The Meaning of Health

THE MEANING OF HEALTH PAUL TILLICH* The difficulty and the challenge ofthis subject is that in order to speak ofhealth, one must speak ofall dimensions oflife which are united in man. And no one can be an expert in all ofthem. But confronting this challenge is the destiny ofthe philosopher and the theologian, insofar as they should envisage the whole oflife. In any case, only a limited part ofthe immense problem can be covered. I. A Logical Consideration The title is not "the concept ofhealth," but "the meaning of health." Concepts are defined by subsumption to a more embracing concept; meanings are defined by being brought into configuration with other meanings. This method is in many cases more adequate and not less scientific than the method ofsubsumption. In our case, it is definitely adequate for a very fundamental reason. Health is not an element in the description ofman's essential nature—his eidos or ide, as Plato would say; his created nature, as theology would express it. Health is not a part of man or a function ofman, as are blood circulation, metabolism, hearing, breathing. Health is a meaningful term only in confrontation with its opposite—disease . And disease contains a partial negation ofthe essential nature ofman. Conversely, in order to understand disease, one must know the essential nature of man as well as the possible distortions of it. In contemporary language one would say that health and disease are existentialist concepts. They do not grasp something of man's essential nature; certainly they presuppose this nature and the knowledge ofit; but they add a new element , the possibility and reality of its distortion. Health and disease are very good examples of e>istentialist concepts. Like theology, medicine * Harvard Divinity School, Cambridge 38, Massachusetts. Prepared for delivery to the New York Society for Clinical Psychiatry onJanuary 14, i960. 92 Paul Tillich · The Meaning ofHealth Perspectives in Biology and Medicine · Autumn 1961 always did unite essentialist and existentialist elements in its thought. Therefore, psychotherapy, especially in its psychoanalytic form, and existentialism have influenced each other profoundly in the last fifty years; and the idea ofan existentialist psychotherapy is only a confirmation and systematization ofan actual situation. II. The Basic Dialectics ofLife Processes Life processes include two basic elements: self-identity and self-alteration . A centered and balanced living whole goes beyond itself, separates itselfpartly from its unity, but in doing so it tries to preserve its identity and to return in its separated parts to itself. Going out from one's self andreturning to one's selfcharacterizes life under all dimensions, from the structure ofthe atom to the growth ofthe plant, to the movement of the animal, to the creativity ofthe mind, to the dynamics ofhistorical groups. One can call this dialectics oflife processes because it implies contrasting movements, a yes and a no, as in a searching conversation. And all dialectical thought is nothing but a mirror ofsuch life processes. The contrast between self-identity and self-alteration produces two dangers for every living being. The first is to lose one's selfin going beyond one's selfand not being able to return to one's self. This happens ifspecial processes separate themselves from the whole and produce dispersion into too many directions, a wrong kind ofgrowth, a loss ofthe uniting center. In all these cases (which are represented by particular bodily and mental diseases and personal disintegrations) the self-identity is threatened and often completely lost (change ofpersonality and memory). In reaction to the awareness ofthis danger, the opposite danger appears. Afraid to lose one's identity, one is unable to go out from one's selfinto self-alteration. Perhaps one has attempted it, but after having been frustrated , one retreats to a limited form of existence in which the selfidentity on a reduced basis is preserved; and it is not only preserved, it is compulsively defended as in most cases ofpsychoneurosis. Ifwe ask how it can be explained that the dialectics oflife processes are interrupted and how its flux is stopped, we may name three main causes: accidents, intrusions, imbalances. A considerationofthesewouldleaddeeply into the philosophy oflife, and especially ofmedicine; we can only point to some characteristics ofthese causes...