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Well-being from the Perspective of Health: Liberation from Physical Constraints

May 15, 2024

Michimasa Haga

Faculty of Social Welfare, Shizuoka University of Welfare

Introdaction

Well-being is an important concept for people working in various fields and with different values to consider their own happiness and that of the people they are connected to. In the previous column, we attempted to organize and introduce the concept of well-being from the perspective of the fields of health, psychology, and society. Over the next three columns, we would like to take a deeper dive into well-being from the perspectives of each of these fields - health, psychology, and society - to reconsider the concept.

Redefining Health

Let's dive right into the focus of this installment and think about well-being in the context of health. When do we typically use the word “health”? It may vary from person to person, but for many, it often refers to the absence of illness or disability. In Japan, there is a traditional concept known as “mubyōsokusai,” which emphasizes living a healthy life without illness. Throughout history, it has been generally considered essential to live a healthy life without falling ill.

In the early 20th century, advances in medical technology led to a global decline in infectious diseases such as cholera and tuberculosis worldwide. As a result, people who survived the high mortality risk infancy period began to increase, and living to old age became more achievable (Willmoth, 2010). In addition, improved social welfare systems have enabled individuals to live independently even if they have illnesses or disabilities. Therefore, it is likely that people living in the 21st century are believed to have a greater number of individuals who, from a young age, strive to live healthy lives even while dealing with illness or disability than those who lived a century ago. If that is the case, as mentioned in the previous column, our understanding of health will need to shift from the absence of disease to other perspectives.

Well-being and Health

Upon revisiting it, according to the definition by the World Health Organization (1948), health is not just the absence of disease or weakness, but being in a state where all aspects—physical, mental, and social—are fulfilled(Note 1). From this, it can be inferred that well-being encompasses the dimensions of physical, mental, and social aspects in the conditions of health. Even if there are illnesses or disabilities on the physical side, if a person accepts their physical condition and is mentally and socially fulfilled, they can still be considered healthy. Therefore, if we base the conditions of health on well-being rather than on the absence of disease, it becomes essential to deeply understand how people with various illnesses and disabilities define their well-being and to shed light on their perspectives on well-being.

Well-being of People with Illnesses and Disabilities

What might be the perspective of well-being be for individuals with illness or disability? Hidaka, Mizuki, and Satou (2012) conducted participatory observations of caregiving styles and communication with caregivers for individuals with amyotrophic lateral sclerosis (ALS) receiving home-based care. ALS is a progressive and intractable disease that causes muscle atrophy and loss of motor function due to the degeneration of the nervous system (Hidaka et al., 2012). Although the people with ALS required full-time care 24 hours a day, they were engaged in various social activities beyond just communicating with close people, such as sharing their experiences with the disease and giving lectures at a specialized school (Hidaka et al., 2012). Since each of these social activities could not be achieved without the individual's own choice, they can be considered expressions of the individual's perspective on well-being. It's worth noting that these social activities became possible not only by the use of Assistive Technology for people with disabilities, but also by the presence of peer supporters with ALS and helpers who received training in caring for ALS patients (Hidaka et al., 2012). Furthermore, ALS is a progressive disease and situations such as” the device that worked yesterday doesn't work today” occur frequently (Hidaka et al., 2012). Therefore, the peer supporters and helpers customized solutions to the problems that arose in using the devices to fit the specific circumstances (Hidaka et al., 2012). It can be inferred that it was the thorough understanding of the individual's perspective on well-being, which includes “living with illness with a sense of ease,” by peer supporters and helpers that contributed to the individual's independence and engagement in social activities.

Lessons from Literature

We can also learn deeply about the well-being of epople with post-stroke sequelae, particularly those who experience Locked-In Syndrome, through literature and its cinematic adaptation in “Le Scaphandre et le Papillon” (Bauby, 1997). In the film, the protagonist, who has lost all physical freedom except for blinking his left eye, gradually finds mental liberation with the support of family, friends, and experts. Eventually, he accomplishes the cultural endeavor of writing a book about his experiences. The process of his recovery, from a state of physical confinement to achieving this cultural feat, is depicted meticulously.

Scenes where the protagonist realizes, “I have a free imagination and memory,” and “I shed the heavy diving suit and take flight like a butterfly” (Bauby, 1997) are manifestations of the “flow experience” (Csikszentmihalyi, 1990) and can be considered moments of reaching well-being.

Liberation from Physical Constraints

As illustrated above, even in the presence of physical limitations due to illness or disability, social participation through the support of caregivers and engagement in social and cultural activities, no matter how modest, can create connections between the physical, mental, and social aspects. It can serve as a catalyst to free the individual from the constraints of their physical condition. Even if there is a temporary decline in physical well-being or health, the collaboration with caregivers and the ability to engage in social and cultural activities can lead to an increase in mental and social well-being. This, in turn, may contribute to an overall enhancement of health.

Note 1: It should be noted that in the field of health, the process of reaching health after experiencing illnesses or disabilities has been explained through the concept of health salutogenesis (Antonovsky, 1979). However, in this article, we have chosen not to delve into this topic, given the scope of our theme.

Next column Preview

In this episode, we've explored well-being with a focus on health. However, we have yet to delve sufficiently into well-being in the realms of psychology and society. Therefore, our discussion will continue in the next episode, where we will delve into the well-being in the field of psychology.

References

Antonovsky, A. (1979). Stress, health and coping: New perspectives on mental and physical well-being. San Francisco: Jossey-Bass.

Bauby, J.D. (1997). Le Scaphandre et le Papillon. Paris: Fixot.

Csikszentmihalyi, M. (2010). Flow: The Psychology of Optimal Experience. New York: Harper & Row.

日高友郎・水月昭道(2011). 第3章難病患者の遠隔地間対面コミュニケーションと技術ピアサポート. 鈴木七美編「障害のない社会」にむけて―ウェルビーイングへの問いとノーマライゼーションの実践― 国立民族学博物館調査報告, 102, 59-67.

日高友郎・水月昭道・サトウ(2012). 神経難病患者の生を捉えるライフ・エスノグラフィ ― 在宅療養の場の厚い記述から. 質的心理学研究, 11, 96-114.

ウィルモス, J.R. (2010). 人類の寿命身長：過去・現在・未来人口問題研究, 66, 32-39.

World Health Organization (1948). World Health Organization HP Constitution. Retrieved June 6, 2023, from https://www.who.int/about/governance/constitution#:~:text=Health%20is%20a%20state%20of,absence%20of%20disease%20or%20infirmity.

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