Unequal

Freedom, responsibility, and health

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7072.1582 (Published 21 December 1996) Cite this as: BMJ 1996;313:1582
  1. John P Bunker, visiting professora,
  2. Stephen Stansfeld, senior lecturera,
  3. Jenny Potter, senior registrarb
  1. a Department of Epidemiology and Public Health, University College London Medical School, London WC1E 6BT
  2. b Tavistock Clinic, Tavistock Centre, London NW3 5BA
  1. Correspondence to: Professor J P Bunker, Cancer Research Campaign Clinical Trials Centre, Rayne Institute, London SE5 9NU.

    Freedom and responsibility, how much of each and how they are balanced, have profound implications for our personal lives and for our work. The health of a population and its achievement in the workplace are enhanced when individuals have some freedom and some responsibility, but not too much of either, and when civil associations of individuals rather than individuals acting alone are the essential social units. The consistent association of social contacts with health and productivity provides strong support for the premise that intimate relationships are the focus around which people's lives revolve. Membership of a “social network” may be merely conforming to a reigning social norm, and this could mean having to pay an important price in the loss of creativity associated with individualism. But social conformity should not prevent individuals from going their own way, and it should be possible to combine the luxury of individuality with an active life in civic affairs. Less than complete freedom may fall short of existential utopia, but it may be best for our health and wellbeing.

    The human yearning for freedom, countered by the urge to escape from it and from responsibility, has commanded the attention of both metaphysical and political philosophers over the centuries. Some individuals seem to need the total, or near total, freedom exalted by Ralph Waldo Emerson and practised by Henry David Thoreau. At the other extreme there are many who voluntarily relinquish their freedom, as described in Erich Fromm's Escape from Freedom and exemplified by the mass movement of groups, and even whole populations, to fundamentalism. Though the philosophical and religious debates continue, new evidence from studies of the length and quality of life indicate that humans, on average, fare better when they have some freedom and some responsibility, but not too much of either—that is, …

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