Dichotomy or Integration?: A Response to McLeroy

Abstract

Kenneth McLeroy’s commentary 1 raises some important points with which we agree. We disagree on two major points, however. First, to dichotomize human experience and action into either a psychological or a social (environmental) level analysis and practice is to create a false dichotomy. The individual and the social aspects are two sides of the same coin. Second, after making the false dichotomy, to argue that only one side or level of analysis is the proper approach is to fail to see the inseparable whole. In the process of creating this false dichotomy, Dr. McLeroy has misinterpreted us, ascribing to ns positions that we do not hold. In contrast, we do hold that the psyche and society are both legitimate levels of analysis for developing approaches to world peace, and that dichotomizing these two is a false dichotomy. Dr. McLeroy has done well in responding to past and present excesses in the focus of education and promotion agendas on the individual to the near exclusion of environment (a response that is desperately needed). However, in this effort there is the danger of mistaking the social part of the human condition for the whole of human existence. This error is not in differentiating the psyche and society bnt dichotomizing the two and then ignoring one of thern. In Dr. McLeroy’s commentary, it is the psyche that has been ignored. To clarify our point, we wish to emphasize that we acknowledge that disease prevention and enhancement efforts across disciplines, professions, and policies have often ignored the influence of society and culture and the embeddedness of individuals in their environment, a focus resulting in abdses such as victim blaming. The first author and colleagues ~,:~ have recently addressed this problem, which is still with us in both research and practice. To the extent that some in the field recognize people as only individuals who are supposed to be completely responsible (culpable as well as liable) for their own (and inner peace) and not also as social beings, victims are still blamed under the banner of promotion. In spite of the lack of attention to sociocultural forces, however, there are still individuals living within environments, and these individuals have psyches. In our view, recognizing both of these elements of the human condition balances our approach, giving both social and psychological realities their due, denying neither. We suggest that these two elements are so intertwined that without attention to both, neither will prosper. If one of our goals is human rights and fieedom, for example, we find that without attention to social oppression, we can never be collectively free. Likewise, without attention to psychological defenses, such as repression, we can never be individually free, and without attention to both we can have neither. Oppression is primarily but not only social; repression is primarily, but not only, psychological. Attention to only the social, which seems to be what Dr. McLeroy is suggesting, still results in psychological problems in individuals that limit both psychological and social freedom, especially if, for example, a repressed, domineering individual is in a position of power over others. Even in the most advantageous of social environments, psychological problems can create tremendous suffering, thereby limiting and human freedom and our chances for both inner and world peace. Of course, the central point, again, is that we can deny neither social nor psychological realities. We never wrote, nor did we even mean to imply that health promotion is primarily concerned with personal growth and development. ~ Nor did we make any normative statements suggesting that heahh promotion should be so engaged . . . primarily. Here Dr. McLeroy is trying to peg us into a hole into which we do not fit. We did write that a theoretical fi’amework for the evolution of conscionsness does not deny the importance of the social, political, military, and economic forces that fi~el conflict, nor the necessity of social action. TM