Values

In previous posts I’ve remarked how values differ. For instance, Wendy and I had different values from our friends in Vermont, who believed in the “Right to bear arms,” expressed by keeping a loaded handgun in the home.  I got interested in values and their influence on health related behavior in 1960 when I began to study social and cultural determinants of health. I defined values in the Dictionary of Epidemiology: “What we believe in, what we hold dear about the way we live. Our values influence our behavior as individuals, groups, communities, cultures – perhaps as a species. Values therefore are an important determinant of individual and community health; they are difficult to measure objectively, except unobtrusively.”  What I meant by this  last statement  is that interviews or questionnaires aimed at eliciting values often yield misleading results, whereas observing ways people behave is more likely to reflect their values quite accurately. When discussing values with medical students I sometimes made a loose distinction between moral values and social values.  Moral values include fundamental beliefs such as the sanctity of life (almost instinctively we try to save life when it is endangered); the incest taboo; and a set of beliefs and behaviors related to family and personal relationships, especially those involving sexual relationships. Values related to sexuality and behaviors that express these values have changed dramatically in my lifetime.  Social values are expressed in ways we conduct everyday life. Perhaps social values are arranged along a continuum with belief that excretory functions require privacy and fastidious conduct near one end, attitudes towards disposal of domestic waste, sharing scarce resources, courtesy and friendliness towards neighbors, workplace colleagues, fellow road users, etc, elsewhere along this continuum. Some values and behaviors of individuals and small groups undergo a change in large gatherings such as political rallies and crowds of spectators at sporting events; in these settings, inhibitions which prevent or restrict violent and antisocial behavior can be overcome, mob rule and riotous conduct unthinkable in everyday circumstances can occur, can even become the norm. 

Reflecting on what I’ve observed and know (or think I know) about my own and my family members’ values and behavior, I am aware of changes in my own values over time, differences between my values and those of some family members, differences in values from one generation to the next and differences among otherwise similar individuals who have had almost identical experience. Obvious value differences that most people can recognize are reflected in religious affiliation and political preferences. Another that crops up in conversations among intimate friends is existence in some but not others of prejudices such as racism and homophobia, revealed in comments about people who are visibly different, or people whose behavior suggests that their sexual orientation differs from the majority. 

When discussing health related values and behavior with students, I describe the cigarette-friendly atmosphere of my youth: almost everybody smoked in those days, and offering a cigarette when introduced to strangers was a token of friendship. We smoked during lectures and had ashtrays on the backs of the seats in front of us in the medical school auditorium. This set of values has been transformed in recent decades.  Ashtrays have almost become collector’s items, and it has become as unthinkable to smoke without permission in someone else’s home as it would be to urinate or spit on the carpet. Generation differences are even more striking. In my grandparents’ childhood it was acceptable for some people to keep other people as slaves. When my mother was a young woman, she and all other women were denied the right to vote which was restricted to men. When I was a young man some crimes (such as a group of offenses called "juvenile delinquency") were punished by flogging, which had been carried out in public until a few decades earlier; and execution by hanging was the usual punishment for murder. 

As a child of divorced parents in the early 1930s, I felt stigmatized, and to some extent I was. Children born out of wedlock were bastards and it was unacceptable for unmarried couples to live together. A few years ago at a dinner party, two women about 30 years my junior described how they had moved in to live with men to whom they felt attracted. One had eventually married the man, the other still lived with her man but remained unmarried because her independence was more important to her than the ‘respectability’ of marriage. They had two children and she thought these children should share any eventual decision about marriage. Familial arrangements like this were unimaginable when I was young. Variations in family formation  and function reflect values – family values, in contrast to the ‘Family Values’ touted by those I describe as ‘religious fascists’ – a term that reveals my own values and prejudices I suppose.

Having described how values change, can I offer any ideas about reasons why they change? I mentioned that some of my own values have changed over the course of my lifetime. I converted like Saul on the road to Damascus from male chauvinism to card carrying feminism while I was on the staff of the University of Edinburgh in 1965-69. I was principal investigator in several research projects for the UK Royal Commission on Medical Education. One project was a cohort study of about 1700 medical students throughout the UK whose progress I followed for seven years. This study revealed several interesting facts, one of which was the existence of a very uneven playing field. Girls and young women who aspired to a medical career had to overcome formidable obstacles. Their parents and school teachers often discouraged them from even considering a medical career and selection committees at many medical schools discriminated against admitting women. Therefore, to be admitted to medical school women had to be very highly motivated and required better academic grades than men. Consequently in medical school, they performed better than the men, got significantly more prizes and distinctions. Despite this, discrimination against women continued beyond graduation, especially if they married, and most of all if they had a child or children, when it was often very difficult for them to get good training posts that would advance their careers. My sense of social justice was so outraged by this that I eagerly joined forces with two women doctors who had achieved positions of power and influence, and helped them to design plans to level the playing field. Among other things, they set up part-time residency training programs for women able only to work part time while raising infants and small children.

My sense of social justice was part of my values. Whence did this come? It dates back as far as I can remember to early childhood, which accords with observations by child psychologists and others who have identified recognition by children as young as 6 years of ‘right’ and’ wrong’ and ‘fair’ or ‘unfair’ treatment.  The consensus seems to be that it is an innate behavioral pattern.  The Earl of Shaftesbury, the 19^th Century British social reformer who worked tirelessly to abolish child labor in factories and mines, would not have been able to enact legislation if his parliamentary colleagues had not shared similar values, or developed these values under the influence of his eloquence and advocacy. I am not up to date in this field. I hope some of the readers of this blog might comment on current work on determinants of human values, particularly on the extent to which values are ‘hard wired’ into the human genome and brain or acquired as a result of parental or social conditioning. One reason I’m sorry my life and career are fast approaching the end is that I’d like to explore this fascinating aspect of human character and personalities in greater depth. There is much yet to be discovered.