The `I` and `we` of illness and wellness

Illness isolates intensely.

It is no coincidence that one key difference between illness and wellness involves “I” and “we”. Illness of any kind—physical, mental, intellectual, social—generally isolates one from the “we”—from family, friends, and community. Illness also can reduce the “I”—one’s capacity to participate in the everyday living necessary to sustain and enhance these interpersonal relationships.

Stated differently, illness can diminish one’s personal voice, which is necessary to engage with others. And it can rob one of the social and emotional supports provided by others necessary to sustain personal self-esteem and sense of efficacy.

Our common everyday language supports these observations. One might say, “I am out of sorts today,” or “I just am not good company today,” or “I just don’t seem to be part of our group now.” In each instance, this means that the person has lost the “I”—his or her voice—the capacity and the energy to engage others fully.

Importantly, however, illness is not just a cause of social isolation, but illness also can be its effect. If family, friends, and community members lack understanding and withdraw, this can lead to trauma and social isolation, and can result in very serious behavioral health conditions. Thus, despite the particular sequence of events, the person who is ill is very likely to be socially isolated. And social isolation can be progressive, thus further exacerbating illness.

Wellness, by contrast, implies the reverse: one can participate fully in everyday living and engage actively with others, and one can depend on receiving strong emotional support from others. One’s wellness can be sustained and enhanced by one’s own voice and actions—a strong “I,” and by effective social support from family, friends, and community—a strong “we.”

We need to develop good evidence to support the assertion that wellness can dramatically mitigate or even prevent illness. Our practice-based evidence already suggests that overcoming mental illness involves “regaining one’s voice” with others; overcoming addiction frequently involves strong social support from family and friends; ability to live a good life in the community with intellectual or developmental disabilities depends heavily upon support from one’s family and friends, as well as the community at large. In each instance, the effects of illness will be mitigated when one’s social connections are strong.

Our colleagues from the health field have a parallel concept—well-being. It almost always includes consideration of both the “I” and the “we,” our physical, mental, and social well-being, and frequently our spirit as well. A person with strong wellness has strong well-being. We need to explore the notion that the process of wellness leads to a state of well-being.

What are some of the implications of these reflections?

• Illness is not simply a characteristic of an individual person, but also a characteristic of a social support system, such as a family, friendship group, or community. Thus, it is important to question the relative contribution of each factor to the genesis of illness.
• Recovery from illness involves development of effective processes for achieving wellness, including regaining one’s voice and one’s social support.
• Wellness is not static; it involves a dynamic interplay between self and others that changes continuously.
• A state of well-being can be achieved and maintained through the process of improving wellness.
• It is quite important to measure well-being to determine how far wellness actually has progressed.

More than 70 years ago, the brilliant authors of the World Health Organization constitution recognized that health is a complete state of physical, mental, and social wellbeing, and not simply the absence of disease. We can and must turn this profound notion into a reality in our own lives and the lives of others.