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pology) should help the student acquire a holistic approach to health and disease and to recognize the interrelationships of cultural, social, psychologi-cal, and environmental factors with the psysiological and biochemical pro-cesses of the body" (Willard Report, 1966, p. 27). Evaluation of the Mandate The important potential role of sociology in the curriculum of the family physician programs has been endorsed repeatedly before, during, and since the publication of the above-mentioned blue-ribbon commission reports (Silver, 1963, p. 74-77; GP, 1966, p. 225-246; Harrell, 1970, p. 61-64). That potential role has been greatly enhanced by the passage of the Health Educa-tion and Manpower Act in 1976, which mandated that by 1980, 50% of all medical students graduating from medical school should be entering residen-cies in the three designated primary care specialties—internal medicine, pediatrics, and family practice. An additional aspect of this act was the allocation of some $40,000,000 for the expansion and improvement of existing family medicine residencies and for the creation of additional resi-dency programs. The question at hand—almost 12 years after these recommendations were submitted to medical educators-is whether a new breed of physicians is being produced by training in family medicine. Is there a new type of physi-cian who is "aware not only of his patient's physicial illness, but also of interrelations of family members and of family and community and socio-economic factors affecting the health of family members?" (Silver, 1965, p. 188-189). There are clearly two elements that must be distinguished in evaluating this mandate to train family physicians—one quantitative and the other qualitative. As far as quantitative changes in the attention paid to training family physicians, there can be no doubt that significant shifts have occurred in the past decade. In 1967, there were only three family medicine training programs in the United States, at the Universities of Miami (Florida), Roches-ter, and Oklahoma. By 1970 there were 49 programs, in 1975 there were 233, and in 1977 there were well over 300. In 1970 family practice became a
Outside those who have tried it, few appreciate the difficulties of behav-ioral scientists attempting to teach in medical settings. The problem for those who are primarily engaged in and who identify themselves with research is not as great. It seems that however antagonizing the research results some-times turn out to be for mainstream medical care and the health professions, behavioral science researchers are of substantial value in medical centers if only because of their comparative superiority and leadership in research design and methodology. The problems of those who primarily teach, how-ever, are enormous, and stem from several sources: from the demands in-herent in the educational context of the medical center (usually a tertiary care base striving to prepare technical specialists), and from the three most relevent groups involved-the medical faculty, students, and often from their own colleagues. Explorations of these difficulties together with a reexamina-tion of the role of behavioral science in medical education have become popular subjects. Useful discussions can be found in the December 1973 Special Issue of Social Science and Medicine, Hunt, 1974; Williams et al., 1974; Sluzki, 1974; Volpe, 1974; Routh & Clarke, 1976; Cohen & Kelner, 1976; and Wexler, 1976. A most penetrating analysis from a sociologist's viewpoint is provided by Jeffries, 1974. The presence of increasing numbers of behavioral scientists in care delivery settings such as kidney dialysis units, pediatric hospitals, primary care clinics, and family practice centers is beginning to contribute examples of how services and teaching can work hand in hand. From these experiences, especial-ly those in family practice programs (e.g., Johnson et al., 1977), a number of observations are beginning to provide the basis for consensus on several issues. These are the subject of another paper in preparation. In closing this discussion, I shall suggest only that the clinical behavioral scientist model advocated here provides a hopeful response to increasing pressure from a major prevailing issue: what and how to teach in order to make behavioral science "clinically relevent," i.e., to help health providers achieve immediate goals and to "actually demonstrate in concrete situatons that (our) knowl-edge and skills can improve the quality of health care" (Cohen & Kelner, 1976, p. 27).* This approach to teaching is admittedly labor intensive and deliberately clinically biased. It also requires that "student" and "teacher" work closely together to construct the ground rules for their relationships, two by two and
Lack of parental interaction and support has consistently been found to be crippling to the development of young children. Spitz's (1945,1947) widely quoted study of foundling homes versus nursery care related maternal and social deprivation to increased infant mortality, susceptibility to disease, retardation in growth, and failure to achieve developmental milestones. Whereas the Spitz study compared the effects of interaction between two highly specialized environments, McCarthy and Booth (1970) found evidence of a syndrome resembling Spitz' "hospitalism" occurring in children living at home with their parents. The most prominent abnormalities they described were dwarfism and subnormal weight/height ratios, interestingly, with little or no evidence of malnutrition. Behaviorally, the children exhibited varying degrees of bodily neglect, apathy, subnormal intelligence, and the inability to play. When these children from 10 families were removed from their homes and placed in the hospital, where it is assumed that a different type of interaction occurred between them and the staff than occurred in their homes, their symptoms, including the dwarfism, were reversed in most cases. While this study was focused explicitly on mothers, like so many studies of mother-infant interaction, the kind of relationship that developed could not have been made possible without either the absence of a father or other available caregiver(s). Behind many studies of negative dyadic interactions is a larger family drama. Such patterns are significantly more difficult to conceptualize and to investi-gate than the study of dyads. At the opposite end of the Ufe cycle, a study by Greene, Goldstein, and Moss (1972) of the psychosocial aspects of sudden death found that among men who developed myocardial infarction, considerable psychological distress had been evoked by circumstances in which there were departures or current disappointing conflicts between the patient and son or daughter, especially a son. Van Heijingen (1966) noted a similar pattern when he reported that rejection by a loved one frequently preceded the clinical emergence of coronary disease. Loss of social supports—particularly loss of a spouse—has been implicated over and over again in rapidly deteriorating health and, not uncommonly, death. Studies of psychosocial correlates of the onset of cancer repeatedly point to torn family relationships as high risk factors in the development of cancer. Similarly, when Parkes, Benjamin, and Fitzgerald (1969) followed the death rates of 4,486 widowers of 55 years of age and older for 9 years fol-lowing the death of their wives, they found that 213 died during the first 6 months of bereavement, 40% over the expected death rate for married men