Overall, skepticism about what people think represents the Cartesian incubus of medicine, an expression that blames René Descartes (the 17th century French scientist and philosopher) for the mind-body dualism that has characterized Western medicine for centuries. Descarte's emphasis on studying observable phenenomena is responsible for the bias against studying phenomena that occur in the mind, primarily because such phenomena cannot be reliably measured or verified. While the body and its tissues can be touched, invaded, observed, and otherwise measured and manipulated; the mind represents a special challenge. What goes on there (beyond visual representations of structures and electrical activity), can't be directly seen, so functions must be inferred. The mind remains a vast frontier of scientific challenge. The "medical mechanics" of the body like to focus on the things that can be observed and manipulated. When it comes to the mind, things like feelings create dilemmas. How can science explain and measure what it cannot see and take apart?
In recent years, faced with data that could not be dismissed so readily, medical science has given a grudging nod to the reality of the mind-body connection. Now, the finding that self-rated health has such powerful predictive power when compared to other time honored measures is an inconvenient truth, sort of a scientific fly in the ointment. Moreover, since many studies have confirmed this finding, the dilemma of how to explain it grows more troublesome and begs for closer scrutiny. This finding may be troubling and inexplicable for some, but not for those who, like me, understand the incredible health giving power of human activity.
One very interesting finding related to self-rated health is that when it comes to the factors that seem to explain this phenomenon, it appears that neither pain, nor fatigue nor other such factors commonly described as subjective "symptoms" seem to explain the predictive power of self-rated health. Instead, actual engagement in activity seems to be a major influence on how people rate their own health. Put in other terms, researchers have found that people tend to rate their own health based on the things they can or cannot do rather than on other factors. This makes sense, because what people experience is what they know best.
These findings make one medical philosopher, H.Tristram Engelhardt, Jr., MD, PhD, seem like a very wise man. He is. Years ago, Dr. Engelhardt observed that people are healthy or diseased in terms of the activities open to them or denied them. Stated in other terms, he was saying that participation in life is the manner in which people normally experience health or illness. If their participation is restricted, it follows logically that they are going to perceive that their health is compromised. People know what they are doing in comparison with what they have done in the past and what they would like to be able to do in the present.
And so, the findings about the predictive power of self-rated health end up being not so improbable after all, but rather logical. Given that a strong connection exists between activity engagement and health outcomes, it suggests to me that when health screenings are done, questions about activity participation should be a central part of the data gathering by primary care providers. Perhaps a question that would be more valuable than "How are you feeling today, Mrs Jones?"" might be "What have you been doing lately, Mrs. Jones?" followed by "Are you doing more, less, or as much as you'd like to be doing right now?" Funny, that in everyday social conversation, people often ask each other "How are you doing?" So, if you think about it, (and I do), this common phrase uses "doing" as a synonym for "feeling". Oops, there is that troubling mind-body connection again! It just may be that life activity itself is a tremendous barometer for health and wellness. For years, activity levels have been used to gauge mental health. Now it seems, those same data might be useful measures of overall physical health as well. On that topic, a future post awaits.
Of course, as much as I'd like to have the last word, that is reserved for you. If you are aware of other findings that relate to this topic, by all means share your comments (subjective and objective) below.