{"id":28603,"date":"2013-09-02T10:25:41","date_gmt":"2013-09-02T09:25:41","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=28603"},"modified":"2013-09-02T10:25:41","modified_gmt":"2013-09-02T09:25:41","slug":"richard-smith-a-bad-case-of-health-2","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2013\/09\/02\/richard-smith-a-bad-case-of-health-2\/","title":{"rendered":"Richard Smith: A bad case of health"},"content":{"rendered":"

\"RichardI\u2019ve 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\u2019t have a wholly convincing answer to the supreme question of \u201cWhy not kill yourself\u2014to escape this \u2018vale of tears?\u2019\u201d The questions of \u201cHow to live the good life?\u201d and \u201cWhat is health?\u201d seem to me closely related (perhaps even the same question), and if three millennia of philosophers have got nowhere what hope have I?<\/p>\n

But then I have the idea that we might go about defining health in the same way that we have defined disease\u2014through 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. <\/p>\n

I should start with myself. I am healthy. I declare myself to be so.<\/p>\n

\u201cNo you\u2019re not,\u201d my cardiologist might say if I had one. \u201cYour arteries I know to be atherosclerosed. Your blood pressure and blood lipids are high. You\u2019re 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?\u201d<\/p>\n

\u201cYou are getting very forgetful,\u201d my neurologist might add, \u201cand look at how your mother and grandmother demented when only 15 years older than you are now.\u201d<\/p>\n

\u201cYour back doesn\u2019t look too good to me,\u201d says my rheumatologist, \u201cand you seem just a little manic,\u201d mutters my psychiatrist.<\/p>\n

\u201cMany 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,\u201d says my dentist, having the last word.<\/p>\n

All this I declare to be irrelevant. I am healthy.<\/p>\n

Beginning with the physical side, I feel fine. Soon I will walk the dog. Later I may go for a run\u2014perhaps 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\u2014but not unhealthily too good. I\u2019m drinking Viennese coffee right now (and listening to Haydn string quartets\u2014almost 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\u2019d dispense with the alcohol before the Haydn (and even more so the Bach and Schubert).<\/p>\n

I sleep well, although often waking for 30 minutes or so in what R S Thomas calls the \u201clean hours.\u201d 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<\/em> I used to feel more stressed in those hours than I do now, but I don\u2019t think a little fretting unhealthy, particularly for me, as for many, daylight brings energy and optimism.<\/p>\n

It\u2019s in my mind that I feel most healthy\u2014despite the forgetfulness. I\u2019m reading Anne Enright\u2019s The Gathering<\/em> and think it magnificent, although it describes yet another dysfunctional family. I\u2019m also reading the \u201cOdyssey,\u201d \u201cAfter the Ice, and \u201cThe Classical World.\u201d After listening to the philosophers and writing this (which I\u2019m much enjoying even if you are not\u2014and there is perhaps no you, which again doesn\u2019t matter) I plan to read Betrand Russell\u2019s account of Schopenhauer, who evidently hated life, and find Lucretius\u2019s poem \u201cDe rerum natura.\u201d 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.<\/p>\n

\u201cBut,\u201d a reader might think, \u201cthis is all about him. Can you be healthy without others?\u201d I think I might be able to be so, and I\u2019d rather be alone than be at a party\u2014despite being regarded by all as being a rather extreme extrovert. But I\u2019m healthier, I\u2019m sure, (and health just like disease can\u2019t 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\u2014which 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.<\/p>\n

And I have a goodly smattering of friends across the world, whom I\u2019m very glad are there but whom I don\u2019t see that often. I have 572 \u201cfriends\u201d on Facebook, 3887 \u201cfollowers\u201d on Twitter, and a host of \u201ccolleagues and contacts.\u201d If I died tomorrow\u2014at 61\u2014I 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.<\/p>\n

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\u2019m 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\u2019s also important that I don\u2019t 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.<\/p>\n

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\u2019m blessed by Eliot\u2019s observation that \u201chuman kind cannot stand very much reality.\u201d 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.<\/p>\n

Richard Smith<\/strong> was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

I\u2019ve 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 […]<\/p>\n

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