Salutogenesis: The creation of health and homeostasis is the underlying process of healing that occurs constantly, every second, every day from the time we’re born until we die. When it breaks down we get sick and then we need help. We need either the pathological breakdown stopped or the salutogenic processes boosted to facilitate healing. We need help to recover and restore homeostasis. To return to wholeness.
But how do we get this healing? Who can and will help boost our recovery? Or if we can’t recover, who will help restore our wellbeing, our wholeness as we die?
One would think that this is what healthcare is for – to support our recovery and healing. Perhaps it was once, but no longer. At least for chronic disease, healthcare is now about holding the illness where it is or palliating the disease that emerges and progresses. When our salutogenic processes break down or are inadequate, healing leaves and the illness becomes chronic. Then, recovery is rarely part of healthcare’s goals or process.
Juan, an 84 year old veteran with Parkinson’s disease, was referred to me by his primary care physician for an integrative, whole person care visit. He came in with his daughter. His main complaint was difficulty sleeping. He’d been given a handout on sleep hygiene, and a sleep medication. But after he had fallen when getting up at night, they recommended he discontinue using it. What else could he do?
As I do with all my patients who come in for an integrative, whole person care visit, I asked him what was the most important thing in his life. What did he live for? What brought him joy?
Like many people with Parkinson’s, his face was expressionless, but he had a glimmer in his eye as he thought about that question. “What’s joy got to do with it doc?” he shot back. I listened, and then he continued, “The most important thing in my life has been my wife of 60 years and now my daughter who helps care for us.”
Soon after his wife got colon cancer, the assisted living home they were in was bought out by a large investment company. Efficiencies ushered in. Staff were cut, prices were raised. They could no longer afford to stay there so they moved across the country into their daughter’s home where she helped care for them between her two jobs. His wife had been placed on a grueling chemotherapy regimen, which the doctor said would lengthen her life by a couple months. She would not recover, they said. After starting the chemotherapy, she lost her energy, her appetite and her joy. His joy left, too, and he found himself waking up in the middle of the night, unable to sleep, listening for her breathing.
I probed further to learn more about their life and them as people. What had he done when he was in the military and afterwards? Where were some of their most memorable assignments? Any interesting places they had traveled? This took time. As it turned out they had some pretty exciting times. Many full of joy, he remembered. They loved to hike and had climbed mountains all over the world.
We discussed nutrition and activity level. What activities did they enjoy during retirement? Revisiting enjoyable activities, connecting with friends, and creating a routine helps to reset your body. I explored further to see if they were engaged in anything that might boost their healing. He was on five drugs and she on seven. They had plenty of healthcare, including seeing their specialists. He saw a neurologist every couple months and she saw her oncologist more often. In between they had appointments with their primary care physician.
Now that I had a bigger picture of their life before chronic illness, I wanted to address his sleep concerns. Without proper rest, your body does not have enough time to heal and reset. I asked if he had ever tried guided imagery, Alpha stim, supplements, or any mindful activities, like tai chi. No, they have not heard of, nor been offered any of these things. Questions arose. How could they get these things? How are they paid for? Their daughter was very busy, so could they get them delivered to their home? The answer to almost all these questions was also no.
You see, no one pays for healing. Even though many profit from its lack.
Who pays for suffering? As it turns out, we all do. Especially the poor and the sick. We pay for it with loneliness. We pay for it with depression and insomnia. We pay for it with pain and side effects. Our caregivers and relatives pay for it with their time and sorrow.
With $4 trillion in health on care costs (read profits), no wonder investment companies, like the one who purchased their assisted living center, are rushing in to buy this suffering. New and expensive drugs are approved, and released continuously. Older drugs are recycled at higher prices. Hospitals that take care of the underserved and the poor, as well as those in rural settings are going bankrupt, while larger healthcare systems with many specialists are rolling in Covid benefit money.
Healthcare workers are without the social support and resources to provide whole person care and so are leaving by the droves from burnout and moral injury. Soon only the very rich will be able to access what is left.
What is the solution to this crisis? We know. In a recent report by the National Academy of Medicine, Valuing America’s Health: Aligning Financing to Award Better Health and Well-Being, multiple solutions have been laid out. They include going upstream in prevention, and broadening services for the underlying determinants of health. They include paying for time to assist in the social, emotional, behavioral and personal ways that help patients like my Parkinson’s patient heal.
Of course shifting to solutions means shifting our healthcare dollars to those activities that create health and wellbeing at the local community level. The NAM report shows how to build that healing highway. It primarily involves creating community level coalitions that access local dollars and resources, retain their own management of those dollars and shift profits and tax benefits gained off of illness into paying for health and community healing.
Who pays for suffering? We all do. Let’s start paying for healing.