The Power of Being Engaged

The last thing a fish notices (if fish do indeed notice, and we presume they do!) is water. They are immersed in it, it sustains their lives, and provides the means for them to get food and swim away when they want to escape being dinner for larger fish. In that sense, water is essential for their well being.

In a similar way, people hardly notice the activities in their lives, and they most certainly underestimate the importance of doing to their well-being and survival. Being engaged is important to us for many reasons, some of which have been articulated in earlier posts on this blog. It's always nice to remind ourselves, however, of things we take for granted.

As a recovering academic (actually, academics are never fully recovered), I have sometimes used examples of life changing events that disrupt people's everyday activities, sometimes temporarily, sometimes progressively, and less often, permanently. Many people fear death, and worry about the complete cessation of their engaging daily occupations, but few people even think about how injuries and disease, or changes in their aging bodies, can limit the things they like to do.

These "things" are activities, sometimes called interests, projects, hobbies, work, tasks or simply "doings." A disease or injury that interferes with movement, or any of our senses, will make doing these things, or engaging in life, more difficult. But, features of the environment, policies, attitudes and other dimensions of life also create barriers to doing. People get passionate about policies that restrict their behaviors. Hopefully, they get equally passionate about finding ways to do the activities they love when adversity starts to create limitations.

If we live long enough, we all begin to experience the normal effects of aging. These diminish our vision, our hearing, our taste, and our ability to move around. People react to these circumstances in different ways. Some compensate and don't miss a beat, and others seem to withdraw, which we now know hastens the process of bodily decline.

So, at long last, the point of all this. Make each activity count. Enjoy the moment and appreciate the power of engagement. It is the very substance that makes life what it is.

Reflections on Not so Mysterious Medical Findings

This post is about subjective health. By that, I mean how people rate their own health when asked. Medical researchers have found that self-rated health is among the best predictors of mortality, even when compared against so-called "objective" measures of physiological function. Of course, when this was first reported, there was great skepticism among medical researchers. They surmised that the finding was in some way explainable through faulty data or perhaps represented a random statistical aberration. In medical research, it seems, subjective feelings about anything are considered "soft" or unreliable data, just a notch above qualitative research, where individual themes rather than grouped numbers represent the data to be interpreted.

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.