Multidisciplinary teams are needed in healthcare, to do different jobs. But high-performing teams need more than jobs to do. They need shared vision and shared projects that develop team-skills with respect for, and understanding of, each other. HEALTH is meant to be that shared vision. But different people mean different things by health.
As Julian Tudor Hart pointed out, a major obstacle to answering the question: What is Health? is the reductionist approach to thinking that imagines that things exist as isolated fact(or)s, and change is a linear process of cause & effect. This leads to a disease-focused mindset. But health is much more than the absence of disease.
The reductionist mindset imagines that things are static – at times this can be useful. But it does not help to see the co-creative nature of life, nor how to collaborate for care, nor how to stimulate inner healing. It sees diseases, but not Health.
Anyone of experience knows that health is whatever people need to navigate the dynamic nature of life, recognising that different things are inter-linked, and people see what they want to see. Heisenberg said – what we see is nature filtered by our way of looking. Kierkegaard said – most people mistake the certainty seen with hindsight with the uncertainty of living life forwards. Donne said: Send not to know for whom the bell tolls…. Yet, many people (and many doctors) still expect to find simple, ‘logical’, linear relationships between specific causes and specific effects.
Recognising that what we see, and do, are snapshots of complex stories-in-evolution could resolve the tension between static and co-creative images of the world. Fritjof Capra shows that everything is constantly adapting to everything else – if things look still, we are watching slow movement. Neuroscientists like Candace Pert and Bessel van der Kolk show that external stimuli, like stress or friendship, stimulate neuro-chemicals that can harm or heal. Laughter may, after all, be the best medicine!
But if health is more than the absence of disease, what is it?
MacIntyre argues that humans are ‘storytelling animals’. Each of us has multiple story-strands running through us and we jump between them and intertwine them, to define who we are. Bio, and psycho, and social, and spiritual, and environmental aspects of health can all help or hinder my efforts to develop my meaningful life story. This chimes with the idea put forward by Seedhouse – health is the foundations for achievement; and Antonovsky – health is rising above adversity.
I like to think that I am the lead actor in the ‘feature film’ that is my life story, and the co-actor in the ‘feature films’ of others. When strands in my life story resonate or entwine with others, I start to consider myself to be part of them – my ‘family’, my ‘friends’, my ‘tribe’. It can be called ‘love’. Health is whatever helps me to make good next steps in my life story.
Reductionist mindsets lead to a belief that things can be improved simply by fighting against a dis-ease. But life is more complex than this, and combat is often self-defeating. Certainly, there are bad things to fight against, and some people want to blame other(s) when things don’t go the way they want; but we must also recognise that health means being able to make good come out of difficult situations, including meaningful stories; addressing many problems at the same time; helping hope to flourish and ‘I’s’ to become ‘We’s’. The importance of meaning, coordinated initiatives, hope and community is particularly obvious in difficult situations.
Truth and Reconciliation Commissions have worked in difficult situations in over 50 countries to resolve conflict. They dramatically show the health-promoting effects of moving from a sense of ‘I’ to a sense of ‘We’. Using the theory and practice of Restorative (perhaps better termed Transformative) Justice, they devise ways for victims and perpetrators to see each other’s points of view. In less dramatic ways, Neighbourhoods can use difficult situations to develop communities of hope.
End-of-life care is always difficult. A healthy death helps all involved to develop a community of hope around the situation. Students, practitioners and citizens can contribute, and learn what health means at a deep level. When my wife was dying, support from my children’s friends & their parents, teachers, friends and many others, helped us to develop a community of hope around our home. Parties, music and rotas of helpers helped 100 people to develop as a community of hope and contribute to a ‘healthy death’.
Neighbourhoods could support health workers and Carers (not just end-of-life Carers) to develop communities of hope around their homes. This would help Carers to do their difficult jobs with greater confidence, help professionals to build multidisciplinary teams for those who most need their help, save overall costs, and develop community-oriented integrated practice throughout society.
Further Resources:
Julian Tudor Hart. A New Kind of Doctor
Fritjof Capra. The Web of Life
Candace Pert. Molecules of Emotion
Bessel van der Kolk. The Body Keeps the Score
Alasdair MacIntyre. After Virtue
List of truth and reconciliation commissions – https://en.wikipedia.org/wiki/List_of_truth_and_reconciliation_commissions
Paul Thomas. Facilitating healthy deaths at scale www.magonlinelibrary.com/doi/full/10.12968/bjcn.2022.27.9.432
Author
Paul Thomas in collaboration with the Journal of Holistic Healthcare & Primary Care Commissioning
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