Heroes Not Zombies

A healthy being has certain qualities or characteristics. Health is much more than the absence of disease. Health is a positive phenomenon in its own right. How can you know if you are healthy? And how can you increase your health?

Adaptation. How are you coping with change? Nothing stays the same. No two days are the same. Sometimes we feel stuck but always our bodies, our minds and the environments in which we live are changing. Change is the reality of life. When we are healthy we cope with change. We adapt. I was once invited to teach in Santa Fe, and flew to Albuquerue from Edinburgh arriving late at night. My host, a doctor colleague, picked me up and took me to his house about 10pm. I went to bed and fell asleep only to wake about 4 hours later gasping for breath. Alarmed I wakened my host saying “I think I’ve developed asthma!”. “Don’t be silly,” he said, “We’re 7,000 feet up here. You’ve come from sea level. It’s the altitude.” By the next afternoon I was breathing completely normally. I had adapted. A healthy organsim adapts. Whether the changes in your life are physical, emotional or social, coping is a fundamental part of health.
Creativity. Human beings don’t just cope by maintaining some kind of status quo however. We continuously grow and develop. Physically and psychologically. Creativity is the ability to both express yourself and to make something new. In biological terms we use the word “emergence”. This is the word coined to capture the idea that things change in a growing system so that new behaviours and new phenomena appear (usually unexpectedly). The abilities to solve problems with new solutions, to express ourselves and to continuously make our lives new is also a fundamental part of health. An organism that is not growing and developing is dying. Think of your house plants for example!
Engagement. “No man is an island.” We all exist within multiple environments – geographical, social, cultural and so on. It is actually impossible to consider someone fully without situating them in the world. In fact, there is a kind of paradox at the heart of all our lives. We need to be separate, unique (we even have a whole immune system dedicated to recognising what is not us and keeping it out!), but we also need to be connected, to love and be loved, to share. Depression is a real black hole. It sucks everything of life inwards and cuts us off from others and from the world. A healthy person is engaged with the world, interacting, loving and being loved.

So, there’s my three criteria. If you want to know how healthy you are check yourself out against them. How are you coping? How are you growing? and How are you connecting?

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When you feel ill, you want to try and figure out what’s going on. If it’s not something simple and obvious then you might need to go and consult a doctor. It’s likely the doctor will ask some questions. These questions are not random. The doctor has been trained to ask them. In fact, the doctor will have a lot more questions in his or her head than the ones you are actually asked. It’s these “back questions” that interest me. The ones running continuously through the doctor’s mind which form the basis of the whole consultation.
Doctors are trained to think about illness in a particular way. The thinking model is known as the “biomedical model”. The biomedical “back question” is this –

“What is the diagnosis?”

By diagnosis, we mean, what is this disease? Of course, there are other “back questions” which become more important once the diagnosis is made – “What action do I need to take?” and “What’s the prognosis?” for example. However, those questions are completely dependent on the answer to “what is the diagnosis?”. In the biomedical model, the diagnosis is the identification and naming of the disease. Once that’s done, the treatments are applied with expectations wholly informed by the doctor’s understanding of disease.
But disease is only part of the problem. You don’t feel diseased, you feel ill. Illness involves both the disease and the person who has the disease. Illness is the whole experience of your suffering. We are not machines and no two of us are identical. If a doctor wants to more effectively treat a patient they should use a different model from the “biomedical” one. They need a model which helps them understand the person who has the disease. This other model has been given many names but let’s use the one “holistic”. To understand the whole of a person’s illness the doctor needs to have different “back questions”.
I think to do this a doctor needs to use these four key “back questions”

1. “What’s this person’s experience?” – the doctor needs to hear your story including a good clear description of what you are feeling, what sensations you have been experiencing, when you’ve had these sensations and in what circumstances. Your experience of illness is subjective. Nobody else can experience the pain, or nausea, or breathlessness, or distress, or whatever it is that you are experiencing. The doctor can only try to understand what your subjective experience is by enabling you to tell your story.
2. “What kind of world does this person live in?” – we all experience the world differently. We pay attention to different aspects of life and we are affected differently by them. To understand who the person is who has this illness, the doctor needs to know what you are affected by, what’s important to you and how you experience the world.
3. “How does this person cope?” – we all have different coping strategies. Some cope by retreating, hiding away, shutting down, whilst others cope by crying for help, needing company and support. There are many other patterns but if the doctor is going to figure out how best to help you he or she needs to find the treatments that will work best with your particular coping strategies.
4. “What sense does this person make of this?” – we are meaning-seeking creatures. We always want to make sense of our lives. Why has this happened to me? Have I done something wrong? Is it because of my diet, or a bug that’s infected me, or my genes, or is it God punishing me? The sense we make of our illness may not only influence our chances of recovery but can actually determine the prognosis.

If these four “back questions” continuously run through the doctor’s mind, the question “what is the diagnosis?” will fall into place, not as THE important question, but as AN important question. The disease can still be named, but it will now be understood within the context of the person who has the disease. Only then will this individual, will YOU, get the most appropriate help to restore your health.

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