Health Is a Means, Not an End : Living: Constant worry over the state of our bodies has become a sickness in itself. Prudence is fine; avoidance of life’s risks is not.
Forget oat bran; forget even cholesterol. Chocolate sundaes are good for you and fatty steaks even better. Or maybe that was true last month, but not this month. This month the word is that the asbestos we have been spending millions to remove from pipes and insulation might not be so hazardous after all. And what we thought wonderful for us, fluoridated water, may have spared our teeth but exposed us to cancer.
Just what the truth is here, I cannot pretend to know. The line between humor and seriousness has become a fine one, the border between joke and scientific fact a battlefield of competing information. What I do know is that we seem breathless to get the latest word. We--the healthiest people in the history of the human race--have made our health, the state of our body, an obsession. We act as if a failure to get the right information on oats, or asbestos, or salt, will make the difference between life and death. Perhaps it will, but it is at least as certain that our passion for daily updates on such matters has itself become a kind of sickness.
It is a sickness worth worrying about, and for three reasons. The first is the high cost of health care, a cost driven in part by intense patient demand for the highest quality care and the meeting of each and every health care need. When that demand is married to high-techmedicine, a powerful engine for driving up costs is set in motion. We have come to expect our lives to be saved, young and old, whatever the costs.
The second reason for worry is our growing aversion to any and all human risks. While the malpractice crisis in medicine is often blamed on greedy lawyers or bungling doctors, a most important but overlooked factor is that juries have become ever more sympathetic to claims of harm and injury. This reflects an intolerance of risk, a belief that if anything goes wrong, it must be someone’s fault. And someone has to recompense the victim. We, as victims or jurors, agree.
The third cause for worry is that our obsession with illness and aversion to risk create a steady state of anxiety and a distortion in the way we think about ourselves. The anxiety is easy enough to understand: If we look on the world as full of hazards to our health, constantly out to get us, there is no end to the defenses we can try to erect--and no end to the way in which, sooner or later, those defenses must fail. It is perfectly true that the hazards to health are multiple, and there is something to our paranoia that nature is out to get us. But it is no less true that even if we have only a moderate interest in good health, our chances of living to old age are extraordinarily high. About 70% of us will die beyond the age of 65, and that proportion steadily increases. Once you have made it to 65, you can expect to live another 18 years, on average.
More subtle than anxiety is the way a constant worry about sickness can distort our self-understanding. Far from relieving our anxiety, it creates its own self-fulfilling dynamic. As Dr. Arthur Barsky has put it in his penetrating book, “Worried Sick: Our Troubled Quest for Wellness”: “The more carefully we scrutinize ourselves for ailments, the more things we find wrong with us. The more we diet, the more frustrated we become with our flab. Though we live longer, we feel older sooner. . . . The more we equate health with total well-being, the more pervasive illness becomes.”
I do not want to underestimate the difficulties here. There are many hazards to our health out there. Illness and death are not myths. How, then, can we both take account of them, act prudently to avoid them, and yet remain sensibly relaxed in the face of multiple hazards? To me the answer is to keep one truth uppermost in our minds: Good health is, at best, the means to a satisfying life, not an end in itself.
The curious feature of good health is that when we have it, we do not notice it. Invisibility is, so to speak, its main symptom. The more we consciously focus on good health, the more we remove that invisibility. Most of the time we have something wrong with us, if only a mild case of the sniffles. To the extent that we focus on those ills, they take us captive. As Barsky has nicely put it, “The feeling of physical well-being is elusive in the same way that happiness is; it is more a byproduct of successful living than it is an objective that can be attained by striving for it objectively.”
The social distortion of an endless quest for improved health is no less damaging to society than to individuals. While there is no doubt that a large number of poor people suffer from poor health, most middle-class Americans are in fine shape, perfectly able to work, to love and to play. Yet we continue pouring money into medical research and care as if we were in the midst of a great plague. We do not need perfect health to run our political and legislative system, or to have a strong, competitive work force, or to educate ourselves. We probably already have a sufficiently high level of general health for most purposes in this country. If, through national health insurance, we could take care of the poor, we would then have more than enough.
Since we all know people who are sick and dying, how can I say such a thing? I say it because illness, decline and death are part of the human experience, an integral part of our very biology. No matter how much medical progress we make, there will always be people who are ill and dying--later rather than sooner, one hopes, but always inevitably. The task of keeping people alive, of curing their ills, is an endless and infinite one, no less so than the possibilities for exploring outer space. Whatever we do, there will always be more to be done, and then more still.
We need, both as individuals and as a society, to come to grips with this reality. Our failure to confront it helps to explain why we remain dissatisfied in the face of great progress, why we can feel at risk despite good health. We have managed to persuade ourselves that sufficient personal vigilance and ever-improved medical care can free us of illness and death. Yet we must know in our hearts that this is not true; in fact, this attitude will probably just make us feel worse.
What is the best way to remain in good health? We have known the answer for a long time: First, think of something other than sickness and death, and then eat well, get a good night’s sleep and exercise moderately. Has there ever been any better prescription?