The most embarrassing question one can put to physicians is probably: What is health? Often they prevaricate by providing the evasive non-definition: the absence of disease. The inability to define health is surprising if one takes into consideration how central the concept of health is in present-day society, both on the individual and the sociopolitical level. Countless policy measures and as many personal endeavours are carried out to improve health, but what health is, remains obscure. It was this paradoxical state of affairs which promptedWill Wright (1982) to undertake his study on The Social Logic of Health. The author is a sociologist and has previously published a book on 'The Western'. The argument of the present study is predominantly philosophical.
Wright develops his argument by contrasting his view with four established opinions about health. Firstly the view, which is common in medical circles, that health refers only to the physiological state of the human body and that it can be verified and measured by external technical means. Secondly the opinion, found both in the medical profession as well as among some advocates of holistic medicine, that health is a concept which is applicable only to the individual.
Thirdly, that health can be divided into two spheres: mental and physical. Finally, the assumption held by some grand theorists in social science, that it is unavoidable that a 'healthy society' imposes unhealthy conditions on at least someof it members.
Anthropologists and others who try to define 'health' are faced with a dilemma. On the one hand, there is the Scylla of a too narrow biomedical definition which does not seem to do justice to the full human experience of feeling well (or not feeling well). On the other hand, they meet the Charybdis of a broad definition which declares almost anything in the human environment part of the medical domain. It is the latter point of view, the socalled 'medicali- zation', which has been attacked by a great number of authors, such as Zola, Illich, Barbara and John Ehrenreich, Crawford and De Swaan I hope to demonstrate that Wright's argument, however interesting and important, fails victim to what I have named the Charybdis.
Wright's approach consists of carefully scrutinizing the meanings of 'health' and 'healthy' in everyday language. Starting from the patient-physician encounter he deduces that patients have a much broader notion of health than 'the right' functioning of their body' The fact that patients often decide not to follow the doctor's instructions, is taken as an indication that they also include phenomena in their health problem which are not strictly medical. He continuously suggests new definitions of health which he then tests by placing them in an ordinary context of people speaking about their 'health'. The pithiest and most satisfactory definition he finds is: "an individual's ability to be fully human"
Wright is conscious of the fact that a crucial test of this definition lies in the meaning of 'fully human.' He clearly rejects reduction to the biological mechanism of the human body and emphasizes the social character of being 'fully human.' At the same time he points out that there are no universal, objective criteria to establish health, as often seems to be claimed by medical scientists. What is considered as 'natural' and 'ideally human' may differ from culture to culture. Wright's most important thesis is that health is not a neutral but a moral concept; one which incites people to action. It is probably one of the strongest values in human ethics, because no moral concept can be so easily brought back to a concrete empirical phenomenon as health. Moral concepts which are much harder to relate to tangible phenomena are justice, freedom, peace and progress, for example.
Finally Wright attempts to convince the reader that it is possible to create a 'healthy society' where optimal 'health' (following his own wide definition) is guaranteed for all. However, I am afraid that this is the least convincing section of his book. His reasoning reminds one of the proof of God by the Scholastic philosopher Anselm: what can be logically thought, must also exist. Wright is certainly right in concluding that it is a contradiction to call a society 'healthy' if in that society a part of the population is forced to live under miserable, unhealthy conditions. However, this observation does not yet imply that a society where 'health' is attainable for all can be realized.
No comments:
Post a Comment