(Reprinted by the Kind Permission of Steven Jonas
and the Springer Publishing Company)
Talking About Health and Wellness With Patients:
Integrating Health Promotion and Disease Prevention
into Your Practice
by Steven Jonas
Chapter 2 - What are Health and Wellness?
V. DEFINITIONS AND DESCRIPTIONS OF WELLNESS
Halbert Dunn, a retired Public Health Service physician, developed the concept of what he called "high-level wellness." For the individual he defined it as (Dunn, p. 4): "an integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable. It requires that the individual maintain a continuum of balance and purposeful direction within the environment where he is functioning."
We shall in this book use this definition of "high-level wellness" as our primary one for "wellness" unmodified. At the same time, it is useful to consider several other related definitions and descriptions of the meaning of the term that have been put forward. For example, Dunn himself elaborated on his concept, stating that "wellness is a direction in progress toward an ever-higher potential of functioning" (p. 6).
One of the principal proponents of the concept of wellness during the last quarter of the 20th century has been Dr. Don Ardell. He has offered a variety of (closely-related) definitions of wellness. For example, in 1984 he said that wellness is (Ardell, p. 5): "[A] conscious and deliberate approach to an advanced state of physical and psychological/spiritual health. This is a dynamic or ever-changing, fluctuating state of being."
He further defined the concept as (1986): "giving care to the physical self, using the mind constructively, channeling stress energies positively, expressing emotions effectively, becoming creatively involved with others, and staying in touch with the environment."
He also said that (1986, p. 55; quotation slightly reordered): "In pursuing wellness . . . your mind, body, and spirit are integrated and inseparable . . . the total you must be involved, including your self-concept, your work, your primary and other relationships, your environment, and so forth."
More recently, Ardell has defined wellness as follows (Sept. 16, 1998): "Wellness . . . is devoted to the promotion of a strategy or philosophy that will help you achieve an optimal level of physical and psychological well-being AND enjoy a wonderfully successful and satisfying life of consequence."
Recently too, Ardell put wellness into the broad political context (Ardell, Summer, 1998): "Wellness as a lifestyle . . . would be unlikely in 20th and now 21st century western civilization without the foundations laid down in Athens long ago. Specifically, we needed such core values as the separation of church and state, constitutional government, the skills of and respect for scientific investigation, the capacity for self-criticism, tolerance for and protection of minority views to become what we are or strive to be, namely, free and democratic and devoted to many ideals, including having the moral, intellectual and political values 'most productive of a good life for mankind' (Frank M. Turner, Wall Street Journal, 5/20/98, p. A12)."
Indeed, Ardell even related wellness to the basic precepts of the Declaration of Independence concerning the inherent rights of all mankind to "life, liberty, and the pursuit of happiness" (Ardell, Oct. 6, 1998).
In 1999, he continued in this vein. In the 53rd edition of the Ardell Wellness Report (1999, p. 1), he answered his own rhetorical question, "What is Wellness?" by saying, in part: "Wellness is about perspective, about balance and about the big picture. It is a lifestyle and a personalized approach to living your life in such a way that you enjoy maximum freedom, including freedom FROM illness/disability and premature death to the extent possible, and freedom TO experience life, liberty and the pursuit of happiness. It is a declaration of independence for becoming the best kind of person that your potentials, circumstances and fate will allow."
Putting these thoughts together, we can see that wellness is a life-long process of striving towards a state of health. (The idea that "health" is a state of being --- and one that is measurable --- appears in virtually all of the definitions offered above.) Encompassing all the elements of living. the well person, the process ends only with death or an unmodifiable prelude to it: the terminal condition. Wellness is thus a journey that has many intermediate milestones but no final endpoints.
Central to the concept of wellness is recognizing that what constitutes a "personal state of well-being" for any individual can vary over time. In most of us, it does indeed vary over time. As Ardell succinctly put it (1986, p. 52): "Don't Sacrifice, Deny Yourself, or give Up Destructive Life Habits --- Until You're Ready to Do So."
Finally on the concept of wellness is the question: are prevention, health, and wellness in different arenas, concerned with vastly different aspects of living? In describing his newsletter, The Ardell Wellness Report, Ardell does see a contradiction between traditional disease prevention/health promotion on the one hand and wellness on the other : "This is a wellness newsletter --- REAL wellness, not that sissy stuff you find in medical[ly]-oriented[,] prevention[-] dominated[,] health education stuff. [This] is wellness beyond just health."
But if health is a state of being and wellness a process of being --- recall that Dunn described the latter as "a direction in progress toward an ever-higher potential of functioning" and note that Ardell's own definitions reflect the same understanding --- then prevention, health, and wellness are not mutually exclusive. Rather, they are all part of that complex, dynamic, three-dimensional feed-back loop referred to in the first paragraph of this chapter.
In each of us, disease prevention, health promotion, and wellness, if undertaken positively in a balanced manner, are continually serving to enhance both our health (status) and our wellness (process). For the healthier one is the more capable one is of being well, and the more well one is, the better is one equipped to be and stay healthy.
If wellness is The Way, then even "medically-oriented, prevention-dominated, health education stuff" --- promoting health by, say risk-factor reduction and early disease-detection --- can be seen as two of the (although certainly not the only) engines, and powerful engines at that, that we can use to motor on it.