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To Your Health

by Inanna Arthen, M.Div

[A sermon given at Ashby First Parish Church, Unitarian-Universalist, on February 26, 2006. Our culture badly needs the philosophy of health Arthen expresses. Probably most canaries already understand this, but that doesn't make it any easier to practice it, in the face of the cultural addiction to fear. When we do stand up for ourselves, though, we benefit everyone. — Catherine]

February 26th is said to be Hygeia Day, honoring the ancient goddess of healing and disease prevention, Hygeia. Her symbol is the serpents of Hermes twining around a staff and bowl, a symbol that to this day is used to represent the science of pharmacy. Z. Budapest calls Hygeia "the preventer, the patroness of foresight to avoid illness." Hygeia is sometimes depicted with a Python coiled around her waist. Snakes were often associated with healing because they renewed themselves each time they shed their skins.

Indirect impressions of the medical system
I have been reflecting a great deal on issues around health, sickness, prevention and medical treatments this year, for a number of reasons. My own health has always been very good, so my personal interactions with conventional medical science--what I sometimes think of as the medical-industrial complex--has been limited. For the most part, I've experienced it indirectly, as I've watched and supported the treatment of people around me.

My mother has been battling cancer for some thirty years, and she is starting radiation treatment now, so my entire family is intensely concerned with her symptoms and how she responds to her treatment. We are currently in a stage of waiting to see what the results will be and taking each day at a time.

At the same time, it seems that never have our clients at the shelter where I work been so physically sick, had so many medical appointments, and been on so many prescription medications for physical, as opposed to psychiatric, complaints, as we have seen this past year. The staff at the shelter has been spending huge amounts of time transporting our clients to doctor's and dentist's appointments, with some clients having several such appointments per week. One older client last fall repeatedly stated that thanks to Massachusetts' Mass Health program, she was finally taking care of health issues that she'd let go all her life up to now.

And yet, the average age and typical demographic of our shelter clients has not changed. They still have an average age of about 32 years, we still get women in their 40's and 50's, mothers in their 30's with several children, and pregnant 19-year-olds. I am not sure whether our clients are really sicker, or whether they're simply getting more medical care than they used to--more physical therapy, more tests and procedures, more follow-up appointments, more varied and numerous prescriptions. All of it paid for, with the rare exception, by you and me and our tax dollars, of course--not that I can think of many better ways for my tax dollars to be spent.

We are hearing a great deal these days about all the people who can't afford medical insurance in our country. At the same time, we're being told that medical costs are rising to astronomical levels because there are now so many sophisticated treatments for so many ailments, diseases, syndromes and conditions. If there's no obvious diagnosis, patients can be sent for test after test after test, and often this is not so much to find things out as to rule things out. If one treatment isn't effective or if it disagrees with the patient, there's another one to try, and another, and another. Not everyone agrees that the high cost of malpractice insurance has a lot to do with the high cost of health care. But someone who deals a lot with the health care system of the 21st century--anyone who works with clients in a shelter, for instance--has to wonder if the fear of malpractice lawsuits contributes to the cost of health care, because it makes doctors afraid not to check for and try everything, just in case.

A closer encounter
My own experience provides some examples of this. Like many people, I don't like doctors, hospitals and the health care system, especially in the era of managed care. I'm luckier than most people in being naturally healthy enough to avoid them. I've also always been fairly proactive in taking care of myself, exercising and eating sensibly, following moderate alternative health regimens, managing stress, using common sense, and not looking for short-cuts or easy answers. It's paid off. I work in a shelter, and I'm so rarely sick, I've taken three sick days in seven years.

But during my 30's, I gradually developed a symptom that caused me increasing concern as the years went by. Although I had never abused my hearing as far as I knew--I'd never gone to a loud concert or club, didn't listen to loud music, and lived quietly--I developed tinnitus. It started very slowly, as a sort of vague, low hum that I was only aware of on and off, late at night. After a couple of years, the hum never stopped, and it gradually grew louder. Then it was joined by an extremely high-pitched sound. Then these sounds were joined by yet another, somewhere in the middle. I wasn't aware of any problems hearing--in fact, my hearing was and is quite acute. But it was less acute than it had been before I started generating my own gray noise.

The humming didn't bother me enough to interfere with my concentration or sleep. What bothered me was worrying that it might mean something serious. Maybe I was losing my hearing and would go deaf. Maybe I had Meniere's Disease and would start having spells of vertigo and wouldn't be able to drive. Maybe I had Parkinson's disease, which my maternal grandmother may have died from.

The medical response
I'd joined the health plan at work, Fallon, when I went to permanent full time hours in 1999, but I'd never even picked a primary care physician. But by 2002 I was worried enough to go through the bureaucratic steps, be assigned a physician and go see her. The physician listened to my concerns about the tinnitus and sent me to an audiologist. The audiologist sent me to an otolaryngologist. The otolaryngologist sent me for an MRI. In the middle of a snow storm in March, I went to the HealthSouth medical center in Worcester, and at Fallon's expense--I didn't even have a co-pay--I got a complete MRI...for tinnitus. I'm not squeamish or claustrophobic, so I found it a rather fascinating experience that I will surely use in a book someday. My MRI turned up nothing unusual and my tinnitus still hums and hisses away, a mystery to medical science.

But that wasn't all. My PCP told me I had a heart murmur, something no health care professional had ever mentioned before in my 46 years in the American health care system, And the next thing you know, I've been sent for an EKG, which was fine, and two echocardiograms, which diagnosed a very minor and common and non-threatening anomaly in my heart, and now I'm taking an aspirin a day--just in case I might have a tendency to form blood clots and have a stroke. And that wasn't all, because of course I was getting all the routine and not-so-routine cancer screenings due to my mother's medical history. Not my history--I'm fine! And I don't even have a co-pay for all these tests. Fallon pays for them all. No wonder they complain that they keep having to increase their premiums.

The illness perspective
The doctors, technicians and other professionals at Fallon treated me very well. But what bothered me about my interactions with all of them was their almost paranoid emphasis on the most serious things that might be wrong.

I wanted to talk about my workout routines, my lifelong struggle with obesity, how flexible I've kept my joints. I wanted someone to notice how energetic, strong, limber, fit and healthy I am for someone who is about to celebrate her 50th birthday. But everyone at Fallon seemed completely oblivious to that. No one wanted to listen. All my PCP wanted to talk about was menopause and my cancer risk. Frankly, I was less worried about either of those than about my weight. But--obesity epidemic and family history of diabetes regardless--my weight didn't seem to be an issue for anyone at Fallon.

They were so busy making sure they checked for every possible thing that might be wrong with me, they didn't have any time to stop and look at what was right. And for someone who's worked as hard at maintaining good health as I have, that was disappointing. I didn't want to hear that I was sick and they could take care of me--I wanted some validation and reinforcement of my wellness. And that, it seems to me, is where our health care system often fails.

Deteriorating American health
Americans are obsessed with matters of health, and yet in statistical terms, the American population seems to be reaching a low point in health--never have so many fortified, vaccinated, affluent and medically supervised people been so unhealthy. True, our life expectancy has improved enormously in the past century. True, we no longer give a second thought to contagious diseases that used to be devastating. But it seems now that our greatest health enemy is ourselves.

We're in the midst of a so-called obesity epidemic that seems to have exploded out of nowhere in just the past ten years, extending over all age ranges. Doctors say that they've never seen so many obese children and adolescents, and patients over 300 pounds, once rare, are now common. San Francisco columnist Mark Morford wrote this week of vacationing in Baja California, Mexico and being shocked that so many of his fellow American tourists were so overweight. He guesstimated that 85% of the Americans he saw were critically, not just moderately, overweight--some of them couldn't get out of the swimming pool without assistance. With this obesity comes a multitude of directly related health problems, such as Type II diabetes, also termed "epidemic," heart disease, cancer, and many others.

Americans who aren't overweight have their problems, too. Devastating addictions, asthma among all ages, and life threatening food and environmental allergies seem far more common than in the past. In the 1950's, who could have imagined schools banning peanuts, or public meetings routinely asking attendees not to wear perfume and scented products?

Reminders of frailty
Why are Americans becoming so unhealthy so quickly? You can't blame the aging baby boomer generation. The younger generations are suffering just as much. You can't blame the lack of universal health care. There have always been poor people with no medical insurance, and the affluent and insured seem to be just as overweight and unhealthy as the poor. And you certainly can't blame Americans for being uninformed about health.

On the contrary, we're flooded with information on a daily basis. You can't open a newspaper or general magazine, watch a complete news program, or surf the web for long without being reminded of some health problem. The media report continuously on the health crises facing us, in regular short columns and long academic articles: every study, every new threat, every expert opinion. Each new treatment for cancer is meticulously tracked and reported. Each new potential threat--bird flu, mad cow disease--is meticulously followed. We're given a constant supply of health tips, suggestions, and advice. Health news, information and support groups make up a large percentage of Internet traffic. And there's an equal amount of information available no matter what type of health care we favor, from mechanistic to holistic, Western to Eastern. We practically need to go off-line, off-grid, and into a hermitage to avoid the constant reminders of our own physical frailty.

More than anything else, advertising for medical products is everywhere. Consumer advertising for prescription medication was legalized in 1988, but being deluged with ads for products such as Zoloft, Meridia, Levitra, and Prilosec wasn't all that new. Well before that, we could hardly turn on the TV or take a bus without being reminded that we couldn't let indigestion, colds, coughs, diarrhea, iron deficiency, headaches, minor aches and pains or the heartbreak of psoriasis slow us down. Pharmaceutical companies aren't the only ones hawking their wares: we now see ads for hospitals, health care plans, cosmetic surgery and specialized clinics as well.

Playing on fear
The underlying message in all these medical ads is that we all are in danger of getting sick at any moment. Writing about fear in the UUWorld, Neil Shister said, "According to one business school theory of persuasion, a convincing marketing message, 'scares the hell out of people; offers a specific recommendation for overcoming the fear-aroused threat; the recommended action is perceived as effective for reducing the threat; and the message recipient believes that he or she can perform the recommended action.'"

This marketing technique doesn't apply equally well to all products--airlines and car companies, for example, usually try to avoid evoking fear in their customers. But this method of peddling remedies, cures and nostrums was the standard approach of the snake-oil salesman, because it worked incredibly well.

Just think of the elaborate routine used by the con-man, Harold Hill, in the musical, "The Music Man." Harold Hill jumps off a train in a random town where he has never been in his life. He strikes up conversations until he hits on a recent local controversy--the mayor has bought a pool table. He then skillfully whips up public emotions with dire pictures of the worst effects on community morals and children's well-being that the pool table could possibly have--gambling, idling, shady activities, immoral music. Once he's got his listeners in a panic, he then presents his solution--a wholesome alternative activity, and so cheap at the price. I can't help wondering what kind of mileage Harold Hill would have gotten if Marion had installed a computer with Internet access in the library.

Manipulation in our own lives
It's funny, in the musical, but one reason that it's funny is that we watch it and recognize its truthfulness. We laugh at the way Harold Hill manipulates the townspeople, but we're slower to identify the same manipulation in our own lives.

The snake oil salesman's pitch is still the universal method of marketing medicine--alternative medicine as well as conventional. The manufacturers, of course, will argue that they're only meeting a need, giving consumers information that a possible remedy for their problems exists and they should "ask their doctors if it's right for them." Harold Hill wasn't lying about the pool table and he didn't invent its associations with a certain shady element of society. Harold Hill didn't create the fears of his audience, but he played on them. In the same way, drug companies didn't invent illness. But they do play on fears about sickness and disease in a number of ways--fear of failure, of being socially unacceptable or a burden to others, fear of pain, fear of not being able to function, fear of being dependent or disabled, fear of being out of control.

When these messages are too obvious, people respond negatively--for example, the "I've fallen and I can't get up" ad campaign is one of the most ridiculed and parodied in recent history. But that doesn't mean that the fear message, on a subliminal level, doesn't have an impact.
And it's not just advertising that uses this technique. The media design their reports to evoke the same fears, in order to attract viewers and readers and keep their attention.

The power of suggestion
And what kind of impact is it really having? Would we really be stepping into conspiracy theory if we consider that medical advertising and reporting may help create some of the conditions it hopes to treat? Deepak Chopra's books are filled with anecdotes about incidents he witnessed in his practice in which people's physical health appeared to be drastically and suddenly affected by something they were told or learned about.

The link between perception and belief in our minds shifts and changes minute to minute. And if we think about it, we realize that we're often in a highly receptive state when we're exposed to much advertising--when we watch TV, when we're riding on public transportation. We're bored, we're passive, we're in a state of reverie, our minds are open, we're in a state of focusing and interpreting messages--in all those situations, we're much more suggestible. How many times do we need to see actors graphically simulating pain and discomfort before we start to get a headache? For some people--not many times at all. And even people who resist suggestion will wear down under constant repetition. When you see a chicken now, how long does it take before you at least think of bird flu?

How we respond
No one could say that Americans are not responding to all this information by taking action. For example, in the late 1990's, Americans spent over $50 billion dollars on diet and weight loss products, and the weight-loss industry has continued to grow. Why then, are obesity and the health problems it causes such huge problems now? There are plenty of theories.

Some researchers argue that Americans are so busy and overworked that they don't have time to exercise, cook healthful foods, and so on. But a number of obesity researchers blame television for Americans of all ages being so overweight, noting that on average, people in the United States watch several hours of television every day, and that the more television people watch, on average, the more overweight they are. Undoubtedly that's a problem, but if Americans have that much free time to watch television, they certainly have free time to cook and exercise, instead.

A theory occurred to me that I haven't seen anyone else propose. Almost all mammals, including primates, react to threats by trying to make themselves look bigger. Could this primal instinct, combined with the intense fear and stress so many people have felt since Oklahoma City, Columbine and 9/11, have something to do with how much bigger Americans have gotten since the 1990's? We know we shouldn't be fat, but something deep in our brains is telling us to puff ourselves up and look scary. And what other messages have we been getting from our media, our leaders, and our experts except those telling us how threatened and scared and on defensive alert we all should be?

Changing our focus
There's an essential perversity in working so hard to avoid being unhealthy, when we should be focused on being and staying well. Fear is deeply involved here--fear of being sick, fear of being held responsible for the sickness of others. We end up defining wellness as a negative--it's the absence of sickness, and that is all. Surely, health and wellness are far, far more than that. But it's difficult to remember this, and make it part of our personal reality, when our culture fails to validate wellness and health and well-being as strong qualities in their own right.

That may be the lesson that the goddess Hygeia has for us today. It's up to us, not the medical system, to sustain our wellness. Wellness isn't a precarious and delicate state of being that is constantly under threat. It's our natural state, which is strengthened when we revel in it--when we run and dance instead of walk, turn off the TV and get outside, rejoice instead of worry, affirm life instead of fear it. Perhaps if all of us did everything we can to validate and reinforce good health, instead of focusing on disease, we could help create a new reality, for ourselves and for everyone.

Copyright © 2006 and 2008 by Inanna Arthen.
Last updated 28 February 2008