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Dennis W. Jirsch
MD, PhD | Editor
 
 

A couple I know – non-medical, but college graduates – surprised me, saying that they’d pushed pause in their busy schedules to go on a wellness program. We didn’t get into particulars, but I gleaned that a special diet was involved, periods of fasting, some dietary supplements I’d never heard of, and, of course, enemas – tea enemas in this case, brand not specified, though coffee may have its own advantages.

I’ve become sensitized to the term “wellness” and see it everywhere. There’s our provincial health department, at times called the Ministry of Health and Wellness. But there are also wellness contests, wellness programs, wellness administrators, wellness journals, wellness tourism, and there’s even a Wellness brand of cat and dog food. The term has come to represent a panoply of things. What are we all searching for?

Definitions may help. “Health” was defined by the WHO in 1948 as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”1 I find this ambitious, but it didn’t suffice for physician Dr. Halbert L. Dunn, known as the “father of the wellness movement.” Dunn wanted to distinguish between health – not being sick – and what he called “high-level wellness.” In his 1961 book of the same name,2 Dunn calls wellness a dynamic situation in which the individual moves ever forward to a higher level of function. An early convert, public health doc John W. Travis opened the Wellness Center in Mill Valley California in 1975, touting a variety of self-directed approaches to well-being as alternatives to traditional, physician-based care. Dr. Bill Hettler, a staff physician at the University of Wisconsin, organized the first National Wellness Conference in 1977-78. Soon after, the Berkley Wellness Letter was born, contrasting itself with the Harvard Medical Letter.

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The global wellness industry is valued at three times larger than the global pharmaceutical industry (photo credit: Stevepb, pixabay.com).
 

Wellness soon gained a serious foothold in everyday life. And what a foothold! The global wellness industry has become a colossus,3 valued at a staggering US $3.4 trillion per annum, three times larger than the global pharmaceutical industry. The industry can be divided into 10 sectors: beauty and anti-aging, healthy eating/nutrition/weight loss, fitness and mind-body, wellness tourism, preventive/personalized health, complementary/alternative medicine, wellness lifestyle real estate, spa industry, thermal/mineral springs, and workplace wellness. 

Emphasis on preventing disease rather than waiting for it to appear has always been central to the wellness movement. Most appealing to wellness enthusiasts, though, are actions impelled by a sense of personal responsibility, individual effort and commitment (smoking cessation, weight loss, etc.).

Sometime, perhaps in the early 21st Century, there must have been a tipping point, beyond which fitness, diet, healthy living, and well-being concepts and offerings proliferated dramatically. Faced with the growing burdens of chronic disease, obesity and health care costs, a majority of global employers have embraced health promotion, with workplace wellness programs targeted at helping employees lose weight, gain fitness and become happier workers. Though participation in wellness programs is generally voluntary, success in terms of financial return on investment has been harder to find. There’s selection bias at work here too, since most gym memberships are taken out by healthy persons and not more sedentary, perhaps unhealthier clients.

Twenty plus years ago, academic medical centers had an adversarial stance toward complementary medicine. Now most elite medical centers feature departments of integrative medicine, complete with training programs. Medical self-help experts – think Dr. Mehmet Oz, Dr. Deepak Chopra (see TedTalk video below), Dr. Andrew Weil and others – have prospered too, never mind the vague or unfamiliar nature of their advice or traditionalist’s calls for real evidence.

There are myriad initiatives in the wellness movement, but a number of core concepts. As Brigid Delaney describes in her best seller, Wellmania,4 it’s all about the search for “clean, lean and serene,” and comes with a new vocabulary. “Detox,” for instance, once reserved for weaning alcoholics and drug users, has gone mainstream. There are now detox foods, unguents, powders and enemas at the same time as there are detox apps and detox holidays. The concept has become space-age elastic too, identifying symptoms more than pathophysiology. Accordingly, feeling tired, wan, sluggish, disconsolate, suffering with bad hair or anxiety have all become spurs: “gotta detox!” Dieting is the sine qua non of most detox initiatives, and the notion that the right foodstuff can correct perceived imbalances and wrongs. 

Orthorexia nervosum, a term not yet found in diagnostic manuals, was coined by an American physician, Dr. Stephen Bratman, regarding our excessive preoccupation with eating healthy food.5 We’re there and beyond: even our standard grocers carry aisles of foods that are leached of this and that, enriched by that or this. They are organic, free range, low fat, low carb, gluten free and so on.

If diets and detox efforts work, the client will become “clean and lean.” While a variety of exercise routines have been added to the mix, none has been more successful than yoga, with dozens of studios in every large city. Twice as many people do yoga as do aerobics, via an array of persuasions: hatha, Bikram, hip hop, kundalini, vinyasa flow, aerial and so on. Yoga, having originated in the 7th Century BCE in India, remains exotic and slightly spiritual, and this helps too. Though it encompasses physical and mental exercises, yoga, as practiced in the West today, has morphed into a quasi-philosophical system concerned with ways of living and personal growth. Many describe it as a way of life.

Hitching the yoga wagon to the free market has become wildly profitable. The North American yoga and exercise mat business is expected to climb from US $11 billion to $14 billion by 2020. Yoga mats, for instance, have become a cult obsession if made by Lululemon, whose prayer beads ring in at US $108.

Yoga was at one time meant to be an aid to meditation and many are convinced that such contemplation, with its Eastern origins, can be both an effective treatment for anxiety and depression and a bulwark against the distractions of our digital age. Jon Kabat-Zinn,6 a Cambridge, Massachusetts, psychologist extracted what he thought was the secular marrow of Buddhism and called it “mindfulness,” a meditative practice that has become hugely popular. As one might expect, there are over 500 mindfulness apps available, with titles such as “Simply Being” or ”Buddhify,” and often replete with trees or waterfalls and soporific, unusual music. Celebrity meditators have gone mainstream; large corporations and schools have gotten on board. By way of contrast, a recent study has found that though meditation programs can help stress-related symptoms, they are no more effective than other interventions7 such as muscle relaxation, medication or psychotherapy. Ditto for mindfulness apps, in which recent work finds no support for their presumed utility or impact on health indicators.8

Astoundingly diverse, the wellness movement tantalizes with its promises of perfection and pleasurable fulfillment, its penchant for guidance without proof, its mysticism. But the endless pressure to maximize our wellness can be frustrating to many a condition termed “The Wellness Syndrome.”9 Our search for the perfect diet, body and mind may arguably make us happier, more productive, but at the same time, we are rendered narcissistic, anxious and self-indulgent. Perhaps worse, we are led to mistakenly believe, contrary to experience and our own good sense that we are in control of our lives.

When we consider the inevitable failures in our paths and the pain this entails, we should regard the illusion of such control – even partial! – as a mistake. Rather than aiming for perfection, we’re better off responding to our lives in ways that hold meaning and that amplify our resilience.

I like the “care” implicit in wellness, though, however egoistic, self-derived and uncertainly justified such care may be. There’s value in looking beyond disease. Accordingly, I’m in favor of a Ministry of Health and Wellness. There’s balance in the designation, a sense of work-in-progress.

I’ll concede that wellness is a tangle and that as researchers say, “It needs more work.”

It does. We all do. But I wouldn’t change it.

Health and Wellness, it is.


References available upon request

Banner photo credit: Leninscape, pixabay.com

Related video: Reinventing the body | Deepak Chopra | TEDxTimesSquare