A philosophical take on prevention.
This week’s Prevention Not Prescriptions guest blogger is psychiatrist, professor and author, Bradley Lewis, MD, PhD.
The most compelling thing I learned about healthcare last year is that above all else it’s COMPLICATED! The year long debate showed that anything you can say about healthcare has another side, a mitigating issue, an unconsidered side effect. Remarkably, this is true even with the idea of preventative health. Increasingly, prevention is moving from the margins of healthcare to take a center stage. It was certainly one of the things that Obama called for in his campaign, and this is not surprising since preventative healthcare is often very popular with consumers. We see it as a corrective to the worst aspects of biomedicine. Rather than waiting till we are sick, when medical or surgical intervention can be difficult, painful, and costly, why not tend to people before they get sick? By heading off sickness before it starts we can side step the pain, expense, and limited effectiveness of corrective interventions. That sounds good, but I’m afraid even here healthcare is complicated and the picture is not so simple.
The major complication surrounding the notion of “prevention” is that the idea leaves itself open to multiple interpretations. This allows “preventative medicine” to be defined in a way that looks a lot like the “interventionist medicine” that it is meant to correct. Over the last 30 years, the pharmaceutical industry has catapulted itself into the corporate colossus we know today not primarily by discovering cures but by extending its reach to more and more chronic conditions for which people can take one, two, three, and more medications for years, and years, and years. This process of selling people on more and more diseases with more and more medication interventions does not stop with “treatment,” it easily morphs into treating the not-sick in the hopes of preventing disease. Thus, even if we are not sick, our doctors are constantly telling us to “know ourselves.” What is our blood pressure, our glucose, our cholesterol, our genetic risk factors, our anxiety, our mood level, our menstrual cycle, our hours of sleep? If we check all of these things, there is a good chance we will find something not “normal,” and guess what, there is a medication (or two or three) for each of these. If we follow out this definition of preventative health then each of us will be taking more and more medications for a longer and longer period of time.
Like everything else in medicine, all of these preventative medical measures are also complicated and I don’t have the space to work through the many pros and cons for each. What I do want to suggest is a very simple alternative logic of prevention. Instead of only using a logic of prevention based on “know ourself” let’s add a logic of “caring for the self.” Here I draw on the work of historian and philosopher Michel Foucault and in particular his study of classical Greek and Roman cultures. Reading a number of texts from these classical eras, Foucault investigates how people in these cultures came to understand and approach themselves. He found that Greco-Roman cultures exhibit a relation to the self which instead of being predominantly based on a principle of knowing oneself is based around the maxim: “Take care of yourself.”
For Foucault, these classical modes of self are chiefly about cultivating and tending to oneself as a practice and a process. They are in sharp contrast to the idea of know yourself that has been overemphasized in modern societies. From this perspective we spend too much time trying to know our IQ’s, our grade point averages, our career status, and our multiple risk factors and diagnoses, and we spend too little time following the maxim take care of yourself. As a result, the practice and process of caring for the self has been relatively forgotten. To re-member these practices of caring for the self, we must develop what the Buddhist call “mindfulness.” We must learn to live in the present, to pay attention to our feelings, to process our painful emotions, and to find ways to get our needs met—whether those needs are bodily needs like nutrition, shelter, and exercise, personal needs like meaning and purpose, relational needs like companionship and community, social needs like ethical work and fair employment, expressive needs like exposure to the beauty and the opportunity to be creative, environmental needs like walks in nature and sustainable living, generative needs like giving time and energy to a neighbor, or spiritual needs like attunement to a higher consciousness or to a religious community.
When we tend to ourselves in these ways we tend to our health because our body is not simply a machine. Our bodies are dynamic living organism with multiple healing capacities for responding to pathogens, toxins, stress, and disequilibrium. When we care for ourselves, we shore up our bodies multiple healing capacities. And, when we do this, we are far from being selfish because tuning into our own needs rapidly reveals our connections to the needs of others and to the world. For me, it is this is approach to “preventative healthcare,” one that brings us back to the cares of the self, that truly deserves our support. And it is this version that we must reinforce so that it doesn’t become lost the cacophony of other voices on “prevention.”
Read this week’s full Prevention Not Prescriptions line-up.
Kathleen’s interview with Bradley Lewis – Beyond Prozac: Look mom, no side effects.
Bradley Lewis’ book: Moving Beyond Prozac
Listen to past shows available on podcast
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