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Understanding Health - definitions and discussions

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Understanding Health - definitions and discussions
by Mike Sheldon
 

 

Introduction

Development of a whole-person understanding of health
Illness is not just in the body – pathological physical diagnoses only one part of the story
Need to see health as a holistic concept
This paper explores the dimensions of health which are relevant to successful treating of dis-ease in the whole person

Historical understanding of health
Very brief historical review – although most beliefs are still present in the world today
Make our understanding relevant in a wide variety of cultures, societies and belief systems
Mystical – spirit world or the will of allah
Natural causes – environment (Aristotle?)
Sin and wrong life-style
Development of scientific humanism
Laboratory based science and pathology
Limitations of this sort of definition – OK so there is coronary artery disease on PM – but why?
WHO definitions and later amendments

Why do we need a definition of health?
Our aim is to promote health and combat disease.
We need to understand a broad view of health otherwise we can be guilty of helping improve health in one aspect but making it worse in another. Simple example of this – coronary stent – releases one person and binds another with fear.

So where do we begin?
Health of a person is influenced by three main dimensions –

Environmental level    The environment in which the person lives will have a profound effect on their health –
    Poverty or wealth
     Political system and injustice, social and cultural
    Housing
  Climate  etc etc
Bio-Physical level  Our traditional western medical way of defining health by the presence or absence of disease, pathology and symptoms
Personal level   The person inhabiting the body will have a profound effect on health through their beliefs, attitudes and actions.

  

A broad definition of health which encompasses these three dimensionsJanuary 7, 200807 effective. Thus advising a person to follow a particular diet if they are too poor to obtain it will not be effective. Likewise giving a patient antibiotics when they believe that they will poison him is likely to lead to non-compliance.

Anthropology
Throughout the world, in most religions and in people with no religion there is an understanding of the concept of thinking about ourselves as body and soul or spirit.. Most people still have a dualistic approach to humanity, which although based on a truth can lead to very un-helpful thinking. We can consider as an illustration of this concept the way in which anatomy and physiology has been taught at medical school in the past. The two subjects were completely separated in the past, so that anatomists could describe the structure, but know little of the function. Physiologists cared less about the structure and examined the function. However both aspects work completely together – there can be no function without the structure, and the structure has no purpose without the function. So with personhood – the physical being enables the person to exist as it’s function – you can’t have one without the other. We are a unity.

We are indivisible beings with many different functions and abilities which mainly include the addition of reasoning and intellect and a spiritual capacity to a physical body. As the Hebrew concept has taught us we are indivisible and a whole being. I cannot divide off my soul or my spirit and nurture that at the expense of my body. Maltreating the body also maltreats the spirit, and vica versa. Every action has spiritual, personal and physical dimensions.

Ill health is the common end pathway of any disorder or dis-ease in the person, whether in the body itself or in their mind, emotions, environment or spirit. The whole person functions together.

Health and wholeness
We can no longer define health as the absence of disease. Genetic science has opened our eyes to the fact that we are “diseased” before birth. When any person is examined closely you can find evidence of disease within them. At the last count I had something like 16 diseases within my person – and yet I consider myself to be healthy. Nor can we use a definition that talks of freedom from symptoms and suffering – for studies have shown that we all have some pain or physical symptoms of dysfunction every day. Rather we need to begin to consider health as the way we adapt and cope with our internal and external environments. Health is more to do with how we manage our health problems rather than the absence of presence of those problems.

Health is a dynamic in which we grow and mature throughout our lives, and is the strength we have to enable us to live life to the full and complete the tasks to which we have been called. It involves an equilibrium between ourselves, and the world around us which is based on right relationships and values such as respect and loving kindness. Health is a therefore a journey through life and into death where we always seek to adapt to disability and suffering and cope with pain and difficulties in a way which matures us.

The dynamic aspects of health
If we are to understand a person’s health then we need to consider the following seven areas which make up our health status –

  1. Self-esteem
    1. What it is to be human. Self awareness.
    2. The integration of the spiritual and physical within us.
    3. How we relate to ourselves,

 

  1. Coping and adapting

We all have some diseases within us, even from the day of our birth. Some of these are potential and may never be realised (I may have the genetic predisposition to lung cancer but reduce my risk of getting it by not smoking). Other diseases are relatively trivial in our society (such as my myopia which is well corrected by glasses, but prevented me from a career in the Royal Navy). Other diseases come with advancing age so that by the time of death a pathologist can list dozens of disease processes in various stages of advancement. Some diseases I have brought upon myself through my lifestyle (I think I am a little over-weight but my doctor says I am obese). Some diseases remain hidden for many years and cause few symptoms in the early days (such as high blood pressure). We also all have symptoms both physical and psychological for much of the time. So in the presence of a continuous presence of disease and symptoms, pain and suffering, our health depends on how we process, adapt to and cope with these health problems.

Various measures such as the locus of control or sense of coherence tests have attempted to demonstrate how much a person is able to take control of their own responses to challenges, and so improve their ability to function and enjoy life despite disabilities and difficulties. Work by investigators such as Aaron Antonovsky, who looked at women surviving the Holocaust, has demonstrated that where some people crumple and suffer health consequences for the rest of their lives, others are able to rise above the horror and become stronger and so less likely to encounter health problems later in life. Thus a healthy person is one who when faced with disease, disability, suffering or pain is able to find inner reserves which then strengthen the person for future challenges.

  1. Self-fulfilment or Courage

Self-fulfilment has three important steps. First you need to have a correct self-awareness in which you understand your strengths and weaknesses, your gifts and abilities. Second these abilities need to be translated into the possibilities and dreams, the heights to which you could scale. But then third these goals and dreams need to be seen as an impossible or very difficult target to reach, but one which must be constantly aimed for. Thus we never achieve complete self-fulfilment, we never arrive at the end of the road – there is always further to go. Thus hope and realism need to be balanced throughout life to provide sensible goals for each stage of our existence. A healthy person can re0evaluate their situation and adapt their goals accordingly.

An important aspect of this concept is the fact that all people are made with creativity within them. The ability to create seems to be an essential human attribute. Each person has to discover where their creativity lies and use this in their life in some way. It may be obvious as in having and bringing up children. Or it may be more hidden in performing a difficult task well under trying circumstances.

The courage to take risks and seize opportunities – the enemy is fear
Hope and a future orientation
Element of pilgrimage

  1. Relationships

The role of relationships in our lives constantly needs emphasising. We are made both by and for relationship. God created us to be in relationship with himself, and then so designed our world that we ourselves are formed as persons through our relationships. In recent times we have seen the equal dangers of treating people as isolated individuals (there is no such thing as society, just a collection of individuals, said Margaret Thatcher) or seeing individuals as insignificant parts of a controlling society as in communism.

Over the last few decades there has been a growing understanding amongst theologians that there is a third way which is more biblical. Here the person is constituted at the most fundamental level by his or her relations, both to others and to God. Christians have traditionally grounded their affirmation of human dignity and personhood in the creation of man in the image of God, yet what it means to be made in the image of God has been much debated. In the Augustian tradition a person was construed in their own relationship with themselves. Thus we began by “knowing our own mind”. However within theological study there has recently been a shift towards the understanding of the importance of relationships in the development of personhood. John Macmurray proposed a complete change of standpoint from the primacy of the cogito to the primacy of the self as agent and constituted by his relationship with another person. In his chapter Persons in Relation (in the book edited by Schobel and Gunton in1991 called “Persons Divine and Human”) MacMurray has said “The self is constituted by its relation to the other; that is, it has its being in its relationship; and that this relationship is necessarily personal”. The being of God, in whose image the Bible says we are made, is understood as a Trinity, in order to exhibit a relationship within the Godhead.  In creation God made us in his image, and then calls us to be in relationship with him.  The broken relationship consequent upon the Fall and man’s sinfulness, is then redeemed through Christ’s work on the cross.

The understanding of man as a relational being is one of the main themes of the work of Alistair McFadyen and is developed in his book The call to personhood (Cambridge University Press 1990).  McFadyen argues that each person can only be understood in social terms, thus “we become the people we are through our relationships with others”.  After describing the two common models of personhood (the models of individualism and collectivism as quoted above), he describes a third way in which a relational model of personhood is developed which does justice to personal freedom and autonomy whilst simultaneously acknowledging the role of social relations and institutions.  From the outset he stresses that this model does not just encompass inter-personal relationships but also includes social, cultural, historical, political and moral relationships.

This concept of a person is both dialogical (formed through social interaction, through address and response), and dialectical (never coming to rest in a final unity, if only because one is never removed from relationship). Talk of how human beings have their being in our society has been so completely secularised that we find it increasingly difficult to talk of humanity with reference to God in a way which is meaningful in our contemporary situation.  It is my belief that this missing dimension makes a real and important difference to our health and to our every day practice and mode of living.

  1. Faith and belief

An important part of our health status concerns what we believe in.  It seems that we are made to work through faith.  We develop a world view which describes what we believe in. However in order to act on our beliefs we need to move, and this acting on our beliefs we can call faith. Everyday we have to put our faith in many things, otherwise we would never get out of bed. So assuming that this is correct and we live day by day thought acts of faith, does it matter what we believe in?  Is some belief better than others, or is it all relative?
Understanding the truth about us and our world is the aim of all religions and belief systems, and each person believes that their own version is the best (but then they have to don’t they?). As doctors we constantly espouse that our way (the western scientific model of illness) is the correct one and seek to get people to follow our advice with pills and medical interventions. Of course we are well intentioned and really do believe what we practice. But what of the growing alternative medicine field – where equally intelligent and committed people believe and practice quite different things. Is it all the same in the end – does whatever you fancy do you good?

There are two parts to the answer to this question. In the first part it may be argued that it doesn’t matter what you believe in, it is the power of belief itself which makes you better. This takes us into the whole area of the placebo response which has been argued to account for a significant proportion of the good done to us by both conventional and alternative medical practice. The power of belief affects our internal coping mechanisms and either makes us better, or helps us to feel better.

However the second answer to the question has to draw distinctions between activities that definitely do us harm, and those which may be beneficial or neutral to our health. Let us take a simple example using diets. All sorts of food allergies, over-indulgence or shortages of essentials in the diet have been put forward as causes of ill-health. When starting a new diet most of us feel better at first (perhaps the placebo part), but then for our health to really improve in the long term the diet we are following must contain certain elements. Thus a diet with no fibre, minerals or vitamins will eventually lead to serious ill-health. The composition of a healthy balanced diet has been well researched, and we should all eat this (with the obvious exception of people who have known allergies to certain foods) in order to maximise our health.

  1. Maturity

So health is a journey rather than a state. We move on through different levels of health. We develop a story which we are always willing to tell to others. This health narrative is an important part of the process of being healthy. The story needs to reflect our response to the illness, but also be truthful as to the causes of the problems. Here we enter the difficult area of sense of coherence and locus of control. Two expressions which seek to encapsulate how much control the person has over their own health. With a good sense of coherence and an internal locus of control the person is able to “do something for myself” to make them healthier. With a poor sense of coherence and an external locus of control the person does not believe that they have any role in making themselves better, but quickly adopt the “sick role” and expect others to make them better.
Thus two people with exactly the same disease process can have completely different understandings of their health. One can quickly follow medical advice, and do numerous things to make themselves fitter over-all, and so minimise or adapt to the pathology which is present. Others will believe that the disease processes cannot be influenced or altered, except by medical intervention, and so become passive.

Health measurements change with age – if as a 65 year old my present good health was in a 25 year old he would be unhealthy (Express this better !!)

  1. Transcendent Relationship

For Christians, Jews and Muslims the final aspect of health is their relationship with God. This of course is a two way affair and we must first recognise that we are often baffled and confused by God’s relationship with us. Many Christians feel that God has deserted them, especially at times of pain and suffering.. It does seem that God uses illness and suffering to help us grow and mature. God’s ultimate desire seems to be for us to enjoy heaven, starting here and continuing after death. Some people seem to reach this point even in the midst of great pain, but for most of us we are still struggling on the journey.

We seek for shalom – that peace with ourselves, with others and with God which is the ultimate aim for us all.

HEALTH IS ………
So we can summarise our understanding of health with the statement that health is …..

  1. understanding the truth about one’s self, having a right self-awareness
  2. the ability to adapt to and cope with changing situations, both internal and external;
  3. being fulfilled, and completing one’s goals in life;
  4. being in right relationships with others;
  5. putting one’s faith in the right things;
  6. completing the journey through life towards maturity,
  7. being in a right relationship with the Transcendent

 

Telling the whole story
Strength to be human – the strength to live and die
Chris’s concept of an “Overwhelming”- where one element completely overwhelms the person’s ability to be healthy. This may be external such as in extreme poverty, in the body such as extreme pain or in the person such as extreme depression

Final chapter in life of a healthy death
Shalom – wholeness and well-being – the space and strength to live life to the full

Measurement of Health
It’s difficult to measure a story or a journey, however some of the aspects of our definition of health do enable us to use both quantitative and qualitative measures to describe them. Some of these measurements will be physical, others behavioural, cognitive and spiritual. We can encourage people to tell the story of their health in a Health narrative which seeks to demonstrate the progression of understanding and movement towards the goal of Shalom – peace in the midst of the clamour of life.

C:\Documents and Settings\Emmanuel\My Documents\Whole-person\definitions  of  health paper - version 4.doc

 

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