EFFECTIVE TWO-BY-FOUR
Most of you know of the story of the man who bought a mule which was guaranteed to be a wonderful worker and the seller gave an impressive demonstration of its abilities.
The buyer took the mule home but try as he did, nothing would get the mule to work at all. He returned to the seller demanding his money back claiming that he had been sold a dud. The seller grinned at him, reachd under his table and picked up a substantial two-by four, hit the mule over the head with it and it reacted like a high powered machine. He was amazed, but the seller was nonchalant about it, and said: you have to get its attention first.
Well no matter how apocryphal that story is, it illustrates precisely what my long life has demonstrated: Individuals rarely ever change their basic beliefs and practices unless a very powerful shock 'gets his/her attention.' Nowadays the most destuctive factor in causing harm to the body, other than lack of food and the necessities of life ,is far and away smoking. According to every annual U.S. Surgeon's Report it causes unbelievable amounts of disease and suffering that collectively add up to one of the major causes of death and fresh evidence of new such diseases appears every year. On a personal note: my father died after a life as a heavy smoker, my brother is very seriously ill with Chronic Obstructive Pulmonary Disease, my friend of over 70 years and his brother and their father all died from the same consequences of life-time smoking. And on and on. Yet although it has been known since 1951 of the connection between tobacco and chronic and terminal disease, none of them chose to stop smoking. As a student I worked as a nurse in the Liverpool Chest Hospital during the 40s and although the statistics were not known then the relation between smoking and chest disorders was as clear as a bell but any attempt to persuade anyone to stop was like using a pea shooter to stop a tank.
Although more people are realising the devastating effects of tobacco smoking few have yet to understand that we are all going to die of a chronic disease, with the exceptions of death through violence - accident, homicide and suicide. The statistics in modern western countries vary only a little and the range is roughly the following:
85% of all deaths are through a chronic disorder of some kind. Heart disease.
stroke, cancer, diabetes and its complications... And
15% from all kinds of violence, accidents, suicide or homicide.
These figures do not take into consideration the increasing numbers who die
because of the effects of treatment and mismanagement or political incompetence.
Yet no matter what people are told about the indisputable facts they persist in their illness-creating lives until either they die or they suffer for years. Some of the most imbecilic behaviour I have ever seen was by a man who had had by-pass heart surgery return to heavy smoking within a few weeks post-op. Not only is this a form of suicide, it is grossly irresponsible in this day age and there is even
much support for a policy of refusing further treatment to anyone who acts so irresponsibly.
Timely access to investigation and treatment is often difficult enough without such totally suicidal irrationality. Which of course brings me back to the near impossibility of people changing long time behaviour even though they may be fully aware of the role of some of the factors - eg, smoking.
Thirty years ago, after ten years running a centre for the treatment of severely disturbed children,my wife and I decided to attempt to raise awareness as widely as possible just how their health or illness is a direct outcome of the way in which they live their everyday lives. But everyone knows just how difficult it is to get people's attention without an effective two-by-four, and at the same time how vital their state of health/illness is in dealing effectively with the problems of living
- 'as long as I have my health and strength.' We long ago realised that by far the most effective two-by four is chronic illness and we knew from experience and from statistics that it is by far the greatest problem in the health of any community, no matter the size or the nature of the health care system
Before going any further it is necessary for clarity of understanding what follows - in fact of any discussion anywhere on the subjects of health, illness and disease.
What I have to say later will be clearer if you understand how I use these words and though you may not agree with me, at least you will know why and how. So many words are used that have no precise meaning that it's not surprising that there is general confusion and often conflict over what words mean. Health, illness and disease are three such words that pervade all our thinking about our physical and mental responses to events in our lives but behind their usage is a way of thinking about our bodies and the way they function. For example the word 'health' is based on the idea that there is such a thing or state of affairs that we can either have or not have, a kind of condition which we all want to attain, whereas in fact there is no such a condition. It seems to mean the absence of disease or illness, but there are problems with this. For example, almost invariably the question whether someone is ill arises when that someone - mostly, of course the individual concerned - complains of some symptom that is bothering them, perhaps a cough. When a physician enquires about when it started and how it has developed it is clear that has been a problem for perhaps a month but that it only became annoying or painful enough to ask for help several days ago. Further investigation makes it very clear that it has in fact been around far longer, but that the patient was simply not aware of it - it has not reached the level of conscious awareness. So at what point is the person ill? And was (s)he healthy right up to the time it was felt necessary to complain?
I could go on with similar questions, but they would all add up to a total lack of precision as what the term 'health' means.
Then there is the question of illness versus disease. Most people, including plenty of physicians, use these two terms interchangeably as though they are synonomous but this doesn't make much sense either. It is more appropriate to use 'disease' to indicate actual changes in the functioning of the body and 'illness' to describe the experience of being ill since the two things are different and therefore need some way of communicating that difference.
Again, to avoid confusion, or lack of clarity, I feel it makes much more sense to talk of changes in function than 'health' or 'illness'. What is happening to the body in any of the organs is a change of function from a 'normal' range, which is known and measurable by various means, to 'dysfunction' which includes all ranges of the changes that can occur from mild to extreme and life threatening. It therefore includes changes of function which we can have without being conscious of them since this happens to everyone. So you can feel 'healthy' whilst in fact your body is far from it: you can therefore be 'dysfunctional'in some way but you may have difficuly persuading yourself you are ill. Then there is the time when you feel ill but it may be very difficult to persuade others that you are and you could be accused of malingering because you appear to them to be 'normal.' The most important question anyone can ask of another, whether they are complaining or not, is 'have you felt any changes in you habits?' This means such things as headaches, changes in bowel functioning etc. and such changes simply have to be taken seriously even if there are no other obvious signs that there's anything wrong. In fact I know a number of people,including close relatives, whose complaints of changes have been ignored by physicians and who have later died of cancer of the bowel, which could have been avoided by proper investigation. It was driven into our brains in medical school that when a person over 50 experiences changes in bowel functions for more than two weeks without a specific reason there must by a full investigation immediately. It is the changes that are so important.
There is one most important point I must make here. There is an appalling lack of knowledge by most of the population about just how the body is made and how it works. In our centre I used to give everyone an outline of a body, and then separate cutouts of organs such as the liver, the stomach, the bladder, lungs etc (they usually know where their genitals are so those cutouts wer omitted!) They were asked to place the organs where in the body outline they should be. The results were always astounding, with organs floating around in all kinds of bizarre arrangements. Few of them knew their pulse rate, their blood pressure or their rates of breathing and the changes that happen under various conditions. With such lack of understanding of their own bodies it is not surprising they found it difficult to know when things go wrong unless it is dramatic. Along with this there is an almost universal tendency to ignore symptoms, to shrug them off and hope they will go away, the effects of which is often disastrous. I realise that there is a possibility that some will see this as an invitation to complain about the least kind of change and make everyone upset, rather like the boy who cried 'wolf' once too often. But the point I make is a vital one: we should be taught far more in school about our bodies and how they function, as well as from parents. There are more programmes available these days with a great deal of information, which is a good thing. One huge problem is that often the things we see most often are advertisements which are very unreliable and are there to promote some kind of fast food.
So for me what is happening is a change in function, whether the person has experienced changes or not, and illness is the description of the experience of such dysfunction. And as we shall see in the next blog - to follow shortly - we are all susceptible to the development of chronic dyfunction/disease (I use both so that you will get used to my use of the word 'dysfunction.')
The buyer took the mule home but try as he did, nothing would get the mule to work at all. He returned to the seller demanding his money back claiming that he had been sold a dud. The seller grinned at him, reachd under his table and picked up a substantial two-by four, hit the mule over the head with it and it reacted like a high powered machine. He was amazed, but the seller was nonchalant about it, and said: you have to get its attention first.
Well no matter how apocryphal that story is, it illustrates precisely what my long life has demonstrated: Individuals rarely ever change their basic beliefs and practices unless a very powerful shock 'gets his/her attention.' Nowadays the most destuctive factor in causing harm to the body, other than lack of food and the necessities of life ,is far and away smoking. According to every annual U.S. Surgeon's Report it causes unbelievable amounts of disease and suffering that collectively add up to one of the major causes of death and fresh evidence of new such diseases appears every year. On a personal note: my father died after a life as a heavy smoker, my brother is very seriously ill with Chronic Obstructive Pulmonary Disease, my friend of over 70 years and his brother and their father all died from the same consequences of life-time smoking. And on and on. Yet although it has been known since 1951 of the connection between tobacco and chronic and terminal disease, none of them chose to stop smoking. As a student I worked as a nurse in the Liverpool Chest Hospital during the 40s and although the statistics were not known then the relation between smoking and chest disorders was as clear as a bell but any attempt to persuade anyone to stop was like using a pea shooter to stop a tank.
Although more people are realising the devastating effects of tobacco smoking few have yet to understand that we are all going to die of a chronic disease, with the exceptions of death through violence - accident, homicide and suicide. The statistics in modern western countries vary only a little and the range is roughly the following:
85% of all deaths are through a chronic disorder of some kind. Heart disease.
stroke, cancer, diabetes and its complications... And
15% from all kinds of violence, accidents, suicide or homicide.
These figures do not take into consideration the increasing numbers who die
because of the effects of treatment and mismanagement or political incompetence.
Yet no matter what people are told about the indisputable facts they persist in their illness-creating lives until either they die or they suffer for years. Some of the most imbecilic behaviour I have ever seen was by a man who had had by-pass heart surgery return to heavy smoking within a few weeks post-op. Not only is this a form of suicide, it is grossly irresponsible in this day age and there is even
much support for a policy of refusing further treatment to anyone who acts so irresponsibly.
Timely access to investigation and treatment is often difficult enough without such totally suicidal irrationality. Which of course brings me back to the near impossibility of people changing long time behaviour even though they may be fully aware of the role of some of the factors - eg, smoking.
Thirty years ago, after ten years running a centre for the treatment of severely disturbed children,my wife and I decided to attempt to raise awareness as widely as possible just how their health or illness is a direct outcome of the way in which they live their everyday lives. But everyone knows just how difficult it is to get people's attention without an effective two-by-four, and at the same time how vital their state of health/illness is in dealing effectively with the problems of living
- 'as long as I have my health and strength.' We long ago realised that by far the most effective two-by four is chronic illness and we knew from experience and from statistics that it is by far the greatest problem in the health of any community, no matter the size or the nature of the health care system
Before going any further it is necessary for clarity of understanding what follows - in fact of any discussion anywhere on the subjects of health, illness and disease.
What I have to say later will be clearer if you understand how I use these words and though you may not agree with me, at least you will know why and how. So many words are used that have no precise meaning that it's not surprising that there is general confusion and often conflict over what words mean. Health, illness and disease are three such words that pervade all our thinking about our physical and mental responses to events in our lives but behind their usage is a way of thinking about our bodies and the way they function. For example the word 'health' is based on the idea that there is such a thing or state of affairs that we can either have or not have, a kind of condition which we all want to attain, whereas in fact there is no such a condition. It seems to mean the absence of disease or illness, but there are problems with this. For example, almost invariably the question whether someone is ill arises when that someone - mostly, of course the individual concerned - complains of some symptom that is bothering them, perhaps a cough. When a physician enquires about when it started and how it has developed it is clear that has been a problem for perhaps a month but that it only became annoying or painful enough to ask for help several days ago. Further investigation makes it very clear that it has in fact been around far longer, but that the patient was simply not aware of it - it has not reached the level of conscious awareness. So at what point is the person ill? And was (s)he healthy right up to the time it was felt necessary to complain?
I could go on with similar questions, but they would all add up to a total lack of precision as what the term 'health' means.
Then there is the question of illness versus disease. Most people, including plenty of physicians, use these two terms interchangeably as though they are synonomous but this doesn't make much sense either. It is more appropriate to use 'disease' to indicate actual changes in the functioning of the body and 'illness' to describe the experience of being ill since the two things are different and therefore need some way of communicating that difference.
Again, to avoid confusion, or lack of clarity, I feel it makes much more sense to talk of changes in function than 'health' or 'illness'. What is happening to the body in any of the organs is a change of function from a 'normal' range, which is known and measurable by various means, to 'dysfunction' which includes all ranges of the changes that can occur from mild to extreme and life threatening. It therefore includes changes of function which we can have without being conscious of them since this happens to everyone. So you can feel 'healthy' whilst in fact your body is far from it: you can therefore be 'dysfunctional'in some way but you may have difficuly persuading yourself you are ill. Then there is the time when you feel ill but it may be very difficult to persuade others that you are and you could be accused of malingering because you appear to them to be 'normal.' The most important question anyone can ask of another, whether they are complaining or not, is 'have you felt any changes in you habits?' This means such things as headaches, changes in bowel functioning etc. and such changes simply have to be taken seriously even if there are no other obvious signs that there's anything wrong. In fact I know a number of people,including close relatives, whose complaints of changes have been ignored by physicians and who have later died of cancer of the bowel, which could have been avoided by proper investigation. It was driven into our brains in medical school that when a person over 50 experiences changes in bowel functions for more than two weeks without a specific reason there must by a full investigation immediately. It is the changes that are so important.
There is one most important point I must make here. There is an appalling lack of knowledge by most of the population about just how the body is made and how it works. In our centre I used to give everyone an outline of a body, and then separate cutouts of organs such as the liver, the stomach, the bladder, lungs etc (they usually know where their genitals are so those cutouts wer omitted!) They were asked to place the organs where in the body outline they should be. The results were always astounding, with organs floating around in all kinds of bizarre arrangements. Few of them knew their pulse rate, their blood pressure or their rates of breathing and the changes that happen under various conditions. With such lack of understanding of their own bodies it is not surprising they found it difficult to know when things go wrong unless it is dramatic. Along with this there is an almost universal tendency to ignore symptoms, to shrug them off and hope they will go away, the effects of which is often disastrous. I realise that there is a possibility that some will see this as an invitation to complain about the least kind of change and make everyone upset, rather like the boy who cried 'wolf' once too often. But the point I make is a vital one: we should be taught far more in school about our bodies and how they function, as well as from parents. There are more programmes available these days with a great deal of information, which is a good thing. One huge problem is that often the things we see most often are advertisements which are very unreliable and are there to promote some kind of fast food.
So for me what is happening is a change in function, whether the person has experienced changes or not, and illness is the description of the experience of such dysfunction. And as we shall see in the next blog - to follow shortly - we are all susceptible to the development of chronic dyfunction/disease (I use both so that you will get used to my use of the word 'dysfunction.')
posted by Charles | 8:23 PM
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