Keywords for the Age of Austerity 15: Wellness

“I cannot excuse you that profess to be my friend and yet are content to let me live in such ignorance, write to me every week, and yet never send me any of the new phrases of the town…Pray what is meant by wellness and unwellness?”

Dorothy Osborne to Sir William Temple, 1653

“Wellness” dates to the 17th century, but it is a staple of contemporary health discourse, from dietary-supplement entrepreneurs and human-resources departments to the high-end beauty and exercise industries. The word’s transformation is nearly captured in the two meanings the Oxford English Dictionary gives. “Wellness” has evolved from a simple contrastive quality—that is, as the opposite of illness—to a positive one, a state of “good physical, mental, and spiritual health, esp. as an actively pursued goal.”

The problem raised by this distinction, of course, is “good physical, mental, and spiritual health” is much harder to quantify or even to ascertain without its opposite. An 1887 Unitarian newspaper used “wellness” in its original sense, “the absence of sickness,” in a way that anticipates the contemporary meaning—the editorial asked the reader to pray for the “spiritual paralytics” that are prostrated on “sofas of wellness.” The joke, here, is that comfort can be its own anxious, incurable affliction. Wellness, in its former meaning, was at least an achievable objective: you could be not sick. Wellness as an “actively pursued goal,” however, is not only elusive but easily and boundlessly monetizable.

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From Unity: Freedom, Fellowship, and Character in Religion, September 24, 1887

6 decades later, Herbert Dunn, a physician at the U.S. Office for Vital Statistics, coined the new term in a series of lectures delivered at a Unitarian church in suburban Washington, D.C. In “High-level Wellness for Man and Society,” published in the American Journal of Public Health in June 1959, Dunn argued that the medical profession’s dichotomous emphasis on the prevention of illness (rather than the promotion of wellness) had ignored “a fascinating and ever-changing panorama of life itself, inviting exploration of its every dimension.” “Wellness” is Dunn’s term for this panorama, a combination of spiritual, psychological, and physiological health.

With “wellness,” Dunn aims to restore to the self a sense of integrity lacking, he believed, in modern society in general, and medical bureaucracies in particular. Dunn accordingly understands wellness as an expression of two underlying forces within the self.  Firstly, it is nourished by what he calls “the creative spirit,” an “expression of self” he understands in completely individual, and inward-looking, terms. “With creative expression,” he writes, “comes intense inner satisfaction.” Firstly, in a move that appears to anticipate the New Age or Orientalist trappings of later wellness doctrines grounded in broad claims about “eastern” religious practices, Dunn describes wellness as a harmonious blending of body and spirit. He attributes the medical profession’s inability to move beyond the sickness/unsickness duality to a failing of “Western culture,” our cleavage of the physiological and the spiritual.

As if we could divide the sum total of man thus! … In fact, the essence of the task ahead might well be to fashion a rational bridge between the biological nature of man and the spirit of man-the spirit being that intangible something that transcends physiology and psychology.

The task is especially urgent, Dunn explains, because in a world whose population is getting older, larger, more alienated, more neurotic, and more desperate for ever-dwindling resources, “it is probably a fallacy for us to assume, as so many of us have done, that an expansion in scientific knowledge can indefinitely counterbalance the rapidly dwindling natural resources of the globe.” Wellness, despite its current reputation for sunny optimism—thanks to its association with northern California, Oprahyogurt, etc.—emerges out a Cold War moment of pessimism about modernity. In the most ambitious part of the article, when Dunn proposes the development of wellness metrics, the concept begins to sound like it belongs in a Philip K. Dick dystopia.

Select groups of people who are disease-free and who are making full use of their talents, capacities, and potentialities; then measure them by biochemical, functional, and psychological tests to establish the characteristics of those enjoying a high level of wellness. Such groups would need to be selected so as to be representative of the various ages, sexes, and racial combinations.

Measuring wellness will be a challenge, Dunn concedes, given the abstract nature of the concept.  “Since the nature of this goal is ever changing and ever expanding, we will probably never reach it in absolute terms,” writes Dunn, somewhat apologetically—but it is this aspect of wellness that has led to its enduring popularity.

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“Peak wellness: the extreme opposite of death,” from Dunn’s “High-Level Wellness”

“Wellness” in its contemporary form was popularized by Dr. John Travis, a physician whose Wellness Resource Center, founded in 1975 in Marin County, CA, retained Dunn’s emphasis on personal autonomy and responsibility, his critique of conventional medical care, and his interest in spiritual or psychic well-being, but discarded his pessimism. “Wellness isn’t a term you hear everyday,” said Dan Rather in a 1979 60 Minutes report often credited with mainstreaming Travis’ still-countercultural Center. Wellness is “self-care” and an “an ongoing state of growth” both physical and spiritual. We don’t prescribe, says Dr. Travis: “our goal is to help the person discover why they are sick.”

As an “ongoing state of growth,” wellness is a receding horizon, which brings us back to the two OED definitions. While it’s possible to say, or at least to feel, that you are no longer ill, you can always be more “well” than you are. This intersects easily and perhaps insidiously with the emphasis on “self-care,” enhancing the stress wellness is supposed to address, as we become ever more anxious about our failure to become less anxious. Wellness discourse, especially once it migrated into the arsenal of “human resources” departments, emphasized personal responsibility for health. It was up to the employee—and sometimes required of her—to quit smoking, drinking, sleeping around, and eating Doritos.

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Dr. John Travis, in the 60 Minutes report on the Wellness Resource Center

The rhetoric of personal autonomy in “wellness” culture recalls the origins of “DIY” and “maker” culture in northern California around the same time, and one can argue that it has suffered a similar fate. In Rather’s 60 Minutes report, he asked a group at the  Wellness Resource Center to respond to  criticism that wellness was a “a middle-class cult” (this was the 70s, after all). One woman responded that if wellness was a cult, it was one in which  “you’re the leader, you’re your own guru.”

Captured by corporations eager to appropriate this libertarian spirit, “wellness” became a niche market for middle-class consumers. The psychologist Lotte Marcus discussed its ascendant popularity in a 1991 Mother Jones article, “Therapy Junkies,” that attributed what she calls the “cult of wellness” to the Reagan era, which as we have seen is not exactly true, but makes political sense given the way in which wellness’ emphasis on “personal responsibility” dovetailed with the Reaganite use of this same moral vocabulary. Linking wellness to the then-popular issue of workplace “stress,” Marcus decries

telegenic wizards, live seers, and mail-order curanderos ready to ward off whatever phantom villains or microbes may be diagnosed as the root cause of a long-standing complaint, by prescribing a remedial regiment, say, of diet, ritual recantation, positivist thought, the use of do-it-yourself improvement kits, and the purging of a variety of ‘toxins’—social, familial, nutritional, and astral. In this way, sufferers…are often condemned to living perpetual reruns of their roles as victims. As a result, they’re sometimes driven to prolong their pain and anguish, beyond the point where it ought, humanly, to be borne.

Marcus’ “mail-order curanderos” are now online, hustling vitamin supplements, detox regimens, and all manner of enemas.

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The fact that you can never definitively achieve “wellness” makes it an industry open for theoretically limitless expansion into more high-end niches, as the Global Spas Summit’s 2010 report, “Spas and the Global Wellness Market: Synergies and Opportunities” argued. Wellness is popular among affluent consumers who value “sustainability, authenticity, and local sources,” the GSS announced, and this core market

positions the spa industry as one of the most logical sectors to take advantage of (and help lead) the wellness movement. Wellness also provides an opportunity to reshape the image of spa, to regroup after the global recession, and to position spa as an investment or an essential element in maintaining a healthy lifestyle.

[sic: there are no articles in front of “spa.” It’s not “the spa,” “a spa,” or “spas.” There is only “spa.”]

Finally, most private health insurance now includes some kind of employer-sponsored “wellness” program, which combines cash bonuses, prizes, or insurance discounts with gamified nutrition and exercise programs (my own employer offers “wellness bucks” in return for meeting certain benchmarks. Quitting smoking will get you a travel mug). “A company’s most precious resource is its employees,” writes well-known health charlatan Mehmet Oz in Oprah Magazine about such programs. Despite the obvious fallacy in this sentence—an oil company’s most precious resource, for example, is obviously oil, since unlike employees, it is a non-renewable resource—Oz makes a valid point here. Employees’ health isn’t valuable because workers’ lives outside the workplace are important—the reason why labor movements struggled for occupational safety standards and health insurance in the first place. Rather, wellness matters because employees’ health and happiness will maximize their productivity at work.

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Harvard Business Review confirmed Oz’s theory in a study that showed employee wellness programs were, in fact, worth the investment: “healthy employees cost you less” (“you,” here, are the managers to whom HBR is addressed) by minimizing insurance costs. Other benefits to the firm were less measurable though no less important, the report argued. And here, despite wellness’ long “journey,” as they say in the wellness biz, from its coinage in 1959, we come circling back in unlikely fashion to Dunn’s original theory that wellness’ most lasting benefits were the intangible ones of “spirit.” HBR pointed out that employee wellness programs don’t just make employees more inexpensive, but also more loyal, a quality hard to measure but impossible to overvalue: “investment in wellness can, when executed appropriately, create deep bonds,” a theory they illustrated with the following, unsettling anecdote:

When MD Anderson initiated its wellness program, president John Mendelsohn took walks throughout the building with wellness coach Bill Baun. For many, it was the first time the president had been in their work space or had shaken their hand, and he tended to start conversations with “How’s your wellness?”

In this sense, wellness programs might help the modern firm finally resolve what Dunn, wellness’ original prophet, described as the “western” schism of body and spirit: both now belong to your boss.

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