Self-determination as a matter of health

The effect of restrictions on personal control, or self-determination, works to the detriment of health. Difficulty in managing the changes linked to health or to life circumstances generates stress.

Being able to foresee and to choose prevents depressions and isolation; being able to manage everyday things reduces stress. Restrictions placed on self-determination, whether social or environmental, weigh on physical and psychological status as much as, if not more than, other factors.

A person who has good possibilities of self-determination has normal levels of catecholamines (epinephrine and norepinephrine), and with them a normal blood pressure and heart rate.

Not feeling competent and able to decide raises corticosteroids, which regulate the metabolism of cholesterol and of other lipids linked to the arteriosclerotic process as well as to electrolyte balance. Self-determination also plays a part in better care of one’s own health.

The limitation of self-determination and of the feeling of competence therefore restricts health potentials and options.

Neither the system without the individuals, nor the individuals without the system

That said, analysing the individual without reference to the social system in which they are embedded is as narrow as describing the system without the individuals. When we speak of social systems, we speak of human beings in a social context.

Today, psychology and sociology tend to reject the simple explanation of the individual by the system, since the individual takes part in producing the social situation at the same time as he is conditioned by it.

Bringing the system down from its pedestal in this way also means demystifying the individual as a mere sum of interests and desires. General systems theory has held that every social organisation is the result of social relations. But the view of the system solely as an order, and the conception of the individual as a mere component, are narrow. There currently exists a functionalist cybernetics that speaks only of mechanisms of integration and disintegration, of stability and change, and that explains behaviours only by situations, without explaining situations by actions.

It is true that our behaviours are explained by the social relations in which we find ourselves, but our relations are themselves established within a given situation.

That cybernetics conceals, behind order and consensus, levels of violence and repression. A good part of scientific modernisation tends to suppress the integrating principles of social life, replacing structure with change and values with strategies.

Alain Touraine, the celebrated French sociologist, reminds us that “the unity of our society can no longer be found in the rules of its functioning, nor in an essence, nor in its place within a long evolution, but in its capacity to produce itself”. He is referring to the capacity to choose, to take part, to determine the conditions under which collective and personal life is produced.

Individuals are not robots, but sometimes they behave as such, or are manipulated as such; in a given situation, they have only one option, which amounts to having none.

This rigid individual pattern is part of a broader interactional pattern. The people taking part in it are limited, enclosed, constrained into recursive interpersonal sequences. At times, these processes repeat themselves over time, organising a rigid structure, that is, relatively lasting rules of interaction that order constant relations, but without options.

The basic postulate of the systemic paradigm applied on the therapeutic plane is that by making the rigid structural context more flexible, one releases the individual options that exist potentially.

Even though systemic thinking has been applied successfully, for the most part, at the level of the treatment of families, the conclusions established above point us not only towards family structures, but also towards community structures. That is to say, by increasing the levels of self-determination, participation and responsibility at work, at school or in hospital, one can increase the alternatives favourable to health. Communities of older people have given an example of this: the introduction of such options there produced a notable decrease, of more than 50 %, in average mortality.

Perhaps by paying more attention to these structural options available to our society, we may avoid the restrictions imposed by thinking and acting without alternatives.