Towards a new model of health and well-being
Practice Makes Perfect
Nora, a woman in her fifties in a wealthy North American suburb, has all the trappings of an enviable life: a devoted husband, two successful children, a beautiful house and the many options that come with financial success. Yet, when we spoke, Nora was despondent. I visited her to learn about her experiences adjusting to a recent diagnosis with Type 2 diabetes. Her story, however, focused less on her reaction to the illness itself, and more on her feelings of disappointment and betrayal. As the conversation expanded, it became clear that much of her pain arose from the sense that her diabetes was assaulting everything she held dear as part of the good life: an ability to consume what she wanted when she wanted, the promise of spontaneity, leisure defined by activities such as relaxing in front of the TV. Her life, she felt, was now one characterized by “work”: the requirement to exercise, the annoyance of having to cook rather than eat whatever she chose and perpetual self-consciousness about her body.
Nora’s pain is her own, but her story touches on themes that I heard consistently in six years of working in pharmaceutical branding and marketing, followed by ongoing research into North American conceptions of happiness and well-being. Over time, and across apparently diverse illnesses, two things have become clear: our cultural script for the good life is making us sick, and the dominant North American paradigm regarding the foundation of health and happiness is paradoxically constraining our ability to achieve both.
It’s All about You
In North America, we tend to view health and happiness as qualities located within the individual and determined by physiological and psychological make-up. Many factors contribute to this dangerously intuitive orientation. Western individualism is its foundation, and it’s been buttressed by neo-liberalism and reified by research emphases in the health sciences and pharmaceuticals. Daily, it seems, we read of new findings in the fields of genetics, epigenetics, neurochemistry and psychology that reinforce the view that the seeds for our health and happiness lie in the sequences of our genomes or some other inner mechanism. We don’t blink an eye when we see articles that hail the arrival of a whole new field of research, such as the Developmental Origins of Health and Disease, which focuses on the way experiences in utero shape the make-up of babies and predict their adult health. It seems perfectly logical that we’d focus health research on novel ways of peering ever more deeply into the individual for answers.
And, as the cause, so the cure: most North Americans find it normal to think that the remedy for any problem associated with health and happiness is an individual “fix”, be it through medications, lifestyle modifications, or therapy. This paradigm of health leads us to see our bodies and minds are like machines, requiring just the right maintenance for our make and model to keep us humming along efficiently—a perception that happens to benefit the healthcare industry.
Living in an individualist culture, it is equally logical that our vision of the good life also centers on the individual. The cultural script for the good life in North America focuses on the pleasures of individual consumption. We are saturated with images that reinforce its desirability. For example, even as I was working on this piece, I happened to pick up the January 2012 Harper’s Bazaar magazine on a flight. An article entitled “The Good Life” illustrated the stupendous consumption of a business executive and his wife, featuring her in different couture dresses in the many rooms of their Connecticut mansion. This, clearly, is the good life to which the popular imaginary would have us aspire.
It is when we look at these two individualist-paradigms in relation to actual experiences of illness that we see how they can contribute to poor health. Without questioning the validity of scientific discoveries, it is reasonable to point out that, by focusing so closely on the body and mind as the sine qua non of health, we fail to consider the importance of the practices that bring states of bodies and minds into being. Yet practices that treat our bodies as mere machines, or that lead us to try to consume our way to happiness, or that isolate us in our individualism can hurt us. At worst, as in Nora’s experience, they invite us to behave in ways actively detrimental to health, such as eating fast food or equating leisure with inactivity. But these practices can also create problems simply because they send us in the wrong direction. This is because it’s not consumption that we crave, but connection.
Practicing Health and Well-being
While the individualist paradigm dominates our perceptions about health and happiness, alternative understandings are appearing and gaining momentum. Rather than focusing on the individual body, this emergent paradigm understands health and happiness to be the products of practices that bring into being emotional and physical states in conjunction with particular understandings of self and the world. These practices could include many different types of activity, social or solitary, so long as they include certain qualities, such as full engagement, embodiment, focus, repetition and respect for the thing at hand. Examples of these practices include cooking, the culture of the table, gardening, playing, making music or cross-country skiing. These activities are the stuff of life, things that our busy culture often dismiss as “work”, or, when reduced to burning 200 calories on a treadmill, mere maintenance of the machinery of our body.
The philosopher Albert Borgmann’s concept of focal practices is a useful way to conceptualize this emergent view. Focal practices orient and contextualize the activities of our lives. They demand physical, intellectual and emotional engagement and effort. They do not always provide immediate reward, for example, cooking can sometimes be a “thankless chore”, but they do create spaces for engagement, connection, delight and self-knowledge, and, crucially, they are a source of feelings that are “unprocurable.”
Focal practices provide striking alternative to the dominant paradigm of health and happiness for at least two reasons. First, they provide a counterforce to the consumptive practices that create so much poor health and reorient us to see things portrayed to us as “work” as potential zones for joy and engagement. For example, in a recent New York Times op-ed piece, Mark Bittman challenged the belief that North American eat junk food because it’s cheap, positing instead that we eat it because food manufacturers have convinced us that it’s pleasurable—and that cooking isn’t. Bittman suggests that the solution to our continent’s junk food addiction, and the health problems that go with it, therefore lies with a reengagement with cooking. In a similar vein, the activist Laurie David, best-known for producing the film An Inconvenient Truth, has written forcefully for viewing the family dinner as a practice that allows parents “to connect with their kids, one meal at a time.” David’s work draws on research that says that children who eat with their parents do better in school and are less likely to suffer depression or to abuse alcohol and drugs. In an interview with me, David remarked that “everything in culture pushes us in the opposite direction, [so] we have to work for the precious moments.” In other words, dinners are powerful, not just because family members sit down together, but because, when they’re a practice, they create a space and time to engage and connect that is otherwise not easily available to us. And that makes us healthier.
It’s also possible that focal practices foster health and happiness precisely because we need the unprocurable feelings they provide, including a sense of being alive in our bodies, and connected to others and the natural world, to feel truly well. Borgmann writes that “certain things and practices provoke and engage our physical and moral gifts.” It’s provocative to think that the power of focal practices lies not just in the behavior they demand, but in the fact that they make us feel deeply human, uplifted and connected.
The Good Life Revisited
To embrace the value of focal practices, especially as they foster health-enhancing behaviors and a connection to our sense of humanity, is not to negate the value of allopathic medical system. If I have an infection, I will be the first in line for antibiotics. Nor it is to diminish the real pain and suffering associated with chronic illnesses such as Type 2 diabetes and depression. Rather it is to emphasize two things. First, humans prosper when we feel meaningful connections to things. To have those connections in one’s life fosters well-being. But beyond that, the practices that create and foster those connections are themselves opportunities to cultivate the behaviors that we know contribute to mental and physical health.
An implicit assumption about the good life glimmers beneath this paradigm, just as it does beneath individualism. In this case though, the good life is not about consumption, but rather about connection and engagement. Focal practices require work and commitment; however, they offer as their reward spaces and occasions to nurture our health, talents and relationships in the context of an engaged and healthy life.
Lisa Meekison Reichenbach is an anthropologist, writer and consultant. She has a doctorate in anthropology from Oxford University and has worked extensively in healthcare, studying the ways in which culture and behavior shape health and illness. She is currently writing a book on the cultural determinants of well-being. You can read her blog at http://lisareichenbach.wordpress.com
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