The Natural History of the Health-Illness Continuum
Lastly, a way of explaining both health and illness is to explore the dynamics of the natural history of the health-illness continuum (Figure 4–6). Here, it is possible to follow the continuum or trajectory of a healthy state through an illness that a person may experience. This summarizes the social science approaches that have been discussed to answer our fundamental questions— “What is health?” and “What is illness?”—and begins to shift our focus to the responses and experiences people have both to and with states of health and illness. The focus now begins to move to the active role the person plays in shaping and experiencing the course of a state of health and a given illness. For example, the seemingly healthy person who develops an illness may experience the following continuum: healthy state—he or she is carrying on activities of daily living, actively participating in family life, work, other activities and so forth; an illness—the symptoms of an illness may be acute, silent, or subtle in nature—occurs; the person may recover spontaneously or with treatment, or comeback and resume his or her life in an expected manner or resume his or her earlier stable status; or, the illness episode may be more severe, and the person may become unstable or experience the illness as a chronic condition; he or she may, over time, deteriorate; and at some point death occurs. The person may die with the onset of the acute phase or later in the continuum. The acute phase most often is treated in the home or an acute care setting, and the early phases of comeback and rehabilitation occur in one of these settings.
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The management of the chronic phase, except for acute episodes, is performed at home or in an institution that is either a rehabilitation facility or a long-term care institution. The illness may profoundly affect the lives of the ill and his or her family in the scope of day-to-day living and hopes for the future.
As you can see, there have been countless explanatory words and models developed over time to define health, illness, and the experiences of each. Each of these theories is valid; each of them is time-tested; each is relevant as we go forward in time and space.
In summary, this chapter has presented an introductory overview of the modern culture’s perception of health and illness through countless lenses. The writings of a number of preeminent theorists and sociologists have been exam- ined in terms of applicability to health care. Box 4-2 suggests resources that provide timely information.