Wednesday 29 June 2022

Medicine, Morality, Personal Growth: Three Models of Illness and Wellness

If we want to support our friends and loved ones, it is important to understand what we mean when we talk about illness and wellness. It would be easier if everyone approached these topics in the same way, but this is not always the case. Our attitudes towards illness and wellness are heavily influenced by our lived experience, as well as broader societal values and beliefs. In this article I want to discuss three models of illness and wellness which Fran and I have encountered at different times in our lives.

The Medical Model

This is the standard Western medical, scientific approach, and is how I was trained to think of illness and its treatment when I studied pharmacy at university. According to this model, the body is a complex machine and illness occurs when components fail or malfunction. The patient is the owner or inhabitant of a machine which has gone wrong and needs fixing. Diagnosis and treatment are the responsibility of people trained in the medical specialties and the patient’s main role is to follow their advice and instruction. Treatments, including medication and surgery, aim to fix what has gone wrong, or where that is not possible to reduce the impact of symptoms on the life of the patient.

This approach can hugely benefit people living with illness, including mental illness. I have seen how dramatically lithium moderated Fran’s suicidal thinking, reducing it to levels she was able to deal with. I have also witnessed the stabilising effects of medication when she was in mania. Of course, outcomes are not always as precisely targeted as this, nor as positive. Fran has been prescribed a wide range of drugs over the years. Not all were effective and most brought unwanted side effects. Side effects are an unwelcome aspect of Western medical practice, and something many people who have undergone treatment for mental illness will be familiar with. This often leads to a number of different medications being prescribed, either to limit the dosage, and thus the side effects, of individual drugs, or to offset the side effects of one with the positive effects of another.

There is little or no moral or spiritual dimension to this approach, although science and the medical professions sometimes appear so elevated and “obviously right” that anyone doubting their relevance or wanting to try different approaches runs the risk of appearing ungrateful at best, misguided or dangerous at worst.

It is tempting to hand responsibility for the care and wellbeing of our loved ones to those who have been trained to know best. I remember feeling relieved when my mother was severely ill with depression and anxiety and was admitted to hospital. At the time she was probably incapable of making a recovery on her own, and the care she received in hospital was appropriate and supportive. Nevertheless, blind trust in professional “experts” can be disempowering, if it removes the patient’s responsibility, and that of their loved ones, to take a role in their path towards wellness.

The Morality Model

It is my personal view that there is no moral component to illness. Illness is not some evil thing to be overcome by the forces of good. Many “good” people get ill, as do many “bad” people. Guilt and blame can be debilitating emotions and may well interfere with how someone approaches their wellbeing and recovery but as far as I can tell, some “good” people and some “bad” people recover from their illnesses, and some do not. Nevertheless, a number of more or less related views place illness and disease within a moral or religious context. For someone who is religious, this might be helpful and constructive. Their belief in a higher power may help them feel supported, or that there is some deeper meaning to their experience of illness.

There is a line, however, beyond which the link between illness, suffering and belief can take on a darker, even sinister hue. Some maintain that a person becomes ill, or remains ill, because they have been bad in some way, or lack the moral strength to overcome their conditions. The patient may undergo conventional medical treatment but there is an assumption, whether implicitly or explicitly expressed, that they also need to atone or repent if they are to recover fully.

This kind of thinking can lead someone into agonising guilt and despair, not only for whatever wrong they imagine they have committed in the past, but for not atoning, repenting or believing sufficiently in order to be healed. A blessing from a priest or spiritual authority may be comforting to those who believe, but at its most extreme, this kind of thinking can countenance exorcisms on people whose mental health conditions would be better managed with less religion, more compassion, and an appropriate regime of psychiatric care.

Sometimes it is not the patient but the illness or disease which is described in moral terms, especially aggressive, debilitating or potentially fatal conditions. Cancer in particular is frequently portrayed as an evil invading force, which must be hated, resisted, fought, and overcome. The person with cancer is generally held to be a hero, bravely battling the enemy against overwhelming odds.

The situation for those attempting to deal with mental illness is likely to be very different. There is generally a poor distinction between bad behaviour and mental illness. On one hand, those affected by mental ill health tend to be treated with less generosity and greater suspicion than those with other conditions, and their symptoms may be poorly differentiated from immoral or criminal behaviour. On the other hand, those who perpetrate extreme, violent, or malevolent crimes are routinely and habitually assumed to be mentally aberrant, irrespective of evidence or clinical diagnosis. The extreme nature of their crimes places them so far outside the norm that society requires them to be mentally ill so as to place them at a safe distance from the well ones.

The Personal Growth Model

In the third of our models, illness is seen as the expression of issues and lessons that the person needs to become aware of, understand, and work through. I do not agree that all illnesses can be viewed usefully in this way: the approach seeks to attribute meaning and significance to all bodily symptoms, and excludes the possibility that some conditions are the simple result of malfunction in bodily processes. That said, I agree there can be much more to illness, including mental illness, than the symptoms which present themselves on the surface. Effective treatment is likely to involve a broad approach which may include, but is certainly not restricted to, conventional medical or psychiatric intervention.

In the time I have known her, Fran has followed a number of therapeutic approaches to wellness, building a composite approach which works for her and encompasses a number of different techniques. These include medication, but at different times have included hypnotherapy, acupuncture, osteopathy, Emotional Freedom Technique (EFT), meditation, and mindfulness. She has also undertaken to explore the relationship between aspects of her illnesses and long standing issues relating to her childhood, body image, and sense of self-worth.

It seems to me that this kind of approach has merit, providing the person is open to deep and honest self-inquiry, and is able to accept responsibility for certain aspects of their illness without translating that into debilitating guilt, blame and despair.

Bringing It Together

No matter what views you and your friend or loved one hold towards illness and wellness, it is vital to respect the differences in emphasis and approach. No single model is wholly right or totally wrong. Discussing where you agree and disagree will bring you closer together and can lead to a greater understanding of who you are and how you can work best together. As Fran has expressed it:

One can either be actively supportive and compassionate of an ill one.. or judgmental and condemning.. Why I am ill.. I do not know.. I do take responsibility for being as well as I can be.. I have accepted there is no cure and finally that gives me peace and grace.. instead of when I was desperately seeking healing, which created enormous anxiety.. and fear about what people think about me.. those who would judge me judge themselves.. and i pray they don’t have to get ill to learn the lessons..

I have shared my thoughts on three models of illness and wellness, but there will be many others. How do you think about illness and wellness? Do you have the same or similar thoughts about it as your friends and loved ones? Have you ever discussed these topics with them? We’d love to hear your thoughts, either in the comments below or through our contact page.


This article is adapted from material original written for our book High Tide Low Tide: The Caring Friend’s Guide to Bipolar Disorder but not included in the final editions.

Photos by National Cancer Institute, Jaclyn Moy, and Jared Rice at Unsplash.


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