Chapter 10: Health
We turn next to a second matter of conscience -- namely, the relation of persons to their own nature, to the concerns of health. Health is one of the fundamental human values, and the promotion of good health is one of the basic moral obligations. Health is wholeness, as the common etymology of the two words suggests. To be healed is to be made whole, to become a well-functioning unity of life. The moral obligation for the advancement of health thus rests upon the duty of becoming integral persons, with the human powers fully operating and cooperating in accord with their proper natures.
Health is an elemental good upon which all other goods depend. The pursuit of truth presupposes sound intelligence. The creative arts cannot thrive on illness. Work and play demand vigor of body and mind. Justice in families, in nations, and in the world as a whole can thrive only when the persons to be related to one another are soundly constituted. Just as mankind cannot continue civilized existence without regard for the resources of external nature, so are all the benefits and achievements of life grounded in personal health.
There are complex problems regarding standards of health and methods of treatment which belong within the province of professional medicine and are beyond the scope of lay inquiry and of ordinary education. One of the objectives of health education should be to develop confidence in the medical profession and reliance upon it rather than upon superstition, hearsay, hunches, or private experimentation for the treatment of illness. Well-informed people know the limits of their knowledge and are acquainted with the expert resources available for dealing with what is beyond their scope.
Nevertheless, it is also a proper aim of health education to advance the layman’s understanding of medicine. A person who comprehends the principles of medical treatment is able to cooperate with the physician more intelligently in carrying out curative measures. He is also likely to be able to identify significant symptoms and thereby to assist the doctor in making an early and correct diagnosis of illness. Knowledgeable laymen further act as a check on medical malpractice. When the curative arts are regarded as secret skills, to be jealously guarded from public scrutiny and communicated in esoteric language only to other members of the guild, the lay public has no protection against fraudulent or misinformed professional activities which the medical associations may fail to detect and control. While professional standards must be set and enforced largely by the profession itself, educated laymen can be of great assistance in keeping the quality of practice high.
From a democratic perspective, medical treatment should be given with the informed consent of the patient. Doctors ought not to render their services with a "take it or leave it" attitude but should assume the role of teachers in relation to their patients, instructing and persuading them in the ways and means to health. Professionals in medicine should be accorded high respect and should be granted status and rewards commensurate with their special contribution to human welfare. But in a democracy of worth they should not become an autonomous ruling body, a powerful new class of medical technocrats, subject to no limits in their self-determination. Medical practice ought to be guided solely by considerations of truth and right. When the motive of service yields to that of prestige and power, the fundamental security of people dependent upon the high quality of medical treatment is jeopardized.
What are some of the conditions and habits of life which engender personal wholeness? There are ten factors which may be regarded as appropriate in a program of general health education in a democracy of worth.
First, the healthful life manifests a proper balance between work and recreation. Relaxation should be harmoniously alternated with effort. The good life exhibits a rhythmic pattern. Gainful occupation and play are mutually supportive components in a unified life. A person whose occupation is sedentary needs active recreations. One whose job requires constant association with people may require contrasting times of quiet solitude. Those who labor with intellectual abstractions often benefit most from leisure-time activity in the field of arts and crafts.
The nature of both work and recreation should further be governed by the age, experience, and native capacities of the individual person. What is healthful to one person may be injurious to another or to the same person at a different period in life. Good health is a consequence of engaging in activities for which one is sufficiently mature, well-endowed by nature, and prepared by education. Constructive work and play provide a focus and an outlet for personal energies. A person is healthy when he is functioning according to his capacities. People disintegrate when they are idle or aimless, badly adapted to their occupations, or perfunctory at play.
The problem of proper balance between work and recreation is of special importance to young people and to elderly people. Persons in the middle years for the most part have established places in the occupational scheme. They feel useful, and their abilities are fully engaged, particularly when they have combined their work with complementary play activities. In youth and age, on the other hand, the feeling of not being wanted, of being superfluous and at loose ends, is common.
For the good health of all citizens, well-organized opportunities for both work and recreation should be provided for people of all ages. In a democracy no person should ever be considered unimportant, unprepared for living, or obsolete. The human career must no longer be segmented into successive life phases devoted to play, study, work, and leisure (retirement); instead, work and recreation must be permanent components in the balanced life, while study is a continual and life-long concomitant and an inspiration and resource for these activities.
Healthful living, secondly, depends upon safety. The good life from which wholeness results is one in which proper precautions against injury are habitually taken. Concern for safety is essential for the preservation of life itself, upon which the good life must rest. Safety education begins in the earliest days of the infant’s life, in the continual watchfulness of parents against any danger to the helpless child. As the child grows and his powers of action increase, he must be saved from an increasingly wide range of perils, of which he is at first unaware. He cannot be permitted to discover most of them for himself, for in many cases the learning experience would result in serious injury or death. Hence, there must be strong prohibitions and taboos in relation to water, fire, highways, electrical equipment, poisons, high places, and the like. Firm direction, and even physical punishment if necessary, are required to enforce the elemental lessons of safety. Still, parents and teachers should keep the teaching of safety realistic, avoiding the creation of fears and inhibitions that are out of proportion to the actual dangers.
One of the features of good vocational and recreational preparation is instruction in safety factors at work and play. Hazardous occupations should as far as possible be avoided. Insofar as they must be carried on by someone -- for example, mining and radiological work -- every available safeguard should be insisted on -- such as proper ventilation, lighting, and shielding. Even jobs that are not intrinsically dangerous may become so if safety devices are not conscientiously used. In the recreation field, expertness in sports reduces the likelihood of injury. One of the objectives of physical education is to develop skills that make it possible to play hard yet safely. Another goal is to develop the habit of scrupulously observing the rules of the game, since one of the main functions of rules is to keep play within the bounds of safety. More important than these matters of safety through skill and rule keeping is the ethical question of promoting and participating in forms of recreation that are unavoidably dangerous -- for example, football for very young boys or motorcycle racing at any age. It is always possible to choose sports that call forth all the courage and skill one possesses without exposure to needless risk of injury.
Because accidents still occur under even favorable safety conditions, a part of everyone’s education should be mastery of the essentials of first aid. Through an understanding of the elemental rules of treatment for the injured, damage may be minimized and subsequent medical care may be made more effective. A layman’s knowledge of such techniques as artificial respiration and bandaging wounds may make the difference between death and survival for an injured person.
Following upon the matter of safety is a contemporary health problem of the first magnitude -- namely, the proper use of motor vehicles. The automobile is a major hazard to life and limb in the modern world. Our whole way of life, including our patterns of working and residence, have been revolutionized by it. By their numbers, speed, and power, automobiles constitute an ominous environmental influence, an ever-present threat of violence. Under these circumstances the will and pleasure of the individual may not safely govern the use of motor vehicles; strict social regulations are necessary. Minimum standards of age, health, and skill for all drivers must be set and enforced. Juveniles who look upon driving as a sport must be kept off the road. People who are infirm by reason of illness or age and who do not have the alertness and reaction speed requisite to good driving should also not be licensed. Periodic tests of knowledge and skill ought to be required of all drivers. Automobile makers should be made legally responsible for the mechanical safety of their product, and all automobiles in use should be inspected regularly.
Provision should be made for driver training -- possibly as an adjunct to the school program -- to insure that every person has an opportunity to learn the right use of the automobile. Enforcement of traffic regulations should be managed by a sufficiently large and adequately compensated corps of traffic policemen, and penalties for the more serious offenses should be substantial --including permanent revocation of licenses of drivers who appear to be a persistent menace to the public safety.
A fourth health consideration is the practice of bodily exercise. As machines have lifted more and more of the burden of labor from men’s backs and hands, demands upon the human body have greatly declined. Transportation, too, no longer calls for physical effort. Walking and climbing have almost universally been replaced by riding. Many Americans will not even walk a few blocks when they have an automobile at their disposal. This multiplication of effort-saving mechanisms has ushered in a new era of physical ease. Freedom from necessary physical exertion has become a cardinal objective of the good life.
But man cannot with impunity ignore the claims of his body. During the eons of evolutionary development his physical structures came into being in response to the challenge of the environment. To remain healthy a person needs to make use of these bodily capacities. Since such efforts are generally no longer physically required, they have to be voluntarily assumed. It is the primary function of physical education to build habits of exercise that will serve throughout life to supply the need for healthful bodily exertion. Since health is wholeness, this goal cannot be reached by concentrating solely on physical activity. A human being always acts as a whole, never simply as a body or a mind. Hence, physical education should be devoted to the development of coordinated intellectual-social-physical activities which meaningfully engage the energies of the total person.
It is a symptom of our contemporary cultural disintegration that the "intellectual" phases of education have been so sharply separated from the "physical" ones, and that physical education has been so largely relegated by academic people to the "all brawn but no brains" category. In principle, physical education provides the best opportunity for the harmonious development of the entire person, through contests of skill in which intelligence, esthetic imagination, social sensitivity, and moral purpose are channeled through significant physical activity. The highest task for health education in a society devoted to excellence is to discover and introduce into the cultural stream modes of living that will fully employ bodily energies in ways that are at the same time consonant with the ideals of reason, qualitative judgment, and ethical concern.
Habits of cleanliness are a further goal for health education. The basic principles of personal hygiene should be taught by parents, and schools should reinforce this home instruction, especially by supplying the physiological and psychological grounds upon which the practice of cleanliness rests. It may be shown that by having due regard for cleanness of the body and of clothing one both helps guard against disease and does honor to other persons and to oneself. Being clean is not simply a physical good; acts of purification have a symbolic significance, too -- as many religious rites testify. But apart from the formal ceremonial aspect, being clean has an elevating effect on the entire person. It is an overt manifestation of devotion to the ideal of purity, a recognition of human transcendence of simple biological existence.
In teaching children to be clean, it is important not to inculcate attitudes of fear and disgust regarding bodily processes. There is evidence, for example, that toilet training based on repugnance for excretory products may result in psychological damage. Likewise, table training that is too early, too rigid, and too negative may induce permanently disabling attitudes. Being clean should not be a means of assuaging irrational guilt feelings. Compulsive, automatic scrupulousness is a sign of illness, not of health. A child should be encouraged by adult attitudes to accept himself and everything related to his body and issuing from it from whatever channel. Then in his own good time (which is usually not long) he will be able to reorganize his bodily activities so as to conform to established social customs.
The last point may be made in another way -- by asserting that a healthy concept of cleanliness is primarily positive rather than negative. Modern sanitation has emphasized the elimination of dirt and the killing of germs. We live in a sterilized civilization. The sanitized culture may also be a sterile culture. The ideal of personal purity is positive in emphasis. It is directed toward the disposition of material things (none of which are evil in themselves) so as to serve goodness most fully. It is aimed not at the total negation of a part of creation, but at the right ordering of created things within the whole economy of life.
A sixth factor contributing to good health is proper dietary habits. The relevant matters here are the kinds of food eaten, their quality and quantity, and the manner of eating them. As to kinds, one principle is that of balance. We possess considerable well-tested knowledge of nutrition, from which it is possible to plan meals so as to supply the substances needed for abundant health. This basic nutritional information should be regularly included in health instruction. Another principle is that of avoiding foods that impose special organic strains -- for example, fats for people whose bodies accumulate rather than use them or salted foods for people with certain circulatory maldispositions. A proper diet is not assured by following one’s fancy, responding to the inclinations of appetite and the momentary leadings of taste. The desire principle may be quite deceptive in decisions about food. It is usually the case that in the long run plain and superficially less appetizing foods are more healthful than rich and fancy ones. While food should be attractively prepared and appealing to the taste, the proper criterion for selection is not immediate hunger satisfaction but reliable knowledge of what is healthful.
Concerning the quality of food, the problem is to a large degree one of social organization and control. The pressures for efficient collection and distribution of foods in urban society and the demand for short cuts in food preparation in high-speed civilization have brought into being a vast food-processing industry. In the interests of efficiency and convenience the quality of many foods has been sacrificed. They have been excessively refined, with resulting loss of nutrient values. They have been mixed with preservatives, dyes, and softeners to make them keep longer, look better, and cook more quickly, but again with possible loss of nourishing quality and perhaps serious long-term detriment to health through the addition of toxic substances. Individuals should be educated to these dangers and encouraged to use foods that have not been ruined by processing. Consumers should organize and support cooperatives devoted to the production and distribution of high-quality foods, scientifically tested for nutritional value and for freedom from adulterants. In addition, citizens must be taught how to secure strong, well-staffed, and amply financed government agencies which are dedicated to the health of the people and serve them through a well-enforced body of pure food laws, a well-organized inspection and grading system, and a continuing broad program of research in nutrition and in food production and processing. As in so many other areas of life, prime concern for ease and profit in the matter of food supply has destructive consequences. The health of all the people requires the restoration of a principle of qualitative excellence as the controlling ideal of the food industry.
Regarding the quantity of food consumed, appetite considerations again ought not to govern. People in an economy of abundance have a special difficulty in that their wants are not disciplined by the scarcity of food. Most Americans eat too much. Overeating in many cases is a consequence of personal frustration and loss of meaning. People try to fill the void in their lives by consuming food. Failing to discover claims of enduring worth upon them, they seek refuge in immediate sense gratification. Excessive eating may also be an expression of the power urge in people who inwardly feel powerless, for nothing more clearly demonstrates mastery over things than does the act of devouring them. The healthy person -- one who is whole -- gratefully receives food (rather than grasps for it) as a welcome energy source for performing the acts of devotion in which his life is centered. He regards his body as an agency for the channeling of the materials of nourishment into the service of worthy ends. Such a person is not controlled by appetite; he harnesses appetite for the sake of high purposes. As a symbol of this subordination of desire, the ancient practice of periodic fasting has special value. That most well-fed moderns tend to feel deprived and anxious if circumstances force them to miss a meal is evidence of how subject they are to desire and how largely their feeding habits are governed by psychological craving. When the act of fasting is united with deliberate rededication to the good, it provides a clear reminder that goodness of life does not consist in obedience to the compulsions of organic existence.
Finally, in the manner of eating, the healthful way includes the avoidance of excessive haste, of much irregularity, and of emotionally tense situations. Food should be partaken with due respect for the functional characteristics of the human organism. The integral person accords the act of eating its rightful place in the whole scheme of life; he does not cheat it of its fair share of time, of its regular place in the ordering of existence, and of its portion in the gift of serenity. Here health and etiquette impinge on one another. Instruction in good table manners serves more than esthetic purposes, for good table etiquette preserves the sense of leisure and order and the relaxed atmosphere which are requisite to good health.
A seventh matter of considerable importance to health is the use of alcoholic beverages. A consideration of the marked effects alcohol consumption has on human behavior makes it evident that questions of conscience are at stake. Alcohol acts as a narcotic -- first, in suppressing the higher mental functions and then, as larger doses are taken, in reducing a person to the animal level and finally to unconscious vegetative immobility.
It can be argued that, ideally, alcoholic beverages should not be used at all, that any substance that renders a person less capable of functioning at the highest human level is not appropriate for human consumption. The contrary argument, in favor of some form of drinking, takes one or more of the following three lines: the religious, the social, or the psychological. Deep in the religious tradition is the custom of using alcohol as a symbol and a vehicle for divine inspiration. Drinking induces a transformation of feeling which removes one from the ordinary and everyday realm into a different world, in which the tensions and anxieties of living are dissolved and a sense of release is enjoyed. Such a total change in outlook is regarded as a glimpse into the life of ecstasy and bliss which is the consummation of the religious quest. Religious drinking generally takes place within the strict discipline of established ritual and hence usually does not go to the harmful excess of deep intoxication. Social drinking is also ritualistic in character, but without the other-worldly overtones of the religious act. The purpose of social drinking is to facilitate interpersonal association by releasing the inhibitions and defenses that commonly separate people from one another.
Both the religious and the secular-social uses of alcohol depend on its psychological effects, but they differ from purely psychological drinking in their emphasis on the objective forms and shared purposes of corporate life. Psychological drinking is a reflection of individual craving for satisfaction. A person who feels lonely, lost, and insecure may find temporary relief and release through the transfigured state of consciousness produced by alcohol. Such psychological drinking is a symptom of personal ill health and is at best not a cure but only a means of escape.
The prevalence of alcohol consumption may be connected with the pervasiveness of the pleasure principle in a democracy of desire. When wanting things is the motivation for conduct, persons are in a permanent state of frustration, because it is in the nature of things that all wants cannot be fulfilled. Alcohol provides a temporary refuge in a world where the barriers, hostilities, and denials of reality are dissolved. Such use of alcohol thus merely serves to render more tolerable a system of life that is unhealthy at the core.
Beverage alcohol is an important topic for health education in homes, schools, churches, and other social agencies. Basic information about the physiology and the psychology of drinking should be widely disseminated. Furthermore, the following five specific problems should be covered in education at the secondary level and beyond. First, the nature and treatment of alcoholism as an illness should be presented. The symptoms, diagnosis, and prognosis of the disease, as far as they are known, should be made clear, and its genetic, physiological, psychological, and moral factors should be analyzed. Second, the fatal connection between drinking and driving needs to be accented. In the automotive age public safety is incompatible with the general practice of alcohol consumption. The importance of heavy penalties and speedy judgment on those who drive while intoxicated must be made clear. Third, the economic aspects of drinking should be considered. Alcoholic beverages are expensive. They impose a heavy drain upon individual resources and family budgets and constitute an unproductive drag on the national economy. Reflection on the relative amounts spent for alcoholic beverages and for such items as education and medical care provides a sobering lesson in relative values. A fourth problem is liquor advertising, whose misleading and value-subverting nature should be made clear by viewing its claims in the light of established facts.
A fifth and most difficult set of problems is the social control of alcohol production and consumption. Even if one holds that the goal toward which society ought to move is the complete elimination of alcoholic beverages, the imposition of prohibition by law does not appear appropriate, as it subordinates values of freedom which take precedence over those of abstinence. Drinking that is a symptom of social and personal malady cannot be effectively eliminated directly; it can be eliminated only by the healing of personality through the exchange of the life of satisfaction for that of devotion. In the absence of this fundamental conversion, other means of control must be employed and should be taught to all citizens. These include licensing and inspection of all liquor producers and distributors, the curbing of the corruption, vice, and crime which tend to cluster about the liquor traffic, and restriction on the sale of alcoholic beverages to minors. Perhaps most important of all is the development of social customs and pressures against individual and solitary drinking for psychological relief and in favor of community rituals in which the need to belong and to celebrate the goodness of life can be constructively satisfied.
Concerning the next matter of health -- the use of tobacco --relatively little need be said. The problems associated with it are in some ways similar to those of alcohol use, but are as much less serious for immediate behavior as the psychophysical effects of smoking are less marked than those of drinking. For the long run, there is considerable evidence of a high correlation between the amount of smoking (chiefly of cigarettes) and the incidence of certain diseases, notably lung cancer and circulatory failures. In health education the injurious medical consequences of smoking should be made explicit, and the various problems of personal hygiene, fire safety, economic waste, and advertising deception connected with tobacco use should be discussed.
A ninth health concern of increasing gravity relates to the use of drugs. The medical profession is the primary guardian of the people’s health in the matter of drugs, for the questions at issue are generally technical and cannot be properly assessed by laymen. Nevertheless, there are broad ethical concerns which are beyond the range of technical competence alone to settle. Medicines are meant to be aids to healing, but there are dangers to health in relying too heavily upon them. No question arises in connection with medicines such as insulin, which supply a vital deficiency without which life cannot go on at all. But serious issue may be taken with the frequent and somewhat indiscriminate use of such drugs as antibiotics. At this point medical practitioners are not in full agreement. Since the body must marshal its own natural defenses if it is to fend off diseases effectively, antibiotics should perhaps be reserved for emergency situations in which the natural defenses are insufficient.
Everyone needs to be taught the right use of other drugs such as digestion aids, cathartics, reducing pills, stimulants, pain relievers, and tranquilizers. In general, our satisfaction-dominated philosophy of life has led to the overuse of these remedies. When a person has an unpleasant symptom, his impulse is to take a drug to make him comfortable. The proper course is to regard the symptom as a welcome warning signal and then to discover and set right the condition that caused it. More often than not the discomfort is a result of unhealthful ways of thinking and acting which need to be rectified. Thus, it is usually wise to avoid palliative drugs, which obscure the true state of health and delay the rectification of life that disease should prompt.
Certain drugs are so dangerous that their use must be rigidly confined to authorized medical treatment. Included are such habit-forming narcotics as opium, morphine, cocaine, heroin, and marijuana. Like alcohol, these drugs afford temporary escape into a transformed psychic world, in which the stresses and pains of ordinary life are obliterated. But unlike alcohol (except for alcoholics), these narcotics cannot be used regularly without progressive addiction and ultimately fatal consequences. The rise in narcotics addiction in recent years, particularly among young people, is in large measure a result of the prevalent decay of purpose, the loss of stable values, and the feelings of personal estrangement, loneliness, hopelessness, and meaninglessness which characterize the present age. Drugs admit one to a haven of light and life, the momentary grasp of which is preferred by the addict to the boredom of ordinary self-centered existence, despite the darkness and death which are the price of the fleeting ecstasy.
It is essential that young people be carefully instructed in the nature and effects of narcotics. They must also be helped to understand the measures required to maintain strict control of drug production and distribution, particularly in view of the incentives to delinquency, violence, and crime which unfortunately accompany general prohibition. There should, further, be diffusion of knowledge about possible ways of rehabilitating drug addicts and open discussion of the moral and social issues that must be settled when decisions as to treatment have to be made.
The tenth and last aspect of health education to be considered concerns mental health. As mentioned before, health is wholeness. Well-being of the body is not separate from that of the mind. A well person is unified, integral, organized for the full and free exercise of all his capacities. Organic disorders often have emotional and intellectual consequences, and many diseases of the body have their origins primarily in psychological disturbances. Many physicians state that a substantial proportion of the bodily complaints they are asked to cure are psychogenic in nature. Furthermore, recent discoveries have demonstrated the close relation between blood chemistry and endocrine balance on the one hand and emotional health on the other.
It follows that sickness is not to be overcome by piecemeal doctoring of separate parts or functions. Medical specialization is essential for the development and exercise of high technical skill, but it must be supplemented by the understanding of the person as a whole and comprehended within a unitary pattern of treatment. Good health is a by-product of complete, integral right living.
Mental health is peculiarly the province of education. In a sense this is its ultimate aim, for all of the other rightnesses of life are caught up in the sanity of sovereign mentality. Mental health means personal integrity -- the unification of bodily functions and emotional impulses through the power of true ideas and worthy purposes. Emotional well-being is not, as the advocates of a satisfaction philosophy suggest, a liberation of impulse for the uninhibited fulfillment of desires. It is the condition of disciplined security in the release of self for responsible dedication to the right. Whatever is done to educate a person to respond to excellence and to abandon futile and self-defeating self-seeking is a contribution to mental health and thus to the welfare of the person as a whole.