How Can We Offer Healthcare If Don't Know What Health is?
What is health? What does it mean to be healthy? We use the word all the time, but could you define it? And does it even matter?
In this article, I argue that the best doctors will be aware of what human health is to be able to treat their patients. Furthermore, to know what health is requires them to understand what a human person is, which means the study and acceptance of Christian anthropology. I argue that the very best doctor - or health practitioner of any description - will do more than grasp this intellectually but will relate to the patient as a human person. To relate with a patient fully involves more than simply the adoption of Christian morality. It is a Christian formation, with the liturgy and mystagogical catechesis at its heart that will most powerfully form a good doctor. The article will be presented in two parts. In today's I try to establish a good working definition of health and why it is important to do so. In part two, which will be posted on Friday, I discuss why the best doctor, one who can help a patient to achieve this ideal, will be one who relates to others as a Christian. I explain why, in my view, such a doctor will be one who deeply appreciates also the beauty of the human person and is formed supernaturally as a Christian through a mystagogical catechesis with the worship of God at its heart.
A Visit to the Quack, by Hogarth, English 18th century. We can expect better today as the treatment of bodily ailments has improved dramatically, but to what end?
Given that health is something we all desire, one would imagine we could say what it is, but in fact and perhaps surprisingly, it’s not that easy. When I looked up the word in an online dictionary it defined it as a negative: a state of being free from illness or injury. This, surely, is inadequate? For while it tells us what we don’t want - illness and injury - it doesn’t define the good that we do want, health.
Philosophically, it seems to be an inversion: the usual approach is to define the good as an entity and consider evil to be a distortion that restricts or reduces what is good. So by this approach, illness, and injury, as human evils, would be defined as privations of health. But if we cannot say what health is, we cannot say what a privation of health is, and accordingly, we can’t say what illness is either. So a definition of health-based upon an absence of something argument is a circular definition, effectively health is the absence of ill-health!
The right wing of Rogier van der Weiden’s Altarpiece of the Seven Sacraments, ca. 1445-50, depicting Holy Orders, Matrimony, and the Anointing of the Sick. (Public domain image from Wikimedia Commons, cropped.)
Perhaps we might suggest that health is an attribute of the human person that can be equated to a wholeness of being? This seems to be better, but still, it doesn’t quite fit. We can imagine a situation where we have an amputee or a blind man, for example, who would not be considered a whole person, could nevertheless be considered healthy.
Looking further, the World Health Organization - which, given their name, you would think ought to know - defines health as follows: Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. Similarly, Medical News Today, in an article aptly entitled, What is Good Health?, defined health as a state of complete emotional and physical well-being. Healthcare exists to help people maintain this optimal state of health.
The Barber Surgeon by Adriaen Brouwer, Flemish, 17th century. If we limit our idea of the human person to body-as-machine, then aren't our modern doctors just glorified highly trained barbers? I would argue so, except that at least the barber is usually sufficiently interested you as a person to ask where you're going for your holidays. No doctor has ever asked me that!
These seem to be getting closer, but in order to understand what these definitions really mean, we need to have a clear understanding of what we mean by physical, mental, social or emotional well-being and unless we can do that, we are still stuck. Well-being is described in the dictionary as a state of health, happiness, and prosperity. This still leaves us floundering somewhat with another circular definition: health is well-being and well-being is health.
Well-being as a state of happiness, the second part of the definition above, does seem to be a better starting point; however. I think we can disregard serious consideration of prosperity - success in material terms - which is only important to the degree that it contributes to happiness, as it seems reasonable to assume that the happy person possesses all the prosperity they need.
So while happiness is not the same thing as health, there is a strong connection, and this will be our starting point in the consideration of what health is. In order to establish what that connection is, we need to consider first why it is important to know what health is.
Why worry about the definition of health?
This matters. Unless our healthcare providers have a clear answer as to what health is, precisely, then every time we go to the doctor’s surgery or the hospital we cannot be sure that he really is trying to make us healthy! Try asking your doctor what he thinks health is and you may be disturbed to find out that he doesn’t really know.
I first learned about this anomaly through my own GP, who told me that throughout his medical training he was never formally taught exactly what health is, and that after many years of practicing, it had dawned on him how detrimental this was to healthcare provision in the country.
Most commonly the goal of a doctor’s treatment today is about relief from illness. So the doctor does not assist the patient in his search for the Good, but rather aids his escape from something bad without really concerning himself with where he is going. This is better than nothing, but it does lead to problems. At best each doctor decides for himself what health is, perhaps in consultation with the patient. We cannot establish what the Good is for a human being without consideration of him as a person, body, soul, and spirit. A physician who is trained to treat the body as a mechanical device to be repaired and often it will not occur to him to consider how it relates to the whole person, especially the spiritual aspect.
Blood-letting in the 14th century. Medical science has undoubtedly improved since then, but has the medical profession lost a sense of how to treat the whole person in the process?
As Christians know, the human person is a profound unity of body, soul, and spirit. Modern medical training studiously avoids taking any position on the spiritual well being of the person, and this has profound consequences because there can be no neutrality in this. As in all things, either we are for God, or we are against Him. A philosophy of medical treatment that takes a position of spiritual ‘neutrality’ as one of its foundational premises will inevitably be anti-spiritual, and will undermine the spiritual health of man, leading us to misery.
Doctors today, it seems to me, are trained experts who treat best the particular slice of human nature they are trained to examine, but they do not have sufficient knowledge of how that slice relates to the whole. To be able to make this connection most likely requires a study of Christian anthropology and the integration of this study with their medical training.
A way of summarizing the situation is that modern doctors are able to analyze well but are less able to synthesize. They can treat the parts in isolation, but they are less competent when putting all those parts together.
To illustrate how this can have an impact on physical health alone (without any thought for the spiritual needs of the person at this point), here are two examples. First, in the appendix of my book The Way of Beauty, entitled Liturgy and Intuition, I describe how on a number of occasions nurses in intensive care wards predicted that a patient was going to have a heart attack. The specialist cardiologist would come in to check the readings of all the vital signs, and say, on the contrary to what the nurse was saying, that there was no risk, because all readings were within the defined limits of healthy function. When asked to explain why they were worried for the patient, the nurse couldn’t say, it was simply a conviction that came from intuition. So typically, the doctor ignored the warning; then, as often as not, the patient had a heart attack. Later, it was discovered that while individual readings of heart function were within the limits of safety, there were certain combinations of such readings that were dangerous. The nurses were picking up intuitively the pattern of readings an unhealthy heart, because of their great experience of being with patients. Their experience and intuition were overriding the knowledge given to them in their training.
Here is another example, given to me by a practicing cardiologist. There are four atria in the heart and sometimes a diseased heart can reveal enlarged or diminished atria. In their training, the doctors are taught the ‘healthy’ range of sizes of each individual heart atria. However, he told me, very often there will be situations where one or more of the atria are outside the range of health, but an experienced cardiologist will ignore the reading if they judge, in light of their experience, the pattern of the relationships between one atrium and the three others to be healthy.
So just as all the parts of the heart ought to be in right relation to the others, the heart should be in right relation to the body as a whole, and the body, therefore, should be in right relation to the soul and the spirit. Then each part is in right relation with the whole.
Hugh Laurie in House. The idea of the doctor who is brilliant at what he does but seems to despise his patients and colleagues makes for great drama. But in truth, could such a doctor be even better if he was joyous and Christian? I believe so.
A proposed definition of health
Reflecting on all of this so far, here is a proposed definition of health: health is the harmony of all aspects of the human person - body, soul, and spirit - in accordance with our freedom to choose happiness both now and in eternity. Healthcare, regardless of what particular aspect of the human person it is focussed on is always concerned, therefore, with the treatment of the whole person and the optimization of that freedom to choose happiness.
Part two of this blog post will be on Thursday. ...
