Heroes Not Zombies

There really are many definitions of health, and that’s not a bad thing. Such a complex phenomenon cannot be wholly understood by the use of a sound bite, a mission statement, or a simple formula. However, a simple statement or formula can provoke thought, change a perspective, or shine a light on a poorly understood issue.
Here’s one simple statement about health

Vitality + Resilience = Health

When someone is sick they seek a restoration of health. They, preferably, want a cure. Something which will completely remove all traces of the disease and leave them back where they were before they became ill (or, maybe even in a better place than they were to start with!). In acute disease that can be a reasonable aim. Infectious disease is a good example. If you suffer from some infection this winter, say a chest infection, a cold or a flu, then you’ll find that the illness will last a few days after which time, the symptoms will all fade away. You might need the assistance of some anti-infective drug to kill the offending bug but the bottom line is your body will repair itself and the disease will be over. (I’m talking best case scenarios here!) However, chronic diseases are not like that. Chronic diseases involve changes which don’t go away. Despite that two people with the same chronic disease will experience very different levels of health. Two people with the same pathological lesions (similar locations, similar severity) may report completely different levels of well-being, and whilst one may state that the illness is making life unbearable, another may state that life is good, or even that they are flourishing. Eric Cassell, the American physician explores this in his writings by taking a focus his patients’ assessment of their “suffering” and shows that whilst there is a relationship between disease and illness, or, shall we say, between lesions and experience, that it’s not a simple one-to-one relationship.
If we return to the scenario of acute disease for a moment, two people who suffer from the same infection don’t have the same experience. One may get severe or long-lasting symptoms whilst the other experiences only mild, short lived ones. Beyond the period of infection, one person may bounce back fully restored, whilst another finds themselves with lingering symptoms or feeling just under par for several days, or even weeks. What makes the difference?
I think one explanation lies in this simple statement
Vitality + Resilience = Health.
Vitality is not an easy thing to pin down. Some people understand it best as “well-being”, “wellness” or “energy”, but I prefer the word “vitality” because I like it’s positive connotations and I think it captures a sense of vigour or brightness. The opposite of vitality would be debility. It would be reasonable to expect that someone whose vitality is very low will be both more susceptible to catching an infection, and more likely to experience a more severe or prolonged illness. Without good vitality, resilience is impaired.
Resilience is the capacity of a person to cope, to deal with what has happened by repairing damaged tissue or systems, and/or by adapting to the changes in their bodies and their lives. Resilience also involves some kind of growth. When we cope with something, or when we adapt to a major change, then we grow. We grow by having learned something, by having become stronger in some way, more able to deal with challenges perhaps. This kind of growth is a part of resilience. When we grow as a result of our coping and adapting then we become more resilient.
I think both vitality and resilience are important parts of health and I think they’re relevant to the treatment of both acute and chronic diseases. But most treatments used by doctors are not designed to influence either of these phenomena. Why is that? Sure, it’s good to have treatments which directly kill bugs, or which assist the body to address a pathology by having a direct effect on lesions, but if we don’t pay attention to vitality and resilience are we really going to become healthy?
We need to understand vitality and resilience better. We need to better understand how they work, and we need to understand what therapeutic interventions will stimulate vitality and enhance resilience. Then we need to develop that whole aspect of health care because so far, we focus almost exclusively on lesions and disease, not on health.