Richard Smith: A bad case of health

Richard SmithI’ve been puzzling for years over how to define health without making much progress, but I thought I might take a step forward by listening to a discussion on the radio about whether philosophy can help you live the good life. The answer seemed to be no: philosophy doesn’t have a wholly convincing answer to the supreme question of “Why not kill yourself—to escape this ‘vale of tears?’” The questions of “How to live the good life?” and “What is health?” seem to me closely related (perhaps even the same question), and if three millennia of philosophers have got nowhere what hope have I?

But then I have the idea that we might go about defining health in the same way that we have defined disease—through a series of cases. The answer to the question may lie in minute particulars. Perhaps we can build up textbooks of health to match our textbooks of disease: we have thousands of pages to go before we sleep.

I should start with myself. I am healthy. I declare myself to be so.

“No you’re not,” my cardiologist might say if I had one. “Your arteries I know to be atherosclerosed. Your blood pressure and blood lipids are high. You’re overweight. You drink too much. And if you are healthy why are you taking a polypill every night to ward off a heart attack or stroke?”

“You are getting very forgetful,” my neurologist might add, “and look at how your mother and grandmother demented when only 15 years older than you are now.”

“Your back doesn’t look too good to me,” says my rheumatologist, “and you seem just a little manic,” mutters my psychiatrist.

“Many of your teeth are filled, more will need filling soon, your breath is less than fresh, and your gums bleed when you brush your teeth,” says my dentist, having the last word.

All this I declare to be irrelevant. I am healthy.

Beginning with the physical side, I feel fine. Soon I will walk the dog. Later I may go for a run—perhaps two miles. Two days ago I walked from Sevenoaks to Hadlow, about 15 miles. If I wanted to walk the Pennine Way starting tomorrow I probably could, although I doubt if I could run a marathon without training. My bowels move regularly and with great satisfaction. My appetite is good, too good—but not unhealthily too good. I’m drinking Viennese coffee right now (and listening to Haydn string quartets—almost a definition of health in themselves) and tonight will chose between a claret and a Beaujolais, perhaps topping it off with an Islay whisky. Alcohol seems to be part of health for me, but I’d dispense with the alcohol before the Haydn (and even more so the Bach and Schubert).

I sleep well, although often waking for 30 minutes or so in what R S Thomas calls the “lean hours.” Those are the hours when we are most likely to die, our steroids are at their lowest ebb, and the vale of tears can feel too much. When editor of The BMJ I used to feel more stressed in those hours than I do now, but I don’t think a little fretting unhealthy, particularly for me, as for many, daylight brings energy and optimism.

It’s in my mind that I feel most healthy—despite the forgetfulness. I’m reading Anne Enright’s The Gathering and think it magnificent, although it describes yet another dysfunctional family. I’m also reading the “Odyssey,” “After the Ice, and “The Classical World.” After listening to the philosophers and writing this (which I’m much enjoying even if you are not—and there is perhaps no you, which again doesn’t matter) I plan to read Betrand Russell’s account of Schopenhauer, who evidently hated life, and find Lucretius’s poem “De rerum natura.” Most importantly I have more gratifying work to do than I can ever get done plus the chance to be diverted, as I am now. Put all this together with the music and for me this is close to the heart of being healthy.

“But,” a reader might think, “this is all about him. Can you be healthy without others?” I think I might be able to be so, and I’d rather be alone than be at a party—despite being regarded by all as being a rather extreme extrovert. But I’m healthier, I’m sure, (and health just like disease can’t be a binary state) because I have a wife sleeping upstairs, who although regularly exasperated by me loves me as you might an old dog or coat; a son who loves being a chef; another son who is at Machu Pichu and has just been bitten by a spider; and a daughter asleep in East Sheen. These are my children, whom I love, but they are them not me—which seems to me important for health. I may have fulfilled my Darwinian destiny of fathering children, but I have childless friends who seem healthy to me.

And I have a goodly smattering of friends across the world, whom I’m very glad are there but whom I don’t see that often. I have 572 “friends” on Facebook, 3887 “followers” on Twitter, and a host of “colleagues and contacts.” If I died tomorrow—at 61—I think a fair few would turn up for my funeral. These friends seem important for health but not as important as a life of the mind and work. Seeing death, by the way, as normal and providing a much needed narrative structure to life seems essential for health, although fear of death and health may be compatible.

The fact that I can afford my Viennese coffee, claret, Haydn, and books, live in a warm house where I have my own basement study, and have no financial worries seems very important for health. Poverty might break me, although I’m very attracted to the idea of shedding as many things as possible and wonder (but no more than that) about committing myself to a year without buying anything new apart from food and medicines. It’s also important that I don’t expect to be blown up or robbed today, and if I want to catch a train to Scotland it will run roughly on time. A functioning society is important for my health.

But what about the credit crunch, the rise in unemployment, the gross injustices in the world, and the overheating of the planet, which is likely to leave a fucked world for my grandchildren? These things detract from my state of health, but I’m blessed by Eliot’s observation that “human kind cannot stand very much reality.” My innate selfishness and lack of imagination, shared with most other humans, insulate me in my healthy state, but I have an unselfish, fingerless friend with severe scleroderma who may in her unselfishness and need to make a difference be healthier. Truly health has many forms.

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.

  • Chris Holmes @4S4GOOD

    Richard, Maybe you are illustrating an issue that lies at the heart of our ill-health prevention challenge. In a world focused on disease, illness and its treatment then perhaps health is defined, for most, only in relation to ill-health and therefore not actually a status to be invested in and protected but simply a goal once one is ill. If our ‘industry’ had defined itself around health not illness then perhaps a greater number of us would invest our resources in maintaining healthiness as goal in its own right rather than something to be regained when ill. My memory says that Unilever did a peace of qualitative research on this issue in mid-2000 comparing Eastern and Western attitudes to the concepts of health and illness.

    I agree with your central tenant that personal perceptions of health are both personal and relative.

  • Eduardo Tejera

    You are healthy and I’m very better after I read your speech. Many thanks from Spain

  • pianogirl0617 .

    What a state of mind~~ Likiiiiiii~~

  • Lara Croft

    Well, I enjoyed that – although I’m trying to work at the moment, and bored…
    I’d probably take the alcohol over the Haydn but might have to negotiate if it came to a bit of Bruce Springsteen instead…