The personal nature of health Joachim P. Sturmberg Associate Professor, Department of General Practice, Monash University, Melbourne, Australia and Associate Professor, Department of General Practice, The Newcastle University, Newcastle, Australia Keywords defining health, health, philosophy of medicine, semiotics Correspondence Associate Professor Joachim P. Sturmberg PO Box 3010 Wamberal 2260 NSW Australia E-mail: jp.sturmberg@gmail.com Accepted for publication: 2 May 2009 doi:10.1111/j.1365-2753.2009.01225.x Every man has his particular way of being in good health. Emanuel Kant Emanuel Kant’s description of health stands in stark contrast to accepted definitions of health. For example, the WHO defines ‘health’ as ‘a state of complete physical, mental, and social well- being and not merely the absence of disease or infirmity’ [1]. However, as people get on with day-to-day living, no one can achieve the goal of ‘complete physical, mental and social well- being’. It is odd to define ‘health’ as a negative state that puts it beyond the reach of everyone [2]. This paper explores the idea of health being a personal state, health being the product of every man’s particular way of making sense of his particular circumstances. Health defined as a negative state renders health an illusion, an illusion that fosters thinking about health in terms of disease [3]. Disease definitions are no more specific – ‘a physiological or psychological dysfunction’, or ‘a biological dysfunction [based on] well-known pathological or pathophysiological processes or a well-known etiology’ [4]. Indeed such a loose definition perpetu- ates a feedback loop that allows disease to be continually ‘gener- ated’ by lowering thresholds of normality [5, 6]. For Illich, however, health is a positive state that dynamically spans across the stages of life – ‘The ability to adapt to changing environments, to growing up and to ageing, to healing when damaged, to suffering and to the peaceful expectation of death’ [7]. Illich’s description points to health being an interconnected fluid state. Health cannot be thoroughly understood in terms of our best theories of physics, chemistry, molecular biology, anatomy and physiology, or sociology; health has multiple dimensions and dynamics. Just as the human body itself has organic structures and processes that organize lower-level ones, so the human person considered holistically lives and functions on various levels that supervene upon and organize other lower levels of bodily struc- tures and functions interdependently [8, 9]. Health is the proper relationship between the microcosm, which is man, and the macrocosm, which is the universe. Disease is a disruption of this relationship. Dr Yeshi Donden, physician to the Dalai Lama Historical, philosophical, scientific and empirical evidence all agree that health and illness result from the interrelated actions within whole persons and their environment, that is, health and illness represent complex dynamic states experienced at the per- sonal level. The somato-psycho-socio-semiotic model of health describes health as the experience of a relative balance resulting from the dynamic interactions between the biological, emotional, social and sense-making (cognitive) dimensions affecting the individual person in all of his/her context (Fig. 1). Shifting away from the centre is associated with an illness experience. The direction of the shift to any domain is associated with corresponding changes to the other three. For example, having a heart attack shifts the immediate balance markedly towards the biological domain, resulting in the immediate need for biomedical intervention to stabilize the physical dysfunction of the cardiovascular system. However, healing of the patient is not solely an issue of stabilizing cardiac function, as the acute event also means loss of social interactions, depressed mood and a loss of self-understanding. The integration of the semiotic, that is, sense-making notion as part of the health experience was first suggested by Jacob von Uexküll in an attempt to overcome the mind–body dualism [10]. He suggested that the way we perceive and respond to our world is mediated by the signals generated by receptors in the various body organs. These signals need to be interpreted to provide meaning, for example, excessive exaggeration of a pressure receptor in the skin is experienced as pain. A clinical example of a shift towards the sense-making domain is bereavement; the loss of a parent or partner questions one’s Journal of Evaluation in Clinical Practice ISSN 1356-1294 © 2009 The Author. Journal compilation © 2009 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 15 (2009) 766–769 766