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.

October Road?

Yo. Here it is, the 21st of October, and it has once again been weeks since my last post. What gives? Part of it had to do with my commuting lifestyle, but the other had to do with enjoying a splendid Summer and early fall in Southern Minnesota, mostly on the bike trails.

I did a little biking, and canoeing, hiking, and even a little (can you believe it?) segwaying. Yep. Segwaying—using that novel two wheeled motor stick that propels you along as though you are riding a push lawnmower! My son Erik and I learned at the same time, and we deigned to take those segways along a few mile stretch of a bike trail outside of Lanesboro. Personally, I think they qualify as motorized vehicles and ought to be forbidden on bike trails, but there are so few of them that I don't think the trail authorities have time to worry about them.

It was a glorious summer, with so many great outdoor experiences that it just went by in a wonderful blur of enjoyment. I hope yours was equally satisfying.

Now, the winterization process begins. Storm doors are being installed tomorrow, and the guy with the compressor blew the water out of the irrigation system this morning. No more mowing— most likely, until next April. A few leaves to rake, perhaps, and a whole lot of memories to reflect are in store as we sip wine in front of the fireplace during the long nights of wintertime in the Northland.

Life is good. We did it well this summer. Next year we'll do it even better.

PS. I titled this blogpost "October Road" from the album (and song) by James Taylor. One of my favorites. Maybe my next post will be about the lyrics to that song, or JT's lyrics in general. Who knows? Share your own stories, I'd love to hear about them. Remember, we live in the shelter of each other.

Interrupting the Hiatus

It's been awhile since my last post, so one can say that this post is an interruption of an interruption. If you Google the word "hiatus" you will find many definitions, ranging from those anatomical to use of the term in the context of breaks in television production or programming. The word comes from the Latin word for "yawning" (interesting), and also is used to signify an opening.

Lately, I have been considering the notion of hiatus from the standpoint of transitions. Most people have transitions in their lives, and often, but not universally, these transitions are marked by a hiatus that serves as a bridge from the old to the new state (whether this refers to jobs, life stages, parenthood, or other aspects of the life course). A hiatus, of course, can also be defined by a vacation period, or time away from a usual routine.

Transitions are often difficult and stressful. I have frequently found that returning to work from an extended break can be challenging, as though one has to move through the gears to get sufficient torque to overcome inertia and resume customary speed. A well-oiled life, it seems, chugging along with a predictable routine, maintains momentum and indeed, even benefits from that momentum (just as a sleigh moves downhill without the need for additional propulsion).

So, I'm hoping that firing up the cylinders for this post will get me back in the groove so that posts will be more regular for the coming weeks and months. Commentary, of course, helps. So if you stop by, please leave a note and share your thoughts about the events and facets of everydy life that contribute to balance, happiness and of course, success in the projects that engage us.

More on the world's happiest countries

Previous posts have discussed the comparative data among countries using measures of happiness or subjective well being. Sometimes, the fact that two different measures are used causes confusion. One measure, used by Martin Seligman to measure "authentic happiness" as described in his book, is the simpler of the two. It measures happiness by asking people how happy they are. A second measure also asks people how happy they are but adds a second dimension called satisfaction. That measure is called a subjective well being score and is used in the World Values Surveys done at the University of Michigan.

Using the second (subjective well being) measure, the following countries rank in the top five across the globe: 1. Nigeria 2. Mexico 3. Venezuela 4. El Salvador and 5. Puerto Rico. At first blush, it is obvious that these countries have something in common: they each have large numbers of relatively poor people, suggesting that money does not equate with happiness. The list brings to mind another truth, which is this: Happiness is a state of mind, and as such, people have complete control over it. If people make the best of their circumstances, they can create the conditions necessary for happiness. One wonders if there is a cultural characteristic about poverty that enables people to see the best in their circumstances, which in turn influences their sense of well being?

I have two friends, both professionals, who respectively are from Nigeria and Puerto Rico. They are both positive energy emoting people. That is, they bring good feelings to situations, in comparison with others who seem to work hard in the opposite direction. Each of these persons also share the trait of valuing things that make a difference in the longer term, while also taking care to make each moment a particular pleasure for themselves and others.

In future blogposts I will explore this notion further. As always, if you have observations about anything on this topic or others that pertains to doing life well, please share it with us!

What to do during Spring

Spring for many is the most glorious of the seasons, and it holds true for me as well. It is especially wonderful in portions of the globe where the winters are long and bitterly cold and people are forced from the warmth of their habitats for only the most essential of tasks (such as going to work, worshiping, seeing friends, dining out, attending school or shopping at the grocery or department store). What's left, you might ask? 

Well, what's left is enjoying nature, sitting on the deck, walking by the river or pond, and staring at the sunset or the birds in the trees. In the winter there are no squirrels scurrying about in the grass, and birds are not nesting in the trees. There is little bicycling either, nor canoeing, nor kayaking, nor in-line skating, or running. The winter worshipers will be quick to point out that there is ice fishing and cross country skiing and ice skating during their season. But even these sports, fun as they are, find their adherents happy to get inside to relinquish the activity to warm drinks and cozy fireside chats.

Yes. Spring is wonderful not only because of the weather, but because of the blossoming of nature and the general spring fever that overtakes the land. People are happy to be out and about, and so are other animals. Everyone frolics. The seasons ahead bode more of the same enjoyment, as spring gives way to the fullness of summer, and summer recedes to the beauty of autumn.

So, what's to do during spring? Enjoy life through outdoor activity...or inactivity. Just be and bask in its beauty.

Home again

It's hard to believe I have not posted a blog entry for three weeks, and I'm amazed at how fast time has passed. Of course, I've been busy; but then again, so have you. Which prompts a reflection in this post about the perception of time. That is, how it seems to pass so quickly on some occasions and so slowly on others.

As a person well into middle age, I have the distinct impression that time accelerates as we get older.  I can recall endless and interminable afternoons in my desk during the fifth grade (and perhaps on more recent occasions as I endured disengaging lectures). In the sixth grade I was fortunate to have a master teacher and felt constantly engaged; the time passed quickly and I excelled. I now wonder if there was a relationship between the two experiences (my performance and my perception of time).

Of course, there have been scientists interested in this phenomenon, both from a psychological perception perspective and a time use/accuracy of reporting standpoint. Not surprisingly, time use scientists report that perceived versus actual time spent working is inflated, while perceived versus actual time spent in leisure and social activity is underestimated. Go figure.

The whole complex matter of perceived time passage, performance, and happiness is immensely interesting, and invites the possibility that loneliness is associated with depression because of disengagement and the perception that time crawls mercilessly through uninviting terrain—rather than springing, as it should, through more pleasant surroundings. 

I'll have a look at the literature to see if any enterprising (engaged) scientist has cleverly considered these questions and report them if I find anything. Meantime, if you discover something, or have a thought to share, please feel free to post it here. Meantime, I wish you engaging moments.

Happiness is about meeting needs...

Over sixty years ago, a psychologist named Abraham Maslow began working on a theory of motivation. His questions had to do with what makes people do different "things" at different times? His work, of course, led to the much studied, and widely known "hierarchy of needs". An idea behind this early work was that some needs are more compelling than others, and thus serve to influence behavior more strongly. Another idea was that once "lower level" needs were met, higher level needs would take over as influences of behavior.

Maslow's hierarchy was often depicted as a pyramid, with survival needs at the base and higher order needs at the top. The survival needs were physiological and safety related, in that we need to eat, sleep, breathe and be protected from harm. Above the survival needs were the need to be accepted and loved by others, and to be approved and recognized as competent. These needs seem associated with our group-living characteristics—indeed, we are social animals. Together, these needs (survival and social) were referred to by Maslow as deficiency needs, suggesting that actions taken to meet them were inspired by their deficiency. That's why Maslow called them "D-Needs".

At the top of the pyramid, were needs Maslow described as "being needs". Being needs include our quest for aesthetics and cognition, the realization that we have that beauty and art and music enrich our lives, and our need to understand the world as coherent—to organize the universe and understand it as having order and symmetry. At the very top, a motive that Maslow called "self-actualization", people are compelled to realize their potentials.

These ideas of Maslow have now been supported by many studies, and have been debated and refined over the years. Yet, they have fundamental value in steering us toward understanding the kinds of things we can do to meet our universal needs through the things we do.

In coming posts, some examples of need meeting activities will be discussed, and readers will be invited to provide their experiences and ideas about meeting essential needs.