Monday, December 29, 2008

Defining Health

Is health the absence of disease, the absence of symptoms, the absence of disability? That seems like a rather negative way to go about defining something that should be a positive, enhancing aspect of life. Yet that is essentially the approach of "modern" medicine (sometimes called "Western" or "allopathic" medicine). "Treatment" consists of fighting off the offending symptoms. If the patient has a fever, give an antipyretic drug such as aspirin to bring the fever down; if nasal congestion, a decongestant such as pseudoephedrine; if an infection, an antibiotic such as penicillin; if a headache, an analgesic ("pain killer") such as acetaminophen (Tylenol).

This seems at first blush like a sensible approach. It sees a diseased human as a smoothly functioning biological machine on which some discordant process has been imposed; counteract the process, and smooth functioning will be restored. But this approach has problems, both theoretically and clinically.

From a theoretical standpoint, it basically represents a reductionist view--that a healthy person is the sum of a lot of healthy parts; if one part is disrupted, one can simply restore that part to smooth functioning and the overall person is restored to health. But the "parts" of a human being are too complicated and interdependent for this view to be workable. For example, a fever may be one of the body's orchestrated suite of ways to fight an infection: there are very few infective bacteria that can reproduce if the body has a few degrees of fever, say a core temperature of 103 degrees Fahrenheit. Or a fever can result from a systemic inflammatory response such as rheumatoid arthritis; from an environmental imbalance such as a hot room with sweating inhibited by dehydration; from a poison; or even from a cancer or other causes. So treating a fever with an antipyretic may be at least irrelevant and at worst an interference with the body's normal, healthy coping mechanisms.

For another example, treating a bacterial infection with a chemical that kills the bacteria such as an antibiotic like penicillin may, at first, seem like an obvious approach. But there are a couple of things wrong with this theoretically--and these are borne out clinically. First, an antibiotic doesn't just kill the egregious organisms, it kills other bacteria as well; and a healthy human lives in dynamic equilibrium with many kinds of bacteria--most classically with the ones that make vitamin K in our intestines, but in fact with many different kinds of bacteria that interact with and are in balance with many body processes and systems. So, giving an antibiotic does not usually just kill off the offending organisms, it decimates the body's normal, health-promoting bacterial friends as well.

Second, when a bacterial species is exposed to an antibiotic, its metabolic and genetic selection processes go to work to outwit that antibiotic. Since bacteria reproduce and evolve very rapidly, over a matter of hours and days the infecting pathogen is likely to produce resistant strains so that the antibiotic is ineffective and the infective disruption of the body's processes can get back under way.

Rather than taking such a reductionist or "separate parts" view, it is wiser, from a theoretical standpoint, to see a human being or a human life as a wholistic* orchestration of a lot of different systems, subsystems, and processes on a lot of different levels. After considerable thought and observation (including clinical experience), some people have characterized the most abstract or generalized levels as these four--

physical--this is the "lowest" (least important) level; it refers to the body's machinery: from that for locomotion to digestion, from vision to reproduction

emotional--this is the next higher level; it refers to how one experiences life: from happiness, satisfaction, and love to boredom, depression, and hate

mental--above and more important than the "emotional" level is the "mental"level; this refers to the clarity and alacrity of cognitive functions such as memory and problem solving

spiritual--this highest, most important, level refers to the sense of purpose in life, the sense of belonging, of having meaningful goals and moving toward them

Note: Many people would feel intuitively that the "emotional" level is more important than the "mental" level--in other words, that feeling love, happiness, joy--even sadness and anger--is more important than mental clarity and sureness of memory, but this is not born out by the careful observation of "disease" and how it is experienced by the patient, nor of healing processes. Some would even say that the "physical" level ranks high--that physical pain, for example, can distract you from a full emotional life and from mental clarity. But clinical observation ranks these four levels as I have listed them with the "spiritual" level highest and the "physical" level lowest, less important than the "emotional" or "mental."

The definition of health, then, from a wholistic perspective, is that all these levels are working well and are integrated smoothly so that the human being is physically able and active, is emotionally happy, has mental clarity, and experiences a sense of belonging and of moving toward meaningful goals.

This seems like a broader, more positive definition of "health" than "the absence of medical signs and symptoms." It is also in consonance with a range of observations of the human experience and has significant implications for healing systems--as we shall see in further essays.

* Note: Although this word is more commonly spelled "holistic," I prefer the equally correct "wholistic" because both semantically and etymologically the word is related to "whole" rather than "hole" or "holy."