What is Health and what is Illness? (Wilfried Rappenecker)

As a young physician in the 80’s, I turned to shiatsu because I constantly had the incling that something was “not quite right” in the way classic western medicine was being practiced. It was as if the connection to the way life really is, was completely missing …it was missing a connection to the life of the patients in the hospital and practice. It also lacked every trace of what life meant to me. I wanted to know what this missing element was and to understand what truly defines health in relation to illness because that also must be a kind of definition of life itself.

The definition of health (and illness) which classic western medicine gave seemed very superficial. Simply said, it stated that illness is when something is not “okay” with the body (or soul) and if no illness is at hand, one is healthy.

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For a while I was enthused by the visionary proposition which the WHO made in their definition of health. They maintained that health was more than an absence of illness but rather an encompasing state of well being. However, my work as a Shiatsu therapist disclosed to me that this definition was on the other hand too visionary. It did not really allow for a true or useful statement about a given persons state of being.

I for one have never met a person who has found himself in such an overall state of well being for more than a few hours or days. Thus most people would be considered in a state of health for only a few hours or days at a time but never for a meaningful length of time in their lives.

Therefore I would like to dare to propose a different definition of health, which has proven to be quite meaningful in my practice. It is a definition, which has continued to gain in meaning for my practical work and has fundamentally influenced my teaching:

A state of health is a continuing and ongoing process of development of a person …as part of a greater whole

This process of development does not by nature follow an even and regular rhythm but is subject to take place in smaller or larger steps.

Such phases of development are an expression of health. Often these phases will be subjectively experienced as phases of uncertainty or feeling ill at ease (“dis-ease”) or even as illness, (be it expressed physically, socially, psychologically or on a more spiritual level). However, these phases are always an expression of a positive life force, which strives towards continual development and evolving, and they are by nature transient.

Thus, in this proposal of health, a state of unease or even the feeling of suffering or illness are not necessarily to be considered in conflict with the definition of a state of health. Instead, one would have to consider them as an important and integral part of health.

This may seem very paradox at first. Yet, it does make sense if one reflects upon it for a moment. This holistic perspective brings forth an understandable meaning to the typical children’s diseases, which in a sense provide an essential building block for the development of a child. Likewise, painful experiences or crisis of a person’s life, which may be manifested in physical illness or disease, become recognizable, when retroflected as an important time of change and as a positive occurrence in a person’s life.

There are many reasons for this view on health

Classical western medicine, which is based on a scientific orientation, sees a person from an anatomical and physiological perspective of growth and development only during the phases of childhood and youth. However, as a fully-grown adult the person is viewed as a static and completed work. The definition of health being presented in this article stands in contrast to this static view because it presumes that a being is in an ongoing process of growth and development for the entirety of its life. Problems and crisises are an integral part of this process of development and evolving.

Suffering and illness are strongly segregated from the concept of health in the general consciousness of our society. Health and well being are defined as equivalent to “right”. Suffering and illness are labeled as “wrong”. The definition of health, which is being proposed here, makes this concept of right and wrong obsolete and not applicable. Suffering and many aspects of illness are the expression of a process of growth. They are a part of health; and can (without any sadomasochistic tendencies) be seen as an integral and welcome part of a positive process of growth and evolving.

The presumptuous notion of classical western medicine, as well as the “health” concept proposed by the WHO, have had the consequence that the absence of pain or discomfort are viewed as a basic human right. Thus even the inevitable death of a person becomes disputable.

Such an outright rejection of suffering, illness and death has the further consequence that such periods in ones life become meaningless and fruitless, thus increasing enormously the subjective experience of this pain, suffering or illness.

If instead, such periods (crisis, physical and psychological suffering or even the perspective of death that we all fear) are seen as necessary and positive, it lessens the perception of suffering and eases the process of development.

The perspective that suffering and illness are something fundamentally wrong which needs to be hindered or eliminated, creates a deep chiasm in a person which separates him from this kind of important and frequent experiences. This makes it difficult if not impossible to discover and to understand the positive function or purpose that a painful experience in my life. Thus the experienced pain becomes even greater.

On the other hand, if one understands suffering and illness as phase in which one’s life as well as the whole person is simply less in balance or less in harmony for a particular period of time, one has a far more neutral point of view that does not automatically judge the experience as good or bad, desirable or to be avoided. This allows the person to accept; to experience suffering and illness, and to begin to understand it and the meaning it withholds about ones life.

What is Illness?

The definition of health being proposed here allows for a completely different view and understanding of illness. The strongest force, which brings about phases of suffering and illness in our lives, seems to be the ongoing and unyielding force towards growth and development. This is the most positive force in our lives even though it is not always perceived as such. This force seems to be an ongoing process or tendency towards a kind of liberation.

Accordingly most problems and illnesses take place in crisis filled times of change. Insecurity, fear (which may not be consciously experienced) bring about resistance, rejection and denial. It is these states of being, which actually cause the experience of suffering, and maybe the main root for physical and psychological illness. The problems and illnesses created by this striving force, are not only positive and the expression of growth itself, but are also transitory in nature. Its essence is that of a crisis. A crisis has a beginning, a climax and ebbs away until it finally disappears. The strongest influencing factor, which hinders this cycle finding its natural end, is resistance itself, mainly out of fear or unknowing.

Yet there are also other roots of illness and suffering, other than these two: the driving force to evolve and the resistance against it. A great deal of suffering seems to originate from a kind of abuse of the body or even the whole person. This abuse comes in part from the above described resistance, partly from not being better informed, as well as from following certain social conventions. We abuse our body through inadequate nutrition, use of drugs, out of laziness and a kind of unconsciousness of being in our body, just to mention some typical examples.

Since persons are always part of a particular social context (i.e. their families) in their joy as well as their suffering they experience the forces within a space, which they have not created individually. There is suffering and there are illnesses which do not seem in any way connected to that which takes place in the person’s life. Different cultures and their different schools of learning or belief have different answers when asking where such illnesses come from. Some will call it karma, fate, God’s punishment, genetic reasons, disposition, etc. Of the above listed roots of illness none are to be seen as absolute. They cannot be isolated from one another. Instead, they form a complex interplay. They influence one another and are more or less obvious in an illness.

This incomplete listing of some of the sources of illness also shows that not all suffering and illness is fundamentally transitory in nature and that not all “ends well”. However, it counts for most problems and illnesses and especially those that we most often encounter in a Shiatsu practice, that they are of a passing nature. Typical examples are: most problems of the body’s movement apparatus such as pain in the shoulders, joints and back; also functional disturbances of inner organs such as headaches, stomach ache or menstruation problems; psychological suffering or life crisis etc.

This understanding of health and illness can have far reaching consequences for our work. In Shiatsu as well as in any other holistic therapeutic approach it means that it is not in any way our purpose to work against a pain, a crisis or an illness with the objective to eliminate it. It is the purpose to accompany the person as these states present themselves, to encourage the person and support them to walk the path and find new solutions. The direct work with the body is a first class method for this approach. Also the importance and meaning of counseling support within our work becomes obvious.

This is certainly a positive perspective for our work! Imagine there is nothing, which needs to be combated, and nothing, which needs to be eliminated. Nothing, neither joy, illness nor suffering is without purpose nor do they become present within a person’s life without a reason. Everything has its place and its purpose. This does not mean that a person must remain stuck in the suffering of his or her illness, on the contrary.

Everything in a person is an expression of the most positive life force. To acknowledge this force in a person, in all its strength and beauty, is far more useful for resolving the essence of a problem than any attempts to combat the problem or to trick it into elimination. This means that we still can implement all our knowledge, all our experience and all our know-how. However, the goal is not to eliminate anything, on the contrary. It is about allowing things to happen and to allow the this life force do its work.

No matter what the problem or the illness, both are always infinitely smaller and less significant than the strength and beauty of a person, which need to be acknowledged. To focus primarily on the illness creates confinement and fear. It is therefore our job to look for and see the strength in a person, to see their beauty. Then do things become liberated to move on: new space is created, new solutions found, a new state of well being can establish itself.

This article far from exhausts this issue in all its different facets. Many things have not been discussed, such as questions about: the interrelation of illness and suffering (they are two very different things); the nature of pain (pain always means separating, not accepting, not allowing something to happen); what can one do (we, as well as our clients) in order to lead healthy lives. Although these questions were not treated in this brief article, the here proposed definition of health provides the basis to find answers to these questions.


© Wilfried Rappenecker, born 1950 near Köln (Germany), is director of the “Schule für Shiatsu Hamburg” (D-22769 Hamburg, Oelkersallee 33, http://www.schule-fuer-shiatsu.de), co-founder of the GSD und author of two books dealing with shiatsu. As physician for general medicine he mainly works with shiatsu.