of organized human behavior. Thus, medical science, social science, and popular interest merge to formulate con temporary approaches and norms in health care.—Ed.

Preventing Curriculum Drift: Sustaining Change and Building upon Innovation

Although the curricula of medical schools in the US have generally kept pace with advances in biomedical knowledge and technology, there have been repeated calls from the public to address psychosocial, interpersonal, and professional issues in the training of physicians. Accreditors have called for changes in pedagogy to incorporate active learning and better integrate basic and clinical sciences. Medical educators have responded with curricular reforms, but many innovations are short-lived. In a process we refer to as curricular drift, the curriculum often insidiously returns to its pre-innovative state. While drift implies forces randomly affecting direction, we contend that such drift is inevitable and predictable. Understanding the forces promoting curricular drift may lead to the development of strategies to prevent it. The authors review the case of the University of Kentucky College of Medicine, which has undergone recurring curricular change, and discuss the causes and strategies for overcoming curricular drift.

Types of Alcohol Dependence

This chapter is concerned with a way of thinking about the relationship between alcohol and human beings. It is not a report of specific research, nor does it attempt systematically to review the literature. It offers some conceptual observations based on a perspective of change as perceived by a social-behavioral scientist. During the last 35 years, there have been significant changes in patterns of alcohol consumption, in the social and the chemical environments in which alcohol is used, in the functions and liabilities of alcohol, in our knowledge about alcohol and the human body, and in our perceptions of the meaning of this knowledge. Not all of these changes are recognized, understood or reflected in currently prevailing definitions of alcohol problems nor in social responses to these problems.

A Role for Behavioral Science in a University Medical Center

In the planning of a new Medical Center at the University of Kentucky, a unique opportunity was provided to begin with the delineation of a philosophy and basic ob jectives around which architectural planning, program design, and staff recruitment could be developed. From the beginning, behavioral scientists have been prominent in planning, activa tion, administration, teaching, and research within the Medical Center. Features of the Center include special emphasis on meeting the needs of students and patients, on providing comprehensive health services, and on relating the Medical Center to the health needs of the community and region. The Medical Center has provided strong support for a Depart ment of Behavioral Science which has assumed many func tions. The primary impact of behavioral science is reflected in the charter and character of the institution and in the extent to which behavioral-science concepts have become inculcated in the philosophy, values, and role perceptions of personnel at varying levels of responsibility.

Goals and Functions of the Department of Behavioral Science in the University of Kentucky College of Medicine

The Department of Behavioral Science at the University of Kentucky was formally established in 1959 as a basic science department in the College of Medicine — part of a new University Medical Center, planning for which began in 1956.