© Living Proof
Questions of Health and Illness arise daily in any medical practice. In this article Dr Wendy Isbell explores some philosophies, view-points and attitudes about health and illness.
In day-to-day practice it is perfectly reasonable to say that "This person is healthy", or "That person is ill", and such view-points may lead to useful action. But when we try to get beyond the physical process of disease to understand something about the nature of health and disease, it becomes less satisfactory to separate the two states as though they were mutually exclusive. For example, a man with one leg may lead a vigorous and productive life, whereas another person with no demonstrable physical or mental disorder may be a hopeless invalid. It may be difficult to decide which of these is healthy and which is diseased.
Traditionally, a fully developed disease is seen as the end of a sequence of events with causal connections between each step.
However, if this view point is taken, then only the findings in the patient which can be fitted into a neat chain of events will be recorded, and all other information may be disregarded. Health is rather a state of dynamic equilibrium in which all kinds of forces – physical, psychological, environmental etc are in balance. When they are out of balance the individual may fall ill.
In ancient times, when someone fell ill people asked "Why?", "Why that person?", "Why at that time?" and "What had that person done to bring down such misfortune?"
This kind of thinking was natural in many early communities when there was a sense of relatedness to the environment which comprised not only other people but animals, plants, the physical surroundings and the seasons. Within the individual also, there was a sense of unity, with no separation of psychological and physical events. Within this system the appearance of illness was likely to be taken to mean the individual had somehow got out of equilibrium with himself and the environment, and such an approach to illness provided a meaning which enabled people to cope with sufferings which could not be relieved.
More recently, Talcott Parsons, and American Sociologist, has identified what he calls the "Sick Role" to describe some of the ways illness is seen in modern society, the ways people regard and behave towards the sick, and the expectations society has of those it has chosen to define as sick.
Firstly, the sick are relieved from the normal social responsibilities, in particular working and earning a living. On the other hand anyone who claims such expectations without "really" being sick will be judged to be malingering and will be punished by society.
Secondly, the sick are not held responsible for their incapacity, and it is assumed that they will need to be looked after. However those who poison themselves with drugs and alcohol are seen as responsible for their actions and so are often treated harshly by the caring professions.
Sickness is regarded as a misfortune, and so it is assumed that the sick will want to get well. The hypochondriac, or any person who seems to delight on the possession of symptoms, does not behave as though sickness is a misfortune so will not be received kindly by doctors or by society in general.
The sick are obliged to seek competent medical help, and to do all they can to get well. The neurotic person can be rejected because he or she can appear unwilling to take constructive steps towards overcoming the disabling symptoms. This concept of the sick role immediately takes illness beyond considerations of pathological processes, signs and symptoms and diagnostic categories. It becomes part of the broader relationship an individual has with society. These aspects may also have a substantial part to play in the origins of illness or the failure to recover as expected, provided of course that the sufferers obey all the rules.
Nobody likes illness or incapacity, but for many the disadvantages of illness are less threatening than full health with all the economic and social responsibilities that come from being a fully able member of society. The temporary regression seen in an acute illness may become a lasting habit in someone with a need for an ‘emotional crutch'. For example, ‘my rheumatics' may become a reason for avoiding all kinds of activities, and a kind of excuse for not being more successful in life in general. This is not to say that such situations are consciously contrived - far from it - and the sufferers would be deeply hurt to think that they were being regarded as malingerers. It is more likely that they simply do not at that time have the emotional resources to carry the burdens they used to.
A notion in our society that is widely held, is that people, through no fault of their own, will from time to time become unwell, may have accidents, and may require surgery. Getting ill or staying well is regarded as a matter of chance, misfortune or luck. So deeply rooted in our belief system is the concept of disease as both inevitable and out of our own control, that in treating disease we usually look only at the very last point of the expression of the disease - the symptoms.
However, beneath the symptoms, those irritating and unacceptable aches and pains, there is a vast network of unrelated causes and factors which may contribute to the disease. We tend to concentrate on the tip of the iceberg, often forgetting the major precipitants of the illness which are unaffected by the treatment and may continue to cause further trouble.
Opinions about health and healing are changing amongst the community, and many people believe that it is their own responsibility to maintain good health, and when required to consult doctors and other health practitioners for the maintenance of their well-being.
Individuals are now taking more responsibility for their own health, rather than giving away the responsibility to designated health professionals. This means that they tend to approach a doctor more on a consultation basis, asking for the doctor's assessment and advice as to what can be done to improve their well-being.
Practitioners and their patients nowadays are increasingly paying attention to states that occurred before the disease process showed itself. In other words, if a person is functioning with poor general well-being, or a level of tiredness, then even if no definite diagnosis is made, this is taken as an indication that there is something wrong in the balance of the person's body. At that state an intervention can be made to improve the person's well-being, in a purely individual way.
Leaving aside definite pathological diagnoses, when a person is unwell some people consider this to be a message from their bodies, telling them that somewhere they are not following their true self, or supporting their feelings. The body gives many such signals, starting with relatively subtle feelings of tiredness and discomfort, and going on to stronger signals, including aches, pains and minor illnesses. The theory holds that if the person still doesn't change, a serious illness or accident may eventually occur. The stronger messages can always be avoided by paying attention to the subtler ones, but once a strong message has come, it is never too late to listen to the changes that may be required, whether they be changes in attitude, lifestyle, exercise, diet, environment or whatever.
Some people go so far as to say that health and illness are both the results of mental thought patterns which form people's experiences. We all have many thought patterns that produce good, positive experiences which we enjoy, but it is the negative thought patterns that produce uncomfortable, unrewarding experiences and which need to be altered.
Louise L. Hay, a popular protagonist of these philosophies, states that the point of power is always in the present moment. It does not matter how long we have had negative patterns, or an illness, or a problem with relationships, finances, or lifestyles, it is possible to make a change immediately. The thoughts that a person has held, the words that have been repeatedly used, have played a significant role in creating the life and experiences up to that point. Yet anything in the past is past thinking, and it is possible to change one's attitude and thought processes, in order to begin changing the person's life.
A century ago, it was taken for granted that disease was an organic, physical process caused be pathogens such as germs, viruses, toxins and so on. It was assumed also that each disease had its own specific cause, and if that cause could be identified and a cure found for it, all would be solved.
Nowadays, it is known that the mind and the emotions play an important part when an individual develops a disease process, and it is widely held that psychomatic aspects of illness are important.
It is exciting that so many doctors are thinking and working holistically nowadays. As well as making definite diagnoses and giving regular treatment as required, they are also offering a general approach to restoring and preserving health, and paying attention to the patient's lifestyle, personality, thought processes, diet, and other factors in the maintenance of health.