To describe health as the absence of disease is inadequate and unsatisfying. We have defined diseases for the last four hundred years or so according to the presence of certain lesions, or the presence of “abnormal” readings measured by instruments of investigation. Illness is a related, but different, term from disease. It is used mainly to refer to the experience of being unwell, incorporating our concept of disease, but actually describing the subjective experience of a person. Only a person can tell you they feel nauseated, or that they have pain. Instruments won’t reveal those phenomena.
Similarly, health should be understood as a phenomenon, or an experience, in its own right. For sure, if you have either a disease or an illness, this will impact on your experience of health, but is it really such a black and white issue? I don’t think so.
Consider these three concepts as a spectrum
H = health; A = acute disease; C = chronic illness
From the condition of health, we can move rapidly into the red zone as we experience an acute illness. Think of “winter vomiting”, which only this morning was reported as having affected one in every five people in Scotland this winter. Suddenly, you feel unwell, and then you start to vomit, and/or, have diarrhoea. You pretty much have to wait it out, resting, and replacing the fluid losses as best you can. Although caused by a virus, we don’t have antiviral drugs which effectively and quickly kill this particular one (and even if we did, killing the virus is only one part of becoming well). What helps?
The body heals itself. Any intervention, including rest and replacing fluids, will only help by supporting the body’s capacity to self-heal. Personally, I and my family, used homeopathic medicines in addition, to speed our recovery from this nasty acute illness.
In other acute situations, relying on the body’s self-healing is not enough. In the situation of acute heart failure, a heart attack, severe acute asthma, a diabetic crisis (hypo or “DKA”), and so on, medical treatments including drugs or surgical procedures can make the difference between living and dying during this acute event.
However, once the acute episode settles, the person may move up into the healthy blue zone of the spectrum, or may slip around into the chronic yellow one. We see this in diseases such as MS (Multiple sclerosis), where the acute episode might settle completely and the person returns to an experience of health, or it might progress into a more chronic pattern.
Similarly, someone might develop a chronic illness insidiously, without any acute episode at the outset, and they might move towards the healthy zone, or they might occasionally fall directly into the acute red zone as they experience a flare-up (as we might see with inflammatory bowel disease, for example).
Why is this spectrum helpful?
Well I think it shows that health, acute and chronic disease and illness, are different, but related phenomena. However, it also shows us that different tools are required depending on where the person is on the spectrum. There are drugs and operations which can assist in the management of problems in the acute or chronic zones, but any movement towards health always requires the good functioning of the individual’s self-healing capacity.
This is one of the main things I find missing in modern health care. We attend to the lesions and dysfunctions, but we lack the technologies for directly supporting and stimulating the body’s necessary self-healing capacity.
This is the area being explored by doctors interested in “integrative medicine” ie interventions which are intended to support greater integration or coherence of the whole system.
We need research to better understand self-healing. In fact, we need to become better able to describe and understand the condition we call health. If we want to increase the health of populations we will probably find the answers, not in drugs, operations or therapies, but in creating the conditions, and supporting the contexts, for adaptation, creating and engagement – characteristics of health.
In relation to illness, however, we also need to explore interventions which are intended to be integrative by examining their impact on health, not on lesions.