DEBATE DEBATE

Health and the lack thereof

In his interesting article, Naomar Almeida Filho complains that sociology has failed to provide an answer to the search for a general theory of health, but does a general theory of health really make sense?

Health is a polysemous notion. Its multiple meanings are hidden or disguised under the cloak of the idea that when it is missing, specific facts like diseases are expressed, but that when it is present, it displays more desires and illusions than realities capable of embodying a general theory.

Health is like one of those signifiers that the unconscious, in the Lacanian view (Lacan, 1966), employs to add successive and mutable meanings. And this is what happens when one attempts to state - reasonably too much so - that health is not only "the absence of disease", and one postulates "maximum well-being" as a positive definition. Maximum well-being is a signifier full of multiple meanings, since it embodies a fleeting desire, a fantasy quite appropriate to the contemporary quest for happiness, which can take the form of free-of-everything (salt, sugar, etc.) diets, body worship through exercise training, the resurgence of new and old religions, and the narcissism of romantic love. Still, is health happiness?

It is interesting that Almeida Filho has to appeal to disease to define health, when such erudite and well-argued positions from Harvard, with A. Kleinman, and Montreal, Bibeau-Corin, also refer systematically to disease. Whether the concept is disease, illness, or sickness, the issue is infirmity of the body, the conscious, or social relations. One does not speak of health, but of infirmity. Health is what is lost somewhere and is defined more by its hollowness than its content.

Disease defines health, just as death defines life. As written by Wittgenstein (1973), it is not that death leads us to silence, since death is not part of life. Death, perhaps rather as conceived by Heidegger (1962), gives transcendence to life; the awareness of death gives impulse to transcendent actions and to the concept of health as this goal of delaying death by extending life expectancy, or that pushes away its traits, like disabilities, which are announced during life.

Both disease and illness are always social constructs, whether derived from witchcraft or scientific knowledge, but which are also a part of a cultural context that mediates them and gives them meaning and force. Or that gives them legitimacy to link to other social relations, to justify absence from work or claim reimbursement from one's insurance company. Yet they are also silences that speak, telling of what is yearned for but not named.

Yet health is all the more a construct in that it is located in the shifting terrain of desire. It is a construct of the way of understanding the body, its vigor and weakness, its odors and stenches, its presence and finitude. But it is a construct where social goals always play a role, defined as historically and socially possible, as well as the individual desires forged in the imagination. The individual scale of health expresses the ideal self (idealich) that has been forged in the social context and that provides the support to be expressed in beauty, longevity, enjoyment, or quality of life as the exercise of potentialities, in the sense proposed by Sen (1973). Health is another way of expressing individual and social aspirations in a historical moment, but in a very dramatic dimension, since it is part of our social narcissism, which tends to shun reality, always fleeing towards the imaginary. That is why health, at the imaginary level, can take the form of individual economic success, social revolution, or nirvana.

Health as a general theory does not exist. There are only historical claims, demarcating what we are missing. Gadamer is right when he considers health elliptic. Almeida Filho stalks it, queries it, but doubts. Nevertheless this is the razor's edge on which one must move forward. Health is our desire for completeness, our narcissism, our endless quest to fill the gap that makes us mortals. There are threats, there are promises, there are changes, there are losses. But everything that is reached is ephemeral, everything is imaginary and at the same time real. Thus any presumption of a general or life sciences theory should labor to grasp this movement, this permanent and unattainable trend that longs to be health when it longs to be something more than the simple absence of infirmity. Thus health should have as an essential component the acceptance of what is missing, the incompleteness and imperfection that we are, since the best of all healths will never save us from infirmity and death. And death must be an essential component of any life science, because it gives meaning to the mutant temporality that we are. Because this is the time of our being, and thus the poet portrays us: "Yours is the time through which your body passes/with the trembling of the world,/time, not your body.../ Yours is the touch of hands, not the hands;/the light filling your eyes, not the eyes;/perhaps a tree, a bird you watch,/the rest is beyond./We only bear the time of being alive/between the lightning and the wind;/the time in which your body spins with the world,/today, the cry of the miracle;/the flame that burns with the candle, not the candle..." (Montejo, 1996:162).

HEIDEGGER, M., 1962. Ser y Tiempo. Madrid: José Gaos.

LACAN, J., 1966. Écrits. Paris: Éditions du Seuil.

MONTEJO, E., 1996. Antología. Caracas: Monteavila Editores.

SEN, A., 1993. Capability and well-being. In: The Quality of Life (K. Nusbauun & A. Sen, ed.), pp. 30-54, Oxford: Oxford University Press.

WITTGENSTEIN, L., 1973. Tractatus Logico-Philosophicus. Madrid: Tierno Galvan.