Illness as a threshold event or as part of a continuum by Dr David Owen
‘I’ve suddenly become ill’ and ‘I’ve never been well since’ are not unfamiliar phrases in my work and are matched, almost in equal numbers by patients that say something like, ‘I can’t remember when I was last well’ or ‘I feel one thing or another has been wrong with me since childhood’. These two, at first apparently opposite views of how disease emerges (pathogenesis) represent what I call the ‘threshold’ view of illness on the one hand and the ‘continuum’ view on the other. Both are helpful in understanding what an illness might be expressing for an individual (or a society if thinking about a populations susceptibility and the evolution of the illnesses in that population). I’ve written elsewhere about thinking of illness like a boat or barrel in water that sinks. The sinking is a threshold event but when exactly it happens depends on how leaky it is, what outside forces (physical and psychological) “fill it up” and the ability to ‘bail it out’. These factors can be thought of as susceptibility (what we are exposed to and sensitive to that contribute to us getting ill), our constitution (our capacity to tolerate potentially harmful or causative factors) and our resistance or ability to overcome or rebalance after such exposure (expressed in a number of ways including immunity, vitality, chi).
The continuum view sees that our susceptibility, constitution and resistance are dynamically related and evolve over our lifetime. They are both influenced by hereditary (the health of our parents and families) and environmental factors. Determining in part our childrens' susceptibility and constitution, plus how we shape the environmental legacy we leave for them. All this is shaped by our current and historic exposure to different challenges and illnesses and how we overcome them and the treatments we use or avoid for one illness all contribute to shaping our constitution. Unraveling this complex matrix of factors and helping individuals see which factors have influenced their health and how an individual might shift these is what I have spent my professional life doing.
Our lifestyle, mental attitudes and nutritional factors all influence these factors which are dynamic and not fixed. These we might usefully think of as our life’s journey up to the point where we become ill. If we use the journey analogy then illness might be thought of as a signpost. What might we glean from our journey to this point and what might we want to do differently? In this way a wellbeing intervention isn’t about retracing or recovering the tracks you came down to become ‘ill’ but rather an opportunity to move and journey in a new direction – a ‘discovery’.
It's how our life journey, the challenges and illnesses we meet along the way and the treatments we use to support us through these that I feel are central to my work and having a commitment to helping patients both when ill but also on an ongoing basis to reduce susceptibility, build resilience and strengthen their constitution. Holistic not just in terms of mind body and environment but also of understanding the here and now priorities of health in terms of the past experience and future wellbeing of the patient and others. Too often it appears that the short term needs of a person can lead to choices of treatments that fail to reduce susceptibility, improve the constitution or build the resistance of the patient.
If you appreciate the relevance of this for your individual health you may also like to ponder how it applies to our society. Whilst focusing on the particular susceptibility to one trigger event (whether a virus or environmental toxin) is of course important. The more harmful the trigger the bigger the consequences for and the more important it is to be addressed and treated. But we also need to attend to the trends we see in relation to our population's constitutional health (reflected by diet, lifestyle and mental health) and our shared resistance and ability to rebalance our personal and collective priorities, choices and actions (what we might call our shared vitality). Looking back historically it is clear that the threat and prevalence of different illnesses has fundamentally shifted how we live our lives. Based on my observations of my patients when ill and on their wellbeing journey in relationships, families, work and social groups my invitation to you is that in parallel with the steps you need to take to protect and treat yourself you also need to consider how we collectively reduce the harmful triggers around us. The factors we are most sensitive to in our environment are a good place to start as they often reflect the need for deeper systemic and social change. Strengthen our collective constitution, the very illnesses we suffer hold the insights that can best inform us of the priorities we need to collectively address. And finally, build our collective vitality, looking at what builds our our own vitality and doing what we can to enable others to build theirs and address the things that personally and collectively block this.