(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?
VI. GETTING ON THE WELLNESS ROAD
How then do we get on the wellness road and stay there?
Expanding on what wellness means, and how to achieve it, Ardell originally identified "five dimensions of wellness" (1986, p. 324): "Nutritional Awareness, Stress Management, Environmental Sensitivity, Physical Fitness, Self-responsibility*."
* That responsibility is presumably limited to those factors
affecting one's own health that one can be reasonably expected
to take responsibility for.
These dimensions are the activities that one undertakes when one is on the wellness road. Ardell subsequently reformulated them somewhat, to (1986, p. 325): "Self-Responsibility and Medical Self-Care; Ethics, Values, Purposes; Stress Management and Boredom Immunity; Nutrition and Fitness; Norms or Rules."
William Hettler of the National Wellness Institute and the University of Wisconsin at Stevens Point, one of the early developers of campus wellness programs, modified the list of dimensions, or one might say "realms," of wellness further (Ardell, 1986, p. 326). His has six groups of components:
- Occupational, Vocational;
- Physical Fitness, Nutrition;
- Social, Family, Community, Environmental;
- Spiritual, Values, Ethics."
They are similar to those of Ardell, differing primarily in that "self-responsibility" is implied by Hettler, stated explicitly by Ardell. Note that in this list are several elements not usually associated with health, but often associated with wellness: the intellectual, the cultural, and the spiritual dimensions or realms of life.
At the State University of New York at Stony Brook, Marcia Wiener, Peter Mastroianni, and their colleagues at The Eugene Weidman Wellness Center and on the Campus-Wide Wellness Program Planning Committee have developed their own adaptation of the work of Hettler and the National Wellness Institute on the dimensions of wellness (Weidman Wellness Center). They call their approach "Centering." This is another term for "Achieving Balance," the "Dynamic Goal" of Concept VII (see chapter three). The approach is visually represented as the Center's "Wellness Wheel," having eight components: "Get Centered! Physically, emotionally, intellectually, environmentally, culturally, occupationally, spiritually, and socially."
Recently a ninth component, creativity, has been added. The definitions for the nine components follow:
- Physical - The physical dimension encourages physical activity that promotes cardiovascular fitness, flexibility, and strength. Physical development encourages fitness and a healthy eating pattern based on food and nutrition knowledge, includes medical self-care and appropriate use of the medical and holistic health systems. The use of tobacco and other drugs is inconsistent with a wellness lifestyle. Alcohol in particular, should be avoided or used in moderation and greater understanding and care taken when using prescription medications, homeopathic remedies, herbs, or dietary supplements.
- Emotional - The emotional dimension emphasizes an awareness and acceptance of one’s feelings. Emotional wellness includes the degree to which one feels positive and enthusiastic about oneself and life. It includes the capacity to manage one’s feelings and related behaviors including the realistic assessment of one’s limitations, development of autonomy, and ability to cope effectively with stress. The emotionally well person maintains satisfying relationships with others.
- Intellectual - The intellectual dimension encourages creative, stimulating mental activities. An intellectually well person uses the resources available to expand one’s knowledge and improve skills, along with expanding potential for sharing with others. An intellectually well person uses the intellectual and cultural activities both in the classroom and beyond the classroom, combined with the human resources and learning resources available both within the university community and the large community.
- Environmental - The environmental dimension explores the world we live in seeking harmony with our surroundings. An environmentally well person aims toward a balance between human needs and environmental needs and takes action to protect and preserve the natural world. Finding time on a regular basis to enjoy contact with nature is also an important component of a wellness lifestyle.
- Cultural - The cultural dimension emphasizes an awareness, acceptance, and appreciation for diverse cultures and backgrounds as well as understanding and valuing one’s own culture. A culturally well person understands that through interaction with other groups, knowledge will be achieved and respect developed.
- Occupational - The occupational dimension is involved in preparing and utilizing one’s gifts, skills, and talents in order to gain personal purpose, satisfaction, and enrichment in one’s life. This allows one to maintain a positive attitude and experience satisfaction and pleasure in one’s work.
- Spiritual - The spiritual dimension involves seeking meaning and purpose in one’s life. It includes the development of a deep appreciation for human experience and diversity of spiritual expression. Spiritual growth includes a strengthening of our connection with others and increased recognition of, and appreciation for, our own ability to affect the world in a positive way.
- Social - The social dimension encourages contributing to one’s human and physical environment to the common welfare of one’s community. It emphasizes the interdependence with others. It includes the pursuit of harmony in one’s family and all communities in which one interacts. It also entails protecting oneself from unhealthy relationships, and learning to build healthy ones based on trust, respect, and open communication. Healthy relationships help a person feel good about themselves while unhealthy ones have the opposite effect.
- Creative - The creative dimension is best illustrated by a child’s wonderment of their world, the human need to explore and the desire to seek proficiency in adapting to the world. One is developing within this dimension whenever they are engaged in the processes of building, creating, improving, discovering, solving, planning, dancing drawing, painting, sculpting, acting. The common process in all of these is drawing from within, using your feelings and intelligence3 in the process.
Finally, it must be noted that as we get on the wellness road or pathway or journey we must recall that it is a journey without end. Wellness, we must repeat, is a process of being, not a state of being. Furthermore, wellness and the striving for it must be seen as facilitating a better life, not as creating for us a series of hurdles that must be overcome.
Above all, on the wellness road one must not be caught up in perfectionism. For humans, perfection is impossible to achieve. Perfectionism is therefore a destructive process. Another way of putting it is to say: "We can never be perfect; we can always get better."
Health and Dying
Interestingly enough, none of the definitions of health or wellness presented above comprehend death as the natural endpoint of life. But some authorities consider that how one comes to terms with death and suffering must be a part of health and wellness. As George Sheehan said (pp. 230, 233): "Death makes the everyday magical, the ordinary unique, the commonplace one-of-a-kind. . . . Once I accept death, I center on the present. . . . To have a death worth dying, you must have a life worth living."
And what would be a "life worth living," according to Sheehan? "The normal life," he said (p. 3), "is one of continual expansion." Another way of talking about wellness. And he went on (p. 5): "Life is not a skill sport. . . . It is a game that anyone can play and play well. . . . The diligent use of our allotted life span is the secret of the successful life."
Presently the boundaries of what we called "life" (not always "successful life" in the Sheehan sense) are being stretched ever further by modern, hi-tech, organ-focussed medicine, with tubes and wires, with "miracle" drugs and surgery, with transports and transplants. Thus, it becomes ever-more important to understand/recognize that part of the concept of health comprehends dying at a certain time as well as living in a certain way. Considering the argument that death must be part of a definition of health, it is interesting to note that in one survey the respondents found some states of life worse than death (Williams). That is part of the reason why some time ago Wynder and Kristein said that the primary goal of health promotion/disease prevention was to "help people die young --- late in life" (1977).