Nourish to Flourish: Reimagining Wellness in the 21st Century
By Dr. Julie Ponesse
“Medical Science has made such tremendous progress that there is hardly a healthy human left.”
The concept of flourishing is conspicuously absent across the terrain of modern medicine. Contemporary healthcare more closely resembles sick care, impressively equipped to treat disease, but blind to the broader scope of what it means to be well. Regardless of how you parse the data, it is painfully clear that our current system needs to evolve. Rates of obesity and chronic disease are at an all-time high. More Canadians than ever suffer from chronic pain. And tragically, the opioid epidemic – which now takes more lives annually than car accidents – has stunted the growth of our collective life expectancy.
Our approach to healthcare, which focusses on prolonging life with disease, misses the point of what it means to live well, to flourish. But what needs to change? To explore how this system might heal, let's begin by borrowing a framework from one of the godfathers of medicine, Aristotle.
The Quest for Eudaimonia
Aristotle believed that all human action aims toward one thing: eudaimonia. Often translated as "happiness," eudaimonia is better understood as “well-being” or "flourishing." A flourishing individual isn’t just free from illness, but leads a full life marked by vitality and a deep sense of purpose. Aristotle grounds this notion in four fundamental aspects of human nature:
- Physical: It is no secret that as biological creatures, we are bound by our bodies to attain a balance of basic inputs to survive. Only with sufficient food, water, light, exercise, and sleep can our physiology thrive.
- Emotional: What distinguishes animals from plants, according to Aristotle, is that animals have complex needs, urges, and desires. The vast human emotional landscape not only colours the subjective character of experience, but also forms the foundation for moral reasoning.
- Social: “Man is a political creature,” Aristotle wrote. Humans cannot flourish alone and are inextricably linked to one another by way of the community, city, or polis.
- Rational: The Ancient Greeks believed that humanity is largely defined by its capacity for reason. This ability sets us apart as creative, expressive, truth-seeking beings.
In the 20th century, medicine operated under the biomedical model, which views patients much in the same way as a mechanic views cars – as sets of components that, if broken, must be fixed. We owe a sincere debt of gratitude to this model; its narrow focus on biology enabled us to cure many terrible diseases and to eradicate others.
But the biomedical model’s major flaw is its ignorance of the emotional, social, and rational elements of human nature which are so fundamental to our well-being.
Recently, a new paradigm called the biopsychosocial model has grown into favour. While this model doesn’t ignore the importance of biology, it acknowledges psychological factors such as autonomy and meaning, and emphasizes the social, economic, and other systems which impact our health.
A concrete example might clarify the difference between these paradigms. A biomedical practitioner reflexively prescribes a drug to correct an anxious person’s “faulty” brain chemistry, adjusting the dial on what they see as a defective biological switch. A biopsychosocial practitioner asks why that person feels anxious in the first place, evaluating their life on several dimensions. How is their sleep, nutrition, and exercise? Are they socially isolated? Do they have meaning and autonomy in their work? The first practitioner treats the downstream consequences of a life off-kilter. The second seeks to intervene upstream.
The biopsychosocial model, which aligns with Aristotle’s aspects of human nature, is a step toward a more holistic approach to healthcare, one which paves the way for individuals and communities to flourish.
Flourishing as a Holistic Concept
The physical, emotional, social, and rational aspects of our nature are interconnected in a myriad of subtle ways. Physical exercise, for example, powerfully impacts the emotional and rational aspects of our being. In the short term, it enhances mood by releasing feel-good brain chemicals. In the long term, it preserves our rational faculties by bolstering the very structure of the brain through a process called neurogenesis (the growth of new neurons).
Similarly, the richness of our social connections influences our physical health. According to recent research, for example, the long-term health risks of loneliness are equivalent to smoking 15 cigarettes per day. Feeling isolated, science suggests, is a clear risk factor for many of the leading causes of death in today’s world, such as heart disease and stroke.
The interconnectedness of the four aspects of human nature underscores the deep truth that to truly flourish, we must take a holistic approach to wellness.
Contemporary Conceptions of Flourishing
Stripped of the constraints of the biomedical model, a holistic approach to flourishing can seem paralyzingly vague. With the scope of wellness suddenly so expansive, where should we actually intervene?
A way forward emerges from “Maslow’s Hierarchy of Needs,” a theory of human motivation published 2500 years after Aristotle’s time. Maslow’s hierarchy is often presented as a pyramid at the base of which are "physiological” needs such as food and shelter. Once these are met, we can focus on “safety” needs, such as employment and property. At the top of the hierarchy are higher-order needs such as intimacy and meaning.
The tiered nature of Maslow’s model implies that broadly speaking, human needs are best addressed in a specific sequence. Physical nourishment and safety lay the groundwork for emotional flourishing, which itself serves as the foundation for more complex aims such as purpose and fulfillment. Maslow qualified his theory with the caveat that each tier exists on a sliding scale, and many needs can be addressed simultaneously. We can work on knowing ourselves, for example, while at the same time nurturing relationships with others. Overall, his model provides a useful roadmap for integrating the four pillars of human nature in a stepwise fashion.
In Jonah Hill’s hit Netflix Documentary Stutz, psychiatrist Phil Stutz presents a simplified model which he uses as a tool with his clients in therapy. He calls it the “Life Force.” The bottom layer of Stutz’ pyramid is our relationship with our physical body. Improving exercise, diet, and sleep habits, he states, accounts for a large proportion of his clients’ success. The second layer is our relationship with other people, which he views as critical to our mental health. The pinnacle of the pyramid is our connection to ourselves, which he suggests is best nurtured through contemplative practices such as journaling.
Flourishing as a Focus of Contemporary Research
George C. Whipple, co-founder of the Harvard School of Public Health, acknowledged the importance of flourishing in 1916 when he stated that “health is more than the absence of disease. It is something positive, and involves physique and vitality, and it is mental as well as physical."
Fast forward a century, and Harvard University has doubled down on Whipple’s belief by founding a “Human Flourishing Program” to promote the concept through research, education, and the development of practical interventions.
It is heartening that the notion of flourishing is entering mainstream scientific and public health discourse, with researchers rigorously investigating positive constructs such as vitality and purpose through a biopsychosocial lens. But there is much work yet to be done if we are to see this important idea frame health care at the levels of policy and clinical medicine.
Finally, as Hippocrates reasoned centuries ago, "If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health." These words are more prudent today than ever. It is time to embrace the spirit of this ancient wisdom and reimagine healthcare as a journey towards "the good life” rather than a race to escape disease.
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