A few quotations on attitudes towards the pursuit health:
And do you not hold it disgraceful to require medical aid, unless it be for a wound, or an attack of illness incidental to the time of year, — to require it, I mean, owing to our laziness, and the life we lead, and to get ourselves so stuffed with humours and wind, like quagmires, so to compel the clever sons of Asclepius to call disease by such names as flatulence and catarrh.
– Plato, The Republic
Yes, we suffer pain, we become ill, we die. But we also hope, laugh, celebrate; we know the joy of caring for one another; often we are healed and we recover by many means. We do not have to pursue the flattening out of human experience. I invite all to shift their gaze, their thoughts, from worrying about health care to cultivating the art of living.
– Ivan Illich, Health as One’s Own Responsibility – No, Thank You!, (PDF) 1990
After I had berated the patient for his obvious failure to comply with my recommendations to correct his “misbehavior,” he said, “You know, doctor, there is more to life than good health.” These words have helped me rein in my sometimes overzealous attempts to force patients into that glorious state of wellness and maintain a more realistic approach to the best possible state of health.
– Lewis E. Foxhall, M.D., The Tyranny of Health, 1994
Thinking that we can make death, illness, or privation easier to bear by preparing for them day and night is a sure way to poison our lives, to spoil the slightest pleasure by imagining its end.
– Pascal Bruckner, Perpetual Euphoria: On the Duty to Be Happy
In the past, health was usually understood as the normal state of affairs, and taken for granted as [a] feature of life largely beyond the control of the person or the society. The proliferation of reflexive techniques which promise actually to improve one’s health has transformed the very meaning of the term ‘health’. The advent of such an immense range of popular ‘health-enhancement’ or ‘self-improvement’ techniques has meant that health is now seen more as a positive goal to be achieved rather than the normal state of a person without illness.
– Christopher Ziguras, Self-care: Embodiment, Personal Autonomy and the Shaping of Health Consciousness
There have always been individuals willing to point out that the constant pursuit of health is not the be-all-and-end-all of life. This eminently reasonable attitude, however, is increasingly rare among both doctors and patients. We have been educated to believe – primarily by what Ziguras calls “commodified and mediated health advice,” but also by the medical and public health professions – that feeling good and assuming we’re healthy could all too easily be a delusion. How can we be certain some fatal disease doesn’t lurk in the unreliable interior of the body?
We choose to pursue health or to pursue disease
One of the more recent individuals to address this issue is Dr. H Gilbert Welch. In his latest book, Overdiagnosed: Making People Sick in the Pursuit of Health
As Welch describes it: (emphasis added)
I am referring specifically to seeking diagnoses in the absence of symptoms, because that’s when overdiagnosis can occur. I am not suggesting all diseases are curable after symptoms appear … nor am I suggesting that no diagnoses should be made in the absence of symptoms. … I’m simply suggesting that we should be most cautious about early diagnosis in those who feel well. …
Some may prefer to pursue health: to focus on feeling healthy and minimize medical contact while they are well. They may accept a slightly higher chance of death or disability to minimize the chance of medicalization, overdiagnosis, and overtreatment now. They prefer to reserve medical care for problems that are obvious to them.
Others may want to pursue disease: do everything they possibly can to be healthy in the future and to decrease their chances of experiencing death or disability – even with the knowledge that they are more likely to be diagnosed with disease, more likely to be frequently exposed to medical care, and more likely to suffer harm. They prefer to work to avoid death and choose to allow medical care to assume a larger role in their lives. Many view this as the best strategy to stay well. But it is difficult to promote wellness when actively looking for things to be wrong. In the effort to find out that everything is okay, people pursue early diagnosis. Ironically, this strategy increases the chances that they’ll be told something is wrong.
Should we pursue health or pursue disease? Our location on this spectrum may vary as the circumstances of our lives change. If we learn that close relatives have been diagnosed with heart disease or cancer, we may be more inclined to seek early diagnosis in the absence of symptoms. Having young children may increase our consciousness of how important our health is to others.
To choose the pursuit of health requires knowing we have a choice
Health is an ideology: a set of ideas that establishes goals, creates expectations, and determines our actions. It’s one means of understanding the world and our journey through life. It’s only natural that we seek to control our health, our susceptibility to illness, and the length of our lives, especially when anxiety about health is amplified by constant warnings and exhortations from all available media. We are enticed by the rewards promised if we adopt the latest health fad – promises that frequently turn out to be an illusion.
The obsessive pursuit of health is itself unhealthy. Those who are fortunate enough to be symptom-free can locate themselves closer to the enjoyment of health end of the spectrum or they can pursue disease. There are many influences on our lives that lead the healthy to pursue disease. To consciously choose the enjoyment of health we must first recognize and resist those influences.
Related posts:
The last well person
Contempt and compassion: The noncompliant patient
From healthism to overdiagnosis
Overdiagnosed and overprotected children
The downside of overly aggressive cancer screening
Creating an epidemic of cancer among the healthy
Screening for cancer and overdiagnosis
Old age and the limitations of a healthy lifestyle
Healthy lifestyles serve political interests
The politics behind personal responsibility for health
The tyranny of health then and now
“Tyranny of health” on KevinMD
The tyranny of health
Resources:
Image: o5
H. Gilbert Welch, Overdiagnosed: Making People Sick in the Pursuit of Health
I really love this blog! Your mention of choice is simply Truth for all areas of life. We are fundamentally not victims, life is in our hands!
– Kim
Thanks for your support, Kim. Both “choice” and “healthism” (being overly preoccupied with matters of health) can be tricky subjects. My feeling about choice is the point I make here – all too often we don’t realize we have a choice because there’s so much media/advertising/propaganda/whatever trying to convince us that there’s only one way things should be. And while our lives — to the extent that we’re conscious of what’s influencing us and not sleep-walking through life – are in our hands, I’m not one who subscribes to the idea that all you have to do is visualize what you want and it’s yours.
Healthism is tricky because it takes a lot of words for me to explain I’m not advocating that we all eat junk food and be couch potatoes, which is the push-back I get when I try to talk to people about this. I’m a small “L” libertarian when it comes to telling other people how to live their lives. My objection to healthism is the same as with lack of choice – people overdo healthy lifestyle habits because the information they’re taking in is out of balance. They read too many health magazines and don’t recognize the financial (and also ultimately political) interests that promote personal responsibility (i.e., guilt) for health.
Yet another excellent and thought-provoking essay, Jan. Thanks for the clips from Dr. Welch’s book too, particularly “…They may accept a slightly higher chance of death or disability to minimize the chance of medicalization, overdiagnosis, and overtreatment now…”
Dr. Welch’s words come at a time when a specialist I’m seeing at our Regional Pain Clinic is “encouraging” me to choose a rather unconventional treatment option for the chest pain of inoperable coronary microvascular disease (MVD), which I happen to have. This treatment is an invasive procedure called a Spinal Cord Stimulator Implant, usually done on pain patients but only rarely, outside of Europe, done on heart patients – but with good results.
Apparently, I am “an excellent candidate” for this procedure because I’ve been responding so well to wearing a portable TENS unit every day, all day, to control the pain of MVD angina. This little electrical gizmo has reduced my need for nitroglycerin substantially! Low-grade daily pain is still there, but frequent episodes of debilitating pain are now much better managed with my little black box. Non-surgical, non-drug, non-invasive, effective – ya gotta love that kind of treatment option!
Now, however, my pain specialist has received funding for a new SCSI study on heart patients – and so has recently called to chat further about my participation in this study, reminding me once again that I’d be an “excellent candidate”.
I’ve already told him previously (a number of times!) that any treatment starting with the words “spinal cord” sounds pretty frightening to me, so let’s just keep on with the current TENS therapy which seems to be working pretty well so far, reserving the SCSI option as Plan B – and only if current treatment stops working. My symptoms are still there, but I’m able to function reasonably well most days thanks to a combination of my TENS unit, my cardiac meds, lots of rest between activities, and a number of heart-smart lifestyle improvements. Things are not PERFECT – but to me they’re “good enough” most days.
So sometimes, it’s not just the patients who are “pursuing disease”. Sometimes we have to stand up to enthusiastic physicians trying to talk us into the latest and greatest “cures” despite our preference merely “to focus on feeling healthy…”
Cheers,
C.
Excellent points, Carolyn – that this applies both to physicians and to patients already being treated for a medical condition, not just to people who are currently symptom-free. Welch does address both of these. Physicians not only have to defend themselves against malpractice, but they’re sometimes employed by a health care system that “grades” them on how much preventive medicine they practice, even when practiced on patients who don’t need to be tested. For patients already being treated, Welch gives several examples of where someone has a mild condition (like osteopinea), takes a drug, suffers side effects, another drug is added, and the whole things cascades until the patient is much worse off.
It seems wise and sensible on your part to question the advisability of an invasive procedure involving the spinal cord that’s not done on heart patients in this country. I’m sure the doctor is only trying to help, but the choice is ultimately yours to make.
I very much enjoyed your post at Patient Modesty (http://bit.ly/eBZeDX), BTW
FYI, I posted a related article (with links) on this topic today at Heart Sisters: “Are You A ‘Health Seeker’ or a ‘Disease Seeker’?” – http://myheartsisters.org/2011/06/06/health-seeking-disease-seeking/
Cheers,
C.
Great post! I guess I hadn’t realized before just how much you’re interested in overdiagnosis and medicalization, but I see you have many posts on the subject. And I didn’t realize there is a problem of the medical profession dismissing those who have legitimate concerns about heart conditions because so many people are “catastrophizing.” As you say in your January post (http://bit.ly/mIwXuh): “Those who insist on wasting limited medical resources in search of a high-drama diagnosis that will never come make it so much harder for those of us who actually are ill to be taken seriously by the medical profession. Instead, we are then lumped in with the cardiophobes of the world, dismissed and sent home in mid-heart attack, as I and many other female heart attack survivors have experienced.”
My interest in this subject – increased health anxiety (what I call “healthism”) – is on understanding how this got started. There was much less of this 50, 60 years ago. My focus is on how the attitudes of patients – the public – changed. I don’t think it originated with the medical profession. It came from a combination of the media and politics/economics. I was just reading in a 1964 JAMA article about patients coming into doctors’ offices with symptoms they’d learned about on medical TV shows. That’s a minor contribution. The major source is health news in all media. The political/economic source has to do with changes that followed the introduction (and expense) of Medicare and Medicaid. Financially, the government needed to reduce medical costs, and one strategy was to teach the public that they were responsible for their health and should practice healthy lifestyles. There were conservative, libertarian/neoliberal-leaning economists who supported this tactic. That strategy filled the media with health advice, prompted more scrutiny among healthy individuals for potential symptoms, and led to an increase in preventive screening. All of which, in the end, contributed to an increase in healthcare costs!
Thanks for the link to my post, Carolyn, and for alerting me to it here.