This is about the nature of health. In a recent post I argued that health services should take priority because everything we do depends on having enough health. Here I ask what we think good health is.
This is about attitudes we usually presuppose without thinking about them. Some presuppositions work better than others. It makes a difference what kinds of gods, if any, we believe in. I draw on the distinctions between polytheism, monotheism and atheism that I analysed in my Why Progressives Need God.
Health as a social construct
To clarify what I mean, I start with beliefs about health which may seem to you to be absolute bonkers, but have been taken for granted as obvious by other societies. Here is an ancient Hittite way of getting rid of a plague, dating from the 13th century BCE:
When evening comes, whoever the army commanders are, each of them prepares a ram—whether it is a white ram or a black ram does not matter at all. Then I twine a cord of white wool, red wool, and green wool, and the officer twists it together, and I bring a necklace, a ring, and a chalcedony stone and I hang them on the ram’s neck and horns, and at night they tie them in front of the tents and say: “Whatever deity is prowling about, whatever deity has caused this pestilence, now I have tied up these rams for you, be appeased!” And in the morning I drive them out to the plain, and with each ram they take 1 jug of beer, 1 loaf, and 1 cup of milk. Then in front of the king’s tent he makes a finely dressed woman sit and puts with her a jar of beer and 3 loaves. Then the officers lay their hands on the rams and say: “Whatever deity has caused this pestilence, now see! These rams are standing here and they are very fat in liver, heart, and loins. Let human flesh be hateful to him, let him be appeased by these rams.” And the officers point at the rams and the king points at the decorated woman, and the rams and the woman carry the loaves and the beer through the army and they chase them out to the plain. And they go running on to the enemy’s frontier without coming to any place of ours, and the people say: “Look! Whatever illness there was among men, oxen, sheep, horses, mules, and donkeys in this camp, these rams and this woman have carried it away from the camp. And the country that finds them shall take over this evil pestilence.
So plagues are caused by enemy gods, and the way to deal with each one is to placate the god causing it. The god is given a nice fat ram to eat and a finely dressed woman. The god is presumably male.
For us today, it’s difficult to imagine what life would be like if we all believed that the world is controlled by beings like that: moody, supporting some people by causing plagues to others, open to bribery. If you want the plague to end you need to know how to propitiate them.
With a mindset like this, what is good health?
There is no biological norm. We just get what the gods give us. ‘Good health’ can only mean whatever bodily state we prefer. It’s a social construct. We don’t like to suffer from a plague. We would rather be without it. On other matters different societies, and different individuals, have different preferences. There are no right answers.
Health as an ideal
The Bible contains a distant echo of the Hittite idea. It appears in the Atonement ritual in Leviticus 16. A goat is driven into the desert ‘for Azazel’. We don’t hear about Azazel anywhere else in the Bible. It was probably an evil demon of some sort.
The Hebrew scriptures we have inherited have come to us in a form that shows evidence of censorship. Early texts were edited to make them conform to the principle that there is only one god. For whatever reason, Azazel escaped the red pen.
In the Hebrew tradition the Hittite idea seems out of place. Neither we nor our environment are battle-grounds between competing gods. One god has designed us for well-being. Good health is more than a social construct. It is the norm, part of the way we have been designed to be blessed, by a god who also designed the environment to provide for our needs.
On this account, poor health means something has gone wrong. When illness arises, it makes sense to ask what went wrong and look for ways to put it right.
Most of the time we assume that good health is the norm. This is presupposed every time we are advised to keep ‘fit’, eat ‘healthy’ food and avoid ‘harmful’ substances.
The idea that we ought to keep fit and avoid junk food seems obvious as long as we presuppose that our bodies function best the way nature intended. Some doctors may be over-pushy about this, but they do it out of a sense that we are all better off if we look after our bodies in this kind of way.
We have inherited this from our Jewish-Christian past, but it is so deeply ingrained in our society that it seems self-evident. People can feel they want to be fit and healthy without reflecting at all on the presuppositions behind their attitudes.
On the other hand, we don’t always accept it. Who has the right to tell you that you shouldn’t smoke 50 a day? It’s your choice. To trade off the enjoyment of cigarettes against the increased possibility of lung cancer can seem just as legitimate as going smoke-free.
There’s a logic to it. I used the term ‘what nature intended’. It is one of those fuzzy terms we still often use because it isn’t clear what it means. Without God, nature is just a process. It doesn’t intend anything at all. To say that nature ‘intends’ something is a way of bringing God in by the back door. It asserts a higher authority while seeming not to.
If we believe there are no intentions coming from a higher authority, then we are back with the ideas of the ancient Hittites, except that the gods have been replaced by impersonal laws of nature. The very idea of good health becomes, once again, a social construct. It only means the bodily state we prefer. There are no right answers coming to you from outside your own desires. Go on, have that 51st cigarette.
The medical profession has procedures of this type too. They have ways to keep the elderly alive when they would otherwise have died. They can help, or hinder, conception. Most of the time, though, medical and surgical interventions are designed to restore a condition that is conceived as normal good health. Artificial hips, for example, are designed to mimic a normally functioning hip, not to enable people to fly.
Design or social construct?
We live with two concepts of good health. In one, it is a truth about how we have been designed to live. We live at our best if we direct our desires so that we want to live according to this design.
In the other, there is no truth about good health given to us from outside our own desires. What we want is the starting-point for deciding how to define good health. It is a social construct, no more.
In practice modern society borrows from both the design and social construct theories. It depends more heavily on the design theory. Our medical professions and general attitudes to health would be very different without it. But we hide under the carpet the implication: that we depend on a transcendent designer.
To live at our best, we need to recognise how we have been designed for good health.