Why "Return to Normal" Cannot Be the Goal

In a recent thoughtful LinkedIn post, the author referred to discussions of spiritual wellness at last year’s National Wellness Conference (NWC) as something that had never really happened much before and was now happening, and identified the “holistic health” concept of “high-level wellness” as an “unrealistic state of perfection.” She then went on to talk about the importance of the loneliness epidemic that is plaguing our society and the tragic loss of a wonderful, dear friend to cancer.

As someone who has been involved in promoting health for nearly 3 and 1/2 decades and who presented at this particular Conference during much of them, I wanted to share my perspective on these important comments and try to connect them to what is going on in our world today. First and most importantly, I want to support what was said about the passing of Carrie Phelps. I have known Carrie for many, many years and the author’s words could not be more accurate.

“She was a shining star in the fields of wellness and mind-body medicine. She was a leader, visionary, mentor, and friend to many of us. If you knew her, you experienced her presence.

For me personally, I would just add that Carrie was simply one of the most delightful human beings I have ever had the pleasure to know and her passing is painfully sad and a loss for all of us!

On Spirituality at The Conference - The comments referencing to the historical lack of discussions about spirituality at the conference are not entirely accurate. While one might argue there could have been more over the years, I and others regularly addressed the importance of these issues. My first book, The Spirit and Science of Holistic Health written with my friend and colleague Karen Carrier was the source of many of our workshops, breakouts and keynotes at the NWC over decades. Dr. Brian Luke Seaward was also a highly respected presenter on spirituality almost every year, and there were others as well. So, while I am delighted newcomers have now taken up the mantle, let’s please be sure to give those in whose footprints they are following the appropriate credit.

On Holistic "High Level Wellness" - I believe the author's comments on “high level wellness” are right on the money and important enough to require further discussion. The problems with the holistic health movement, particularly how we have promoted and too often continue to promote health, wellness and now well being over the decades is something I have written and spoken about often. I am delighted that it was addressed even fleetingly in this short piece, but I believe there is more we can learn from a slightly deeper dive. Perhaps the best way to accomplish this goal begins with an understanding of the term healthism.

Healthism - To get to an understanding of the significance of this term we have to go back to the Scientific Revolution of The 17th Century. The great thinkers and scientists of the day proposed a mechanistic worldview that conceptualized the universe and everything in it, including human beings, as machines. As Renes Descartes, one of the sculptors of this worldview put it:

"I do not recognize any differences between the machines made by craftsmen and the various bodies that nature alone composes...I consider the body as a machine...my thought...compares a sick man with an ill-made clock with the idea of a healthy man and a well made clock

We see this view of humanity clearly echoed in the Holistic Health Movement hundreds of years later. Here is a 2006 definition of healthism that supports the sentiment. The three most critical components of this conceptualization are that health: 1) "is solely an individual responsibility," 2) envisions "the concept of the body as a machine," and 3) "is influenced only by physical factors."

While the Holistic Health Movement of the 1970'S and 80'S did begin to make a distinction between humans and machines and did make room for other than just physical factors that impacted health, the obsessive emphasis on health as "solely an individual responsibility" remained a central focus. Here is a quotation from a book from that era aptly entitled, The Holistic Revolution:

"The gift of health, then, is the gift of happiness of completeness, of love, and of being. To abuse it or to fail to seek it out with all our power is a denial of the value of self. Anyone who disregards the magnificence of life deserves only pity.”

If this makes you cringe just a bit, as it does me, it is only the beginning. Here is a quotation from another book during the same time period entitled High Level Wellness, the term that was directly critiqued in the above mentioned LinkedIn Post.

?“The only tyrant you face is your own inertia and absence of will - your belief that you are too busy to take your own well being into your own hands and that the pursuit of self-health through a wellness-promotive lifestyle is too hard, complicated or inconvenient.”

Really? Nothing else separates you from High Level Wellness except for your own absence of will? Everybody starts off at the same playing level when it comes to their health? Did we really believe that back then? Does anyone really still believe that now? More about the negative consequences of this belief later.

I would love to be able to say that we have come a long way in the last 50 years when it comes to this out of touch understanding of health. But, have we really? Here is a short excerpt from a more recent book (2004) published by a well known wellness vendor talking about the people they are supposed to be serving. The book posited the following important question: - What Is The Most Common Health Problem In The United States?

Contemplating the question, I came up with the following potential answers: (remember this was 2004)

• 1 of every 6 Americans living in poverty
• > 1 out of every 5 children living in poverty
• Poverty rates double for Blacks & Hispanics
• 200,000-400,000 preventable hospital deaths
• A woman is beaten every 15 seconds

To my surprise, or perhaps not so much, the answer supplied by the book bore no relation whatsoever to any of my suggestions. Their answer to the most common health problem facing our country?

 “I-Don’t-Care-Itis”

“A common condition in which an individual has no interest in adopting a healthy lifestyle.”

I have been in the health fields for more than three decades. I have worked in various capacities with thousands of individuals. And I can say with some certainty that I have never met anyone who did want to be and do better. I have met many people with sometimes overwhelming barriers, but never anyone who did not want to be better

Unfortunately, this demeaning, shaming approach to promoting health is still too common. Here is another quite recent (2016) such comment from a wellness vendor:

"Our role as wellness professionals is to try to get people to do something they do not want to do. After all, it is fun to get fat. It is fun to be lazy. Not everyone likes the taste of fresh fruits and vegetables, they would prefer chocolate, soda, and Cheetos.”

Clearly, nothing "spiritual" about any of these responses. I would go just a step further and ask any employer if these kinds of statements would encourage them to choose their sources to be the ones to whom they would entrust the health and well being of their employees?

Wellness and Perfectionism - Again, I applaud the author of the LI post for bringing this component of the issue to our attention. Part and parcel of this obsession with individual health is indeed the implication that with just the right amount of effort, individuals can reach some state of perfect or complete health - often referred to as "optimal health." I have argued for decades that definitions of health that emanate from this perspective don't apply well to our species and can actually have negative consequences. Let's have a look at what is likely the most oft-quoted definition on the planet, one that comes originally from the World Health Organization in 1946:

"Health is a state of complete physical, mental and social well -being and not just merely the absence of disease or infirmity".

In my presentations to health professionals, I have for decades asked them how they feel about the accuracy, appropriateness, and scientific validity of this definition. Typically, most people say they feel it is a pretty good definition.

I then invite everyone to stand, and explain that in a moment I am going to ask those who (following the first part of the above definition) have the absence of disease or infirmity to remain standing. Before we do that however, I suggest we review a definition of infirmity so we are all on the same page when they make their decisions. I then reveal the following dictionary definition for “infirmity.”

1. A bodily ailment or weakness, especially one brought on by old age.
2. A failing or defect in a person’s character.

After the laughter subsides, I ask everyone who has the absence of disease or infirmity to remain standing. In a group of 200 or 300, typically 10 to 20 people remain standing. I next ask individuals in this group to remain standing if they satisfy the other half of the definition by having complete physical, mental and social wellbeing. Everyone but one or two sit down. I then remind those still standing that telling the truth is a sign of mental health, and everyone has a good laugh as the remaining folks seat themselves.

I would suggest that there is more to this exercise than meets the eye. Traditionally, even when health is defined as more than just the absence or opposite of disease, it is still most often envisioned as some “optimal state” that can be achieved if we just try hard enough (think about the passages from the books of the holistic period I quoted before).

A trip to the local bookstore will reveal a seemingly endless offering of "self-help" books by health experts (as well as those who are clearly not) claiming to provide the precise nutrition, exercise, sleep, stress reduction, etc. techniques needed to reach this proposed "optimal" state. It says something about our culture in general that, as Simon Sinek is fond of saying, there are endless bookshelves of "self-help" books but very few "other-help" books.

The essential problem is of course, that as human beings we all live with varying amounts of physical, emotional, and spiritual baggage. How many people have ever experienced or ever known anyone in “optimal health"? What does “optimal health” or complete health even look like? As medical writer David B. Morris suggests in his insightful book Illness and Culture in the Postmodern Age:

“Complete wellbeing is a fantasy. Health, whatever else it might be is something that happens not so much in the absence of illness as in its presence.”

Let that definition wash over you for just a moment: “Complete wellbeing is a fantasy. Health, whatever else it might be is something that happens not so much in the absence of illness as in its presence.”

It helps me to think about our difficulties surrounding the concept of “optimal health” in this way:

• If you can start the day without caffeine,
• If you can be cheerful, ignoring aches and pains,
• If you can resist complaining and boring people with your troubles,
• If you can eat the same food everyday and be grateful for it,
• If you can understand when loved ones are too busy to give you time,
• If you can overlook when people take things out on you when, through no fault of yours,
• If you can take criticism and blame without resentment,
• If you can face the world without lies and deceit,
• If you can conquer tension without medical help,
• If you can relax without liquor,
• If you can sleep without the aid of drugs,
• If you can do all these things …

Then you are probably the family dog!

Dogs, and especially golden retrievers just seem to be at peace with the universe and everything in it. The WHO definition is not a bad one; it just doesn’t fit our species. Living skillfully and compassionately with our inevitable struggles, rather than perpetually searching for the latest “holy grail” of “optimal health” may come closer to what it truly means to be healthy.

Furthermore, the constant pressure to strive for this unreachable perfection; the quest for the perfect body, the perfect diet, the perfect exercise program, the perfect risk factors, behaviors, etc., sets us up for almost inevitable frustration and failure. In his often cited 1975 article Medical Nemesis, philosopher and theologian Ivan Illich addresses this issue head on saying:

“Health is not freedom from the inevitability of death, disease, unhappiness, and stress, but rather the ability to cope with them in a competent way.”

The Real Causes of Poor Health - Unfortunately, this obsessive focus on individual responsibility and the search for the holy grail of perfection have negatively influenced the fields of health promotion, wellness and well being in other significant ways as well. For example, for at least the past more than 30 years in which I have been involved, this field has (with some exceptions) mainly been focused on middle and upper middle class populations.

Of course this is a problem as about 25% of the population was non-white in 2013 and less that 50% will be so by 2045. Perhaps even more importantly, the attendees and speakers (including myself) at the field's conferences have typically come largely from a socially and financially privileged class, in which the focus on personal responsibility takes on an entirely different context than exists in groups without such privilege.

Perhaps ironically, though not surprisingly, this issue of fairness is actually at the root of why most established health-related organizations in the United States vigorously opposed the incentive-laden, punitive wellness approaches implemented in the past decade as a result of the passage of The Safeway Amendment of The Affordable Care Act. In their own words:

“Based on the evidence to date regarding the impact of financial incentives on behavior, we believe the potential to discriminate against persons with chronic conditions - like heart disease, cancer, and diabetes - far outweigh any potential benefits to improving wellness.”

Unfortunately, presentations and workshops at these conferences have focused to a large extent on individual approaches to change that are dependent on time and other resources much more accessible to the privileged groups of people both speaking at and attending them than they are for both populations of color and undeserved Caucasian populations as well. For me, this hearkens back to the narrowly-visioned statement from the original holistic health revolution that:

“The only tyrant you face is your own inertia and absence of will - your belief that you are too busy to take your own well being into your own hands and that the pursuit of self-health through a wellness-promotive lifestyle is too hard, complicated or inconvenient.”

While there has been some effort in the field to remedy this dilemma, it remains a problem going forward. Tragically, we are seeing the dire consequences of such disparities in the current pandemic as black, brown and indigenous people are dying at twice the rate of their more privileged white counterparts. This is one of the many reasons why the desire to "return to normal" is a seriously misguided one. "Normal" has unfortunately become good for fewer and fewer people in this country.

NO to Normal! - Perhaps the disastrous consequences of "normal" that are being unearthed and brought to the surface by the pandemic will finally convince us that a strikingly different focus to successfully and sustainably impacting our health is critically needed. Decades of research clearly demonstrate that individual health behaviors, those that have been dominating presentations at health promotion and wellness conferences for decades ARE NOT the major determinants of the disparities in health across our population. What can we do about this?

• For workplace wellness, the Equal Employment Opportunity Commission just put out its new ruling on the use of incentives. When businesses "return to normal" it will still be okay to charge employees thousands of extra dollars for their health insurance if they don't attain their goals for outcomes-based "wellness or else" programs. This in spite of the fact that these programs don't save money, don't improve health, and are generally hated by employees.
• Individual "responsibility" needs to be re-envisioned as "the ability to respond." In a country (the richest in the world) where almost 80% of workers live paycheck to paycheck, 40% cannot financially handle a $400 emergency, 40 million people live in poverty (try living on 26,000 a year for a family of 4), and the best determinant of your health status is likely your Zip Code, "normal" is neither desirable nor unacceptable.
• The stock market was a misleading economic indicator before the Pandemic and is even more so now. The reality of "normal" is that full-time minimum wage workers cannot afford a two-bedroom rental anywhere in the U.S. and cannot afford a one-bedroom rental in 95% of U.S. counties, meaning they would need to work 97 hours per week to afford a two-bedroom and 79 hours per week to afford a one-bedroom according to the annual "Out of Reach" report from the National Low Income Housing Coalition. 
• The United States was born out of the genocide of our indigenous population and built and sustained on the backs of Africans violently abducted from their homes and enslaved by our European ancestors. The institutional racism that has been so highlighted by the Pandemic, the murder of George Floyd and so many other people of color over the generations, and that innervates every fabric of our society, from education to healthcare to housing to employment to law reinforcement is not a "normal" any of us should desire to revisit!
• Finally, all of the suffering of the Pandemic and even the horrendous racial and economic disparities that threaten to tear our nation apart will be dwarfed by what climate change holds for us in the very near future if we don't radically change our behaviors as a species. As always, those who suffer first will be those with the fewest resources. Returning to "normal" with respect to how we take care of our suffocating Mother Earth will end up destroying Her and us!

The most important lesson we can take from this Pandemic, is that "normal" or anything even remotely resembling "normal" should not - can not be our goal. If we want our country, our species, and our planet to survive, we have to throw out "normal" and replace it with equitable and sustainable. Aggressively addressing the growing wealth gap in this country, the systemic racism and widening inequities in every part of our society and the ongoing abuse of our Mother Earth must become the focus for everything we do going forward.

Take care and stay safe - Dr. Jon

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