The World Health Organization’s 1948 definition of health speaks of a “complete state of physical, mental and social well-being,” and not merely the absence of disease. In hindsight, this may appear as a form of collective omnipotence, in which the laws of nature were presumed to be overcome and the “men” who drafted that declaration momentarily felt like “gods.” The great illusion lies precisely in the idea of complete well-being: a condition without falls, fragility, ageing, or death. The only genuinely positive aspect of that definition was the shift away from disease—which, after all, exists in childhood, adulthood and old age—toward the three psycho-physical-social dimensions, though these were implicitly treated as given and stable.
It is more realistic to speak of a tension toward harmony among these three dimensions, to which I would add a fourth: the spiritual one. By “spiritual” I mean the sense, the meaning of what we do and think. And let us clear the field of another prejudice: it is possible to experience well-being even while being ill. We know that emotions, resilience, the ability to draw on inner resources, and the strength of relationships play a major role in restoring harmony.
Carver identifies the personality traits that activate coping—the ability to deal with something that generates stress: extroversion; the capacity to talk about it with others—chosen carefully; responsibility; the willingness to maintain a healthy lifestyle regardless of circumstances; openness. And this is a point that resonates deeply with me: curiosity about what comes next, not having already decided how one’s future will turn out; awareness, being conscious of what is happening. A lack of resilience, and therefore of well-being, occurs when thought, according to Carver, becomes fixed on a single idea. There are various techniques to recover from this “thief of time and life”: obsessive thinking. Denial, not only total denial—typical of conspiracy theorists (for example, “the Holocaust never existed”), which is easy to recognize—but also partial denial, far more common, in which one sees and points to the finger but not to the moon it indicates. And introversion, the tendency to keep everything inside, which will inevitably erupt into a volcano of anger or a river of tears when we have failed to ask for help at the right time.
The fourth dimension, spirituality—on which the WHO has nevertheless established working groups—has, for me, a fundamental component: it is based on the inner narrative that each of us constructs, grounded in our values and disvalues, made up of light and shadow. Well-being arises when we think and act in accordance with our deepest values, attributing meaning that begins to bring some clarity to the mystery or helps us accept a situation, depending on whether a person believes in chance (one mental pattern), genetics (a second), epigenetics (a third), destiny (another mental pattern), and so on. This “story” is well documented in the scientific literature: those who have mental harmony and a sense of purpose, who recognize that there are grey days and sad moments in the balance of their lives and do not obsessively remove them to pretend that everything is fine (denial), but instead give voice both to the hours of spring sunshine and to the long season of winter rigor, fall ill less often and live longer.
In this fourth quadrant—spirituality—I include, in addition to meaning, life purpose: having one or more purposes; loving people, mystery, nature, the soul of things is itself a purpose. But feeling alone is not enough. In many cases it is not emotion that guides action, but action that makes emotional change possible. Doing has a direct effect on the mental and bodily processes that regulate mood, motivation and the sense of personal efficacy. Acting interrupts repetitive thought cycles typical of depressive and anxious states and reactivates a sense of control. At the neurobiological level, doing is associated with the activation of dopaminergic circuits linked to reward and motivation, and with modulation of stress systems. Doing also plays a central role in building a sense of agency, that is, the perception of being able to influence events. This sense of efficacy is one of the most protective factors for mental health: knowing that one can act generates a form of “eudaimonic” well-being, achieved through effort. Behaviors of help and cooperation are likewise associated with increased subjective well-being and a reduction in loneliness and introversion.
Not only loving, then, but also doing, because love as an inner state is “useless” if it does not find concrete expression. Shall we try an “experiment”? Let us take a “selfie” while ruminating over something that did not go as it should have, or even over our illness, and then take another after completing a small effort: a drawing, a long-postponed phone call, finishing a book, tending to a wound… and then compare the differences. A more tired face? Brighter? Or less tired and more smiling?
Let us return to the utopian 1948 WHO definition of health. When I open a classroom with doctors, students and nurses, I ask each participant to write what health means to them. Some respond by citing the WHO definition. Others say: waking up in the morning and discovering that the taste of coffee is good, with the energy to get through the day. Some write about a meal, a family event, the good that is seen and felt in a bond, the joy of seeing one another again in the evening. Others describe a time of silence and quiet with themselves.
I feel healthy as I write these lines, because I know I am within the meaning I try to give to my days: exploration and the rejection of platitudes and extreme generalizations, the welcoming of nuanced differences. Even knowing that some will not like it. And so perhaps today, for me, health is also learning not to give too much weight to the opinions of others, strengthening one’s own path and having the courage to walk it. A path that is never truly ours alone, because along the way we encounter many other people.
And you, reader, how would you define your health today, beyond the declarations of major institutions?
Further Reading:
- Article on the contemporary evolution of the concept of health (PMC)
What is health? – PMC - Concepts of Health in Different Contexts: A Scoping Review
The Role of Social Determinants of Health in Promoting Health Equality: A Narrative Review – PMC
