THE MEANING OF HEALTH AND THE HEALTH OF MEANING

On January 14, 1960, Paul Tillich presented a paper to the New York Society of Clinical Psychiatry entitled, "The Meaning of Health."  Dr. Tillich, at that time a professor at Harvard Divinity School, had established a reputation as a philosopher/theologian who recognized the inseparable tie that held together the disciplines of theology, medicine, and psychology. What made his insights so profound was his capacity to consider not only the roles of those disciplines in their respective clinical settings but also their roles in society as a whole where the disease of individuals impact the well-being of families, groups, and even nations. As a refugee himself from Hitler's Germany, Paul Tillich had seen first-hand how the insanity of persons infected the nation, leading to the establishment of the Third Reich and Germany's eventual collapse in World War II.

As was characteristic of Tillich's well-researched papers, this one on the meaning of health was elegant, deep, and profound in its far-reaching orbit of elements affecting the health of persons, and societies. During the street theatrics of what passed for political deliberations in Congress and the White House at the time of my writing this past week, I thought about Tillich's paper, the very different age in which he wrote it, and the conditions making health care a crisis in our country. 

I will come back to Tillich's discussion in a moment, but first I want to say more about the different conditions separating our present time from the years in which Tillich lived. What comes to my mind immediately are the conversations I have with physicians in my consulting room. As a whole, they talk about their disenchantment with medicine. They reference many things, most of which are visible to the public:

• the aggressive drive for profits, controlled by management gurus who take the temperature of the markets as a priority over that of their patients;
• the awesome developments of medical technology, making possible diagnostic and treatment options not even dreamed about during Tillich's lifetime;
• the astronomical costs of these technologies, making it almost impossible for the survival of small practices while fueling the absurd growth of our medical complexes and corporations;
• the alliance of the pharmaceutical industry with the individuals and medical institutions that further dehumanizes the patients who have become conditioned in our drug-obsessed society to take whatever makes them feel good, especially if it has the blessing of a doctor still carrying some remnant of the hallowed regard once ascribed to the medical profession;
• the role of the insurance companies in dictating (a) the appropriate treatment for a medical condition, and (b) the method and duration of the treatment, as well as (c) the medications recommended;
• the numberless forms of new age treatments marketed in competition with traditional medical care, boastful of their curative powers, in competition with the triadic monopoly of medical conglomeration, pharmaceutical giants, and insurance authorities;
• the loss of jobs, life styles, homes, and old neighborhoods where the factories and businesses shut down either because the old products no longer are used, they can be produced more economically, or new technologies make the old work lines obsolete in our emerging technocratic world where one robot can replace five human beings, or where one technician in a small office thousands of miles away can perform the tasks formerly requiring a room full of people.

In all of these examples of changes over the past forty years, each one has a profound impact upon our understanding of "the meaning of health and the health of meaning." The implications are quite apparent in those examples having to do with the medical profession but perhaps less obvious in my last example. But it is in that last example -- the loss of jobs, life styles, homes, neighborhoods -- where a very scary thing is happening that affects the health of each of us while also offering us a deeper look into the meaning of health. 

That scary thing is the loss of meaning. It should frighten each of us that the 2016 report from the National Center for Health Studies shows a sharp increase in the US death rate of younger and middle-age white men. These surprising and disturbing statistics prompted an all-out study to find the possible causes. Here are the results: suicides, drug-related poisonings, heavy alcohol abuse, and drug overdoses.

But the important question is, What accounts for the unexpected spike in these deaths? And for that answer, we do not need the analyses of our sociologists. All we have to do is to reflect upon the misery of those places and persons who have lost all meaning in their lives. There is no purpose, no hope of there ever being one again, and -- ultimately -- the loss of meaning, which is a terminal disease of the soul.

Hold that thought while I return briefly to a summary of Tillich's paper. Speaking to the New York Society of Clinical Psychiatry, he attempted to provide an overview describing a way to consider the meaning of health. To do this, Paul Tillich drew upon his philosophical and theological background that understood human nature as a unified whole of many dimensions. There are several dimensions to human existence which may be described as:

1. the mechanical -- referring to the body parts such as the skeletal system that supports the physical structure of the human body;
2. the biological -- having to do with the organs, tissues, and interrelated processes that make possible life itself;
3. the chemical -- dealing with the interworking of those biological processes, as we descend into the deeper complexities of the biological organism;
4. the historical -- referencing a term from the social sciences to describe the role of societies, groups, and organizations and how they impact persons for better or worse, health or disease;
5. the spiritual -- encompassing all the other dimensions with a safety net for meaning-gathering, purposive-serving, hope-generating functions that makes possible what Joseph Campbell has referred to as "the joyful participation in the sorrows of the world," a soulful embrace of the cosmos with a trusting affirmation of that "something" which is alive in each of us and connects us with the wonder and awe of the universe.

Without this meaning, our souls die, and with it our hopes and dreams, our societies, our civilization. Without recognition of the importance of each person having access to the conditions that make such meaning possible, then there can be no vision for a "health plan" that is anything more than a political ploy, a self-serving subterfuge that destroys the meaning of health because there is no health of meaning.


Paul Tillich (1984). The Meaning of Health: Essays in Existentialism, Psychoanalysis, and Religion.  (P. LeFevre, Ed.). Chicago: Exploration Press.