On Inception, WHO, and my Aunt Jan

HygeiaMy Aunt Jan is an extremely kind woman,* who has a toasting problem. Given the chance to lead a toast, she will start off with something normal like “Happy Thanksgiving, everyone. We are thankful for a lot of things, including that Cousin Shlomo graduated from dental school.” Then she will start to worry that singling out Cousin Shlomo will make Cousin Elmer feel slighted, so she will quickly add, “And we’re thankful that Cousin Elmer was able to take time away from his curling team to be here.” But now it’s going to be weird if she doesn’t mention all the other cousins, right? And then you wouldn’t want the children to feel left out. So she’s standing up there while the Turkey congeals, listing, “and we’re so proud of Haley for growing so many new teeth, and we’re so proud of Lefty for graduating fourth in his class at obedience school,” and her (admittedly mean) relatives are just blatantly laughing at her even though, to be honest, they probably would feel snubbed if they didn’t each get a mention. So strong is her urge to be inclusive that Aunt Jan has wound up forbidden to give toasts at family functions.

I was thinking of my aunt during the lecture I attended this morning, which posed us the question What is Health? Intending no disrespect to my professor, nor to the scholars who spend their lives’ work defining health, I have to say that this is not the kind of question that turns my intellectual crank. At least, not in the decade or so since I quit smoking weed. I have long been familiar with WHO’s definition of health as, “A state of complete physical, mental, and social well-being and not just the absence of disease or infirmity.” In fact, I was extra familiar with it this morning because I had done the class reading. So it might not be obvious why I chose the wrong answer on our first multiple choice question: “If you are not sick, then you are healthy: True or False.”

I picked True because I think the WHO definition is hilarious. I get where they’re coming from. They are pushing back against a medical model that understands health as something bestowed upon sick people by disease-vanquishing doctors. But their inclusive definition of health is like one of Aunt Jan’s toasts, to the point where if they are right, it means no one is actually healthy. I do basically believe that if you’re feeling alright, then you really are alright, i.e. healthy and not sick.

I suspect most people would agree that health is not an all-or-nothing concept.  Nobody is completely healthy; it’s all a matter of degree.  People whose only health concern is hypertension often feel fine, but they can’t really be said to be as healthy as they would be with normal blood pressure, since high pressure is thought to lead to things that make you feel either sick or dead. So if, in theory, everyone could be healthier than they are, is WHO really wrong to define health as an ideal no one can reach?

That depends on how much harm is done by misclassifying a healthy person as sick. People tend to be pretty good at assessing their own health, and predicting their mortality. What happens when the medical or public health community comes and informs someone that although she thought she was healthy, they know better, and really she is sick? The idea that people have to be motivated to make themselves more healthy, and that the best motive is fear, pervades the health disciplines. I have to wonder, is the entire enterprise of defining health a form of population-level gaslighting,** designed to increase the dependence of the public on the authority of the health professions? Or if not actually a design, subconsciously appealing? And if the perception of good health itself predicts disease-freedom and long life, then we can’t ignore the possibility that the Inception-style planting of the idea that you lack health is a thing that makes you sick.

*No, that is not my aunt to the left with the snakes. That is Gustav Klimt’s painting of Hygieia, the goddess of health. But thanks for asking.

**A form of abuse in which the abuser tries to interrupt the victim’s sense of reality, convincing her that what she knows to be true is her own fantasy.


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