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Commentary is a regular feature of the Crimson editorial page that provides a forum for opinion from members of the Harvard community. Those interested in contributing pieces should contact the editorial chairman.
OURS IS AN ERA of heightened health consciousness. Physical health has become an end in itself, rather than a means to other personal goals, and living a meaningful life has been reduced to a health problem. Health is an imperative, a sort of super-value which stands for personal achievement, social esteem and strength of character.
The evidence of our preoccupation is everywhere: in the physical fitness boom, in every magazine and television program, in our perpetual dieting, in our increasingly frequent trips to the doctors and in the rising costs of medical care. Everyone is taking up jogging, aerobics and isometrics. An estimated 57 million Americans participate regularly in physical fitness programs and the sporting goods industry is a $12.3 billion per year economic juggernaut.
Diet, weight reduction and nutrition have become national obsessions, and everything seems to be an elixir or a poison. The 1980s are the "Age of Enlitenment": one-third of Americans are on weight-reducing diets, and half of us regularly take vitamins or mineral supplements.
The mass communications media are increasingly devoted to health and medicine. Advertising, public relations and the media together collaborate in a kind of "medico-media hype," as every new research finding or experimental treatment spawns an immediate press conference and a torrent of publicity. With each month, a new disease comes into vogue--osteoporosis, premenstrual syndrome, Alzheimer's disease and, of course, AIDS.
We have medicalized a variety of human miseries and afflictions, things which we never used to think of as diseases, as disturbing as they may have been. Almost anything which affects the workings of the body, or even the workings of the mind, may now be labeled a medical problem.
Socially undesirable or deviant behaviors such as drug addiction, alcoholism, child abuse and poor performance in school or on the job are now subject to diagnosis and treatment.
Many bodily states and physical characteristics which are unwanted or uncomfortable can now be altered by medical means: an unattractive nose, baldness, small breasts, infertility, sexual dissatisfaction, motion sickness, jet lag, etc.
WHERE HAS OUR pursuit of health and medicine taken us? Our national health is excellent and continuing to improve, though many disadvantaged populations remain as important exceptions. Advances in medical care and medical research and disease prevention, and alterations in our unhealthy lifestyles, have dramatically increased life expectancy and lowered infant mortality. In 1984, life expectancy--74.6 years for the average American--was a staggering 3.7 years greater than it was only 14 years ago, in 1970.
But our focus on health has also had some negative side-effects as well. For instance, while sustained moderate exercise is clearly beneficial, this new cultural norm has been carried to an unhealthy extreme by some.
Obsessed with extremely strenuous physical conditioning, some people have withdrawn into themselves, into a personal world of relentless physical exertion. Their problem, like that of a workaholic, is not the goal pursued, but the exclusivity and single-mindedness with which it is pursued. We have even had to create a new medical specialty, just to treat all the damage we inflict upon ourselves in our over-eager pursuit of fitness.
Obesity, to take another example, is a proven health hazard and optimal nutrition is very important. But at what point does controlled, appropriate and moderate dieting become uncontrolled, excessive and dangerous? Dieters who restrict themselves to less than 1000 calories a day--and there are many--are by definition starving themselves.
Is it medically dangerous? Yes. Fad diets are significant health risks. And some people are unable to pursue thinness in moderation and have been adversely affected by this social pressure.
Two such vulnerable groups are children and people who are predisposed to developing eating disorders. The incidence of anorexia nervosa has risen steeply in the last 15 years, an increase partly attributable to our increasing cultural emphasis upon slimness. Children are swayed by the obsession with weight: a survey showed that half of fourth grade girls say they diet, and 75 percent of them feel they are too heavy and are terrified of gaining weight.
And while a better informed and more alert public results from the educational and instructional efforts of the mass media, here too, there are casualties. Some people are confused and frightened by exaggerated reports of new and dreadful diseases; some with untreatable or terminal diseaeses have their hopes raised in vain. Misinformation also leads people to seek medical care needlessly and makes them vulnerable to exploitation by quacks.
ONE FINAL CASUALTY: some people seem to be becoming more hypochondriacal. In about half of all visits to primary care physicians, no significant disease can be diagnosed to account for the patients symptoms. Indeed, about one-third of all the patients in a general medical practice have no serious medical disorder.
Per capita physician visits are also higher than ever before. Surveys reveal that we now seek medical attention for milder symptoms than ever in the past. We seem to be growing more discomfitted by the inevitable aches and ailments of life.
Thus, while our society's increasing pursuit of health has resulted in enormous gains, a note of caution may also be in order. Medicine, health promotion and disease prevention have their limitations after all, and we would do well to bear them in mind.
Arthur J. Barsky is an assistant professor of psychiatry at the Medical School. He is the director of the Primary Care Psychiatry Unit at the Massachusetts General Hospital.
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