Traditionally, medicine aimed at health, seeking primarily to make sick people healthy again. Health, however, is a difficult concept to define, because a person does not have a distinct experience of health. Health is an absence: it is an absence of negative bodily experiences, since when a person is healthy, there are no dissonances or pains that draw his attention. Health is “a state of unawareness where the subject and his body are one.” Because of this inattention, “our enjoyment of good health is constantly concealed from us.” Ancient doctors spoke of health as a harmony, or balance. Usually, they drew on theories of the balance of the humors, but these theories involve the same sense of nothing being noticeably out of order. Fredrik Svenaeus has called it a feeling of being at home in the body, meaning that we do not feel out of place in our body. Even more reductionist, medical understandings of disease define health in contrast to dysfunction or an abnormal range of values. In all of these understandings, disease is the primary experience. Health is merely disease’s absence.
Pain or the failure of the body draws one’s attention. Otherwise, the body freely manifests a person’s action into the world, seemingly transparent to the person’s will. The body is one’s tool for engaging the world, as Aristotle suggests in describing it as an organic body, a body made of tools. Describing the body as a tool does not instrumentalize it, but instead recalls the experience of the craftsman whose commonly used tools become almost an extension of the self; or the blind person’s cane; or the short-sighted person’s glasses. These tools are absorbed into the experience of the body and ultimately disappear from awareness. The craftsman only notices his tools when they break or malfunction. They cease to be a transparent medium of his action into the world and are brought to his attention as a problem, or something that he needs to address. It is the same with the body; a person attends to it when it ceases to function or brings pain to her attention, while its erasure from attention is a characteristic of health. The focal attention on pain, dysfunction, or limitation is the experience of disease. In disease, the body becomes other to one’s will.
Even an experience of pain or discomfort does not necessarily mean that disease is present or that the person feels the need to seek medical care, or even that she should be concerned. There are defined rhythms to health, quirks of a season or of a period in life; to continue the tool metaphor, a car might take longer to start in the winter or a lock might need a jiggle when you turn the key without these being indications of a broken car or lock. As I write this section, my nose is running due to allergies, which always appear in the spring as flowers bloom. The discomfort of a runny nose or a sinus headache is not strange or unpredictable. I am not concerned by these symptoms, as they are how my body usually responds to the cycle of seasons. Similarly, I do not grow concerned over a minor cold in the midst of winter, as I expect to get a cold at some time during these months. Women are especially familiar with this rhythmic nature of healthy bodily processes, with predictable changes occurring over both the short term (monthly cycles) and over life as a whole (puberty, pregnancy, menopause). Even serious discomfort does not inspire concern if the cause is apparent. If I drink too much and am laid up much of the next morning, I do not blame my body, but my foolish choices. The discomfort is a natural response to my actions. If I eat at a dodgy restaurant and spend the next day with stomach pain, my feeling of my body as predictable and reliable is not necessarily disrupted, and I only seek medical care if the stomach pain lasts longer than usual. These kinds of expected, rhythmic discomforts do not lead to medical care. Instead, people turn to nonmedical remedies, like sleep, chicken soup, the BRAT diet, Neti pots, a hot toddy, and so forth; or they turn to the common over-the-counter pharmacopeia for support: aspirin, Sudafed, Nyquil.
Similarly, not all limitations are a disease or indicate the absence of health. If I am out of breath after hiking up a hill that I used to climb with ease, I recognize that I am out of shape, not unhealthy. I will just need to exercise more if I want to climb it without difficulty. As people age, they face more and more limitations and aches in the body. This can be accepted as part of the rhythmic nature of health, with a rhythm extending over the whole lifecourse. There are some limitations to physical endurance and performance that appear no matter what one’s physical fitness or health; humans only run so fast for so long or stay up for so many continuous nights in a row. These are accepted as a limitation of the body, as what one expects of it, unless one seeks to exceed the human condition.
Even states that most people would see as requiring medical care, like disability or chronic disease, can still lead to an equilibrium recognized as a new form of health. Many people with disabilities do not even recognize them as a source of limitations, but merely as a different way of being in a body. Even those with chronic illness can reach normal states of comfortable action in the world once they are medically stabilized. They accept their new bodily equilibria as their state of health.
(excerpted from chapter 1)
