Boost Health for All of You
The concept of whole health challenges the one up one down approach to managing health and recognizes that wellness involves more than just the body. Staying well involves caring for the body, mind, soul, and spirit. These concepts explain how whole health fits in today’s modern world.
A quintessential ‘town doctor’ and the associated relational care as we once knew it is on the endangered species list and quite possibly extinct. Gone are the days when colloquial reference to the family doctor was received as a healing relationship. Nowadays, ‘family medicine’ refers to a systems-based practice. At the start of 2021, nearly 70% of U.S. physicians were employed by hospital systems or other corporate entities (Eddy, 2021). Suffice it to say, majority of modern-day care is provided by a system or business as opposed to a person.
Therefore, it is not surprising to learn that 43% of Americans are dissatisfied with the healthcare system (Yang, 2021; Shmerling, 2021). On May 23, 2022, the Surgeon General issued a warning on health worker burnout and resignation based on projected shortages of 3 million “essential low-wage health workers” in the next 5 years and nearly 140,000 physicians by 2033 (Health and Human Services, 2022). These data suggest that both the patrons and providers of healthcare are dissatisfied with the status quo.
Despite paying and investing the most per capita dollars in healthcare compared to other developed countries, Americans are seeing lower life expectancy, higher preventable hospital admissions, unprecedented substance use disorders and drug overdoses, as well as high maternal mortality (Shmerling, 2021; Centers for Disease Control, 2021). The U.S. healthcare system is well equipped to acutely react to a diagnosis. However, proactive care—focused on prevention and wellbeing—that is provided earlier in the disease continuum is not routinely supported. Making matters even more incomprehensible, 7 in 10 of the leading causes of death result from chronic conditions of which preventive measures are possible (National Center for Health Statistics, 2021). Is there anything that can temper this madness?
Scientism suggests that we are simply physical creatures who have neurons and chemicals that create our inner world. Rooted in the scientific revolution, philosophers like Descartes proclaimed that by learning how the physical world worked, human beings could become masters and possessors of nature (Burnett, 2012). Today, scientism still influences modern culture. Therefore, Dr. Candace Pert observed that “most physicians treat the body with no regard to the mind or emotions. Conversely, psychologists treat the mind as disembodied, a phenomenon with little or no connection to the physical body. But, the body and mind are not separate and we cannot treat one without the other.” Dr. Pert made the seminal discovery of neuropeptides, molecules that arise from the brain in response to thoughts connecting its activity to the endocrine and immune systems (Ruff, 2019). This discovery paved the way for Dr. Pert to introduce her concept of the bodymind, which puts forth the idea that there is more to life than what is physically observed and that these things are related as well as connected.
The concept of whole health challenges the dogma of scientism as it relates to healthcare by suggesting that health—and the things that influence it—extend beyond the physical. Whole health is a holistic approach to care focused on empowering individuals, families, communities, and populations to improve their health (National Center for Complementary and Integrative Healthcare, 2021) in multiple interconnected domains: 1) physical and structural, 2) nutritional and chemical, 3) mental and emotional, 4) environmental, 5) spiritual (National Institute of Whole Health, 2022). These 5 aspects of whole health(TM) influence the quality and function of one’s well-being and health behaviors. The basis of whole health education(TM) is understanding why and how these 5 aspects impact one’s health, well-being, purpose, happiness and longevity. This demystified understanding empowers one to apply whole person approaches when choosing health behaviors or lifestyle choices that support sustainability despite the ups and downs of life (National Institute of Whole Health, 2022).
Pure Presence
Abraham Maslow posited that alongside survival and safety—but antecedent to self-esteem and self-actualization—a sense of belonging or relationships are a basic human need (Donadio, 2021). When facing chronic illness, one might perceive that their survival or safety is compromised. Therefore, receiving care from a system, thereby potentially removing the relational component of care, may compromise all basic human necessities to get well. Consequently, self-esteem and self-actualization may not be possible in the context of Maslow’s hierarchy of needs theory.
The National Institute of Whole Health (NIWH) asserts that “every person deserves respect, compassion, and justice. Those who treat another otherwise diminish themselves and all of us, each a unique and irreplaceable part of the human family. Nature is the reflection of the innate order, perfection, and interrelationships of creation. Life is not only physical and chemical, mental and emotional; it is also an expression of a profound spirituality, which we do not yet fully understand. Given this, it becomes appropriate to approach health care from a whole person-oriented philosophy, which is educational, focused on disease prevention and, to the extent possible, fully engages the participation of individuals in their health recovery process.” This is an empowering philosophy that supports a sense of autonomy with respect to health and wellbeing.
Applying this philosophy is only possible in the context of a healing relationship. How is a healing relationship cultivated? Dr. Georgianna Donadio developed the model of behavioral engagement (BE)(TM), which provides guiding principles. BE is expressed using a practice called pure presence—a state of being fully and wholly present to another person (Donadio, 2012). Pure presence(TM) is fully centered on connecting through relationship and employs multiple communication practices. These include clearing away distractions and making oneself physically comfortable, centering your body to maintain soft eye contact. This posture supports presence and the conversation can begin with clarifying any intention and allowing space. Space can be provided by being comfortable in silence and remaining open to the other person—owning any feelings that are expressed. Pure presence(TM) should invite sacred listening and, in this process, both parties walk away having been internally shifted in some way by the interaction.
Fostering this sacred form of communication has the propensity to consider a reimagining of the current model of healthcare. Instead of a codependent, one up one down approach to cultivating health and developing healthy behaviors, a pure presence-based interaction is centered on healing relationships and applies shared decision making when it comes to choices that impact one’s health. This encounter functions more similarly to an accepting of an invitation than heeding advice or recommendations.
Since behaviors demonstrate true feelings or intentions more accurately than words, changing behaviors requires this internal emotional shift (Donadio, 2012). However, human beings are complex and behavior is impacted by other variables as well. Much of behavior is driven by a desire to reduce pain and experience pleasure (Donadio, 2012), but, is influenced by environment as well. Further, a person’s experiences within their environment are relative and unique due to things such as their perception, mental filters, attitude, belief systems, or values (Donadio, 2021). Consequently, relationships based upon integrity, respect, and compassion—those that respect the uniqueness of an individual while promoting self-efficacy—can support cultivation of healthy lifestyles.
The Bodymind
Plato said “therefore if the head and body are to be well, you must begin by curing the soul.” These things that extend beyond the physical were well recognized in ancient times and often referred to as the soul, heart, spirit, love, beauty, etc. The placebo effect provides a clue on the interconnectedness of our bodies with that extending beyond the physical. A placebo is anything that appears to be a medical treatment but isn’t (Saling, 2022). In some cases, people have a physical response to a placebo. This “placebo effect” is often related to beliefs about the placebo and can be positive or negative.
The body has potential to make the invisible, visible. For example, high hopelessness was found to predict myocardial infarction while moderate hopelessness was associated with cancer (Everson, 1996). Besides hope, other attitudes can influence the bodymind. Dr. Redford Williams of Duke University Medical School and his collaborators looked at the hostility component within type A personalities and found that high hostility scores predicted not just myocardial infarction and death from heart disease but also increased death from cancer and all other causes as well (Kabat-Zinn, 2013).
Chronic stress is well characterized to negatively impact several systems of the body. The work of Hans Selye provides foundational insight into how this occurs (Kabat-Zinn, 2013). Selye defined a stressor as any event that requires adaptation by the body. Therefore, this could include “good” or “neutral” demands such as exercise, changes in temperature, getting married, etc. Subsequently, the body physically adapts to the stressor, whether real or perceived. In the short term, the body responds by releasing neurotransmitters like adrenaline or an increase in heart rate, lung capacity, glucose, fat utilization, blood pressure, excitation of the nervous system, blood clotting, and sweating. Additionally, the body will dilate the pupils and decrease digestive function—all in an effort to adapt to the stressor.
However, if the stressor is removed, the body moves to recovery in its attempt to regain homeostasis—physiological equilibrium. However, if the stressor is prolonged, exhaustion could result. This persistent response to a stressor, or chronic stress, over time may result in decreased immune function, increased susceptibility to disease, digestive problems, reproductive issues, fatigue, desire for stimulant use, demand for certain nutrients, and vascular tension. This continual upregulation promotes an inflammatory state within the body and this silent inflammation contributes to development of chronic disease (Sears, 2021).
Whole Health and Lifestyle Modification
In the context of the bodymind, a reductionistic viewpoint on illness begets the chicken or the egg question. However, because many chronic conditions arise from the totality of a human experience, a holistic approach is necessary to move toward wellness. In that context, can whole health education(TM) facilitate sustainable lifestyle changes for individuals with chronic conditions? This is an important question to ask and poignant given current states of health and the modern-day healthcare system. Meijing said “prevention is the ultimate principle of wisdom. To cure a disease after it has manifested is like digging a well when one already feels thirsty or forging weapons when the war has already begun.” Indeed, Benjamin Franklin rightly declared “an ounce of prevention is worth a pound of cure.”
Georgianna Donadio said “by learning how the brain works and how emotions and chemicals influence it, we can understand how to make better choices (Donadio, 2021).” Learning improves lives and a sound educational framework supports integrity of the teaching provided. Whole health education(TM) provides the theoretical framework for a holistic approach to identifying the big picture of health(TM) and factors contributing to development of chronic disease, which ultimately require lifestyle modifications. Whole health education(TM) is designed to understand, remember, and experience wholeness (Donadio, 2021). “Everything is interconnected to everything else, everything is everything,” Dr. Donadio astutely observed.
However, it is only when one experiences justice that they are present to the natural order of things (Donadio, 2021). The square of common good philosophy contends that living by respect, integrity, and compassion creates a byproduct of justice. All humans have the ability to make choices and change their circumstances (Donadio, 2021). Therefore, understanding can often be the first step toward healing. However, this understanding requires a teacher with a sense of the big picture, what is meaningful, and one who teaches to learning needs in order to best serve others (Donadio, 2021).
Sustainable health refers to health as a sustainable state and is related to the concept of environmental sustainability, which denotes that humans and other living creatures on earth are interdependent (Last, 2019). The NIWH describes whole person health as a conglomeration of 5 essential aspects of one’s life that influence the quality of function of that person’s life (National Institute of Whole Health, 2022). These 5 elements can be likened to functioning as a whole health ecosystem that impacts health, well-being, purpose, happiness, and longevity (National Institute of Whole Health, 2022). Whole health education(TM) invites someone into the process of evaluating their whole health ecosystem to determine if any one of the 5 aspects of whole health are out of balance.
Fortunately, there is evidence to suggest that change in lifestyle does prevent certain health events. Walter Willett combined results of the Nurse’s Health Study and the Health Professionals Follow-up Study to assess factors that prevented certain chronic conditions (Willett, 2021). Willet’s findings indicated that 5 lifestyle adjustments were preventive and they are: not smoking, maintaining a body mass index (BMI) <25, exercising at least 30 minutes daily, maintaining a healthy diet (i.e., low trans fats, high polyunsaturated/saturated fats ratio, low glycemic load, high fiber, high fish, and high total folate), and not drinking more than 5g of alcohol daily. Unfortunately, <4% of people in this study fell into this group. However, those that did would have prevented 80% of health events, 92% of diabetes and 85% of colorectal cancer incidence. Therefore, in the context of the 5 aspects of whole health, modifications to lifestyle such as changes in nutrition, physical activity, stress management, sleep, avoiding risky substances, or relationships are possible to enhance wellness and move toward wholeness.
Definition of Terms:
Behavioral Engagement(TM) – A model for health behavior change utilizing a Pure PresenceÒ approach, which has been developed, validated, and applied in clinical care.
Bodymind – The mind and body integrated as a single entity that is interconnected through neuropeptides and their receptors, which illustrate how emotions can be manifested throughout the body.
Chronic stress – A consistent sense of feeling pressured and overwhelmed over a long period of time.
Extrinsic motivation – An external incentive to engage in a specific activity, especially motivation arising from the expectation of punishment or reward.
Five aspects of whole health(TM), Five Elements – The five aspects of health are physical/structural, emotional/mental, nutritional/chemical, environmental, and spiritualÒ. These pillars provide a holistic view of cause, effect, and solutions to health issues.
Homeostasis – A state of balance among all the body systems needed for the body to survive and function correctly.
Intrinsic motivation – An incentive to engage in a specific activity that derives from pleasure in the activity itself rather than because of any external benefits that might be obtained.
Maladaptive coping – Actions that prevent people from adapting, adjusting, or participating in different aspects of life. Such actions are intended to help relieve or avoid stress, but are often disruptive and may contribute to increased distress, discomfort, anxiety, and illness over time.
Maslow’s Hierarchy of Needs – A theory developed by Abraham Maslow, which puts forward that people are motivated by five basic categories of needs: physiological, safety, love and belonging, esteem, and self-actualization.
Nutritionism – An assumption that the sum of all the individual scientifically identified nutrients, vitamins, and other components in food determine its value.
Pure Presence(TM) – A state of being fully and wholly present to another person through communication practices that include an warm and inviting physical posturing, non-judgement, providing space, and mindful listening intended to bring about internal shifts in perspective.
Self-determination theory – A framework that supposes conditions supporting an individual’s experience of autonomy, competence, and relatedness foster the level of motivation and engagement for activities.
Self-efficacy – An individual’s belief in his or her capacity to execute behaviors necessary to produce specific performance attainments.
Silent inflammation – an inflammatory response that occurs within the body but is not detected through normal mechanisms of detection such as pain, redness, or swelling.
Transtheoretical model of change – A model illustrating stages of change: pre-contemplation, contemplation, preparation, action, maintenance, and termination.
Well-being – a state of feeling healthy and happy. Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
Whole health – A proactive, personalized, patient-centered holistic approach to caring for someone.
Whole health educationÒ – A model of patient education that combines behavioral engagement(TM) with evidence based medical and complementary health information pioneered by the National Institute for Whole Health.
Wholeness – A state of completeness, joy, contentment, safety, integrity, peace. Signifies a sense of wellbeing and harmony both within and beyond.
Registered Trademarks are those of the National Institute of Whole Health.
References:
Burnett, Thomas. 2012; What is scientism?, Dialogue on science, ethics, and religion; https://sciencereligiondialogue.org/resources/what-is-scientism/
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Centers for Disease Control. 2022; How much physical activity do adults need? https://www.cdc.gov/physicalactivity/basics/adults/index.htm.
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Everson, S.A., Goldberg, D.E., Kaplan, G.A., Cohen, R.D., Pukkala, E., Tuomilehto, J., Salonen, J.T. (1996, Mar-Apr). Hopelessness and risk of mortality and incidence of myocardial infarction and cancer. Psychosomatic Medicine 58:2, 113-21.
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Last, J.M. 2019; Sustainable Health, reference article;
https://www.encyclopedia.com/education/encyclopedias-almanacs- transcripts-and-maps/sustainable-health.
National Center for Complementary and Integrative Healthcare. 2021; Whole person health: What you need to know, health information; https://www.nccih.nih.gov/health/whole-person-health-what-you- need- to-know
National Center for Health Statistics. 2021; Drug overdose deaths in the U.S. top 100,000 annually, Center for Disease Control and Prevention; https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20 211117.htm.
National Institute of Whole Health. 2022; 5 essential aspects of an individual’s life; https://www.wholehealtheducation.com/a-whole-person-health-approach-to-health-and-healing/.
National Institute of Whole Health. 2022; Philosophy, mission, purpose, goals; https://www.wholehealtheducation.com/about-niwh/philosophy/.
Ruff, Michael. 2019; The wisdom of the receptors: Neuropeptides, the emotions, and the bodymind, featured article; http://candacepert.com/articles/the-wisdom-of-the-receptors-neuropeptides-the-emotions-and-the-bodymind.
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