What is wellness? The word “wellness” is used by many people and organizations, especially since the sharp rise in healthcare costs, diabetes and obesity during the past decade. Wellness has a history of being defined within a disease framework, meaning reducing health risks and preventing disease. Those are good goals, but it’s an outdated vision. A new vision was articulated by a few innovators, including Wellness Inventory creator Dr. John Travis
Flashback: while fulfilling his residency in preventive medicine at Johns Hopkins and the the Health Services Research department of the US Public Health Service, Dr. Travis was also a protégé of Lewis Robbins, MD, creator of the Health Risk Assessment (HRA), currently used by most employers and insurance companies. Dr. Travis created one of the earliest computerized HRAs, but soon realized that this approach failed to address the attitudes and beliefs underlying high-risk behaviors that determine wellbeing. He explored the work of Abraham Maslow and other leading visionaries, including Halbert Dunn, MD, whose book, High-Level Wellness, was an important catalyst to Dr. Travis' vision.
A New Vision: Dr. Travis decided that rather than treating sick people, he would dedicate his life to inspiring people to be well. After creating his breakthrough wellness model, the Illness-Wellness Continuum (below), Dr. Travis opened the first wellness center in the United States in 1975, the Wellness Resource Center (Mill Valley, CA). There he developed an innovative program for personal lifestyle change that focused on self-responsibility and engaged the whole person — body, mind, emotions, and spirit.
Dr. Travis created the first wellness assessment, the Wellness Inventory, as a whole person intake for his new center. The work at the center championed "wellness" and attracted media attention including 60 Minutes with Dan Rather in 1979. His classic Wellness Workbook, which has been used by wellness and health promotion educators in undergraduate and graduate programs in universities for over 30 years, is still used and quoted today as a foundational wellness vision. Working with Dr. Travis, we adapted and expanded the original assessment into a robust online wellness program.
Three Key Wellness Concepts
Beyond basic prevention, achieving balanced wellbeing is an ongoing process.
KEY CONCEPT #1: ILLNESS-WELLNESS CONTINUUM
Wellness is a process, never a static state.
The Illness-Wellness Continuum is the first of Dr. Travis’ three key wellness concepts. Most of us think of “wellness” in terms of “illness” and assume that the absence of illness indicates wellness. There are actually many degrees of wellness, just as there are many degrees of illness. The Illness-Wellness Continuum illustrates the relationship of the treatment paradigm to the wellness paradigm. An individual can move beyond the “neutral” point to increasingly higher levels of wellness.
Moving from the center to the left shows a progressively worsening state of health. Moving to the right of center indicates increasing levels of health and wellbeing. The treatment paradigm (drugs, surgery, psychotherapy, and so on) can bring you up to the neutral point, where the symptoms of disease have been alleviated. That’s all it’s designed to do.
On the other hand, the Wellness Paradigm, which can be used at any point on the continuum, helps you move toward higher levels of wellness. The wellness paradigm directs you beyond the neutral point and encourages you to move as far toward wellness as possible.
If you are ill, then treatment is important, but don't stop at the neutral point. Use the wellness paradigm to move toward high-level wellness! This makes all the difference in quality of life!
Even though people often lack physical symptoms, they may still be bored, depressed, tense, anxious, or simply unhappy with their lives. Such emotional states often set the stage for physical and mental disease.
Diseases such as cancer can be brought on by excessive stress that weakens the immune system. Medical science has demonstrated that negative emotional states can also lead to abuse of the body through smoking, over consumption of alcohol, and overeating – these behaviors can be attempts to fill the void left when other basic human needs are unmet, such as acknowledgment and respect, a stimulating and supportive environment, and a sense of purpose and meaning.
High-level wellness involves giving good care to your physical self, using your mind constructively, expressing your emotions effectively, being creatively involved with those around you, and being concerned about your physical, psychological and spiritual environments. In fact, it less important where you are on the continuum; it’s more important which direction you're facing – toward illness or wellness.
High-level wellness doesn’t preclude periods of illness and weakness, nor does it attempt to deny that death is a natural part of life. We know that genetics and other factors can cause disease. High-level wellness simply defines choices we can make over things we can control in our life, including our behaviors.
The Illness-Wellness Continuum was first envisioned by Dr. Travis in 1972, late one evening at his office at the U.S. Public Health Service hospital in Baltimore. It was a melding of Dr. Lewis Robbins health risk continuum (the basis of his Health Risk Assessment), Maslow's concept of self-actualization, and the high-level wellness model proposed by Halbert Dunn, MD, PhD in 1961.
Once published in 1975, the Dr. Travis’ Continuum became an immediate success, an easy way to illustrate what this newly emerging wellness concept was all about. Health practitioners and educators began using it, and soon it was appearing in books, journals, and slide presentations. With only minor modifications, it has withstood the test of time and remains a core concept today in textbooks worldwide. And it’s a core concept of the WellPeople approach.
KEY CONCEPT #2: ICEBERG MODEL
Illness and Health are only the tip of the iceberg. To understand their causes, you must look below the surface.
Icebergs reveal only a small part of their true size above water — about 90% submerged.
Your current state of health, be it one of disease or vitality, is just like the tip of the iceberg. This is the apparent (visible) portion. If you don't like your state, you can attempt to change it, do things to it, chisel away at an unwanted condition such as weight. But, like an iceberg, if you chip away a piece, another portion rises to the surface!
For true whole person life-balance and wellbeing, you need to dive deeper. To understand all that creates and supports your current state of health, you have to look below the surface of your wellness state. Science has clearly demonstrated that our conscious and unconscious can impact our mental and physical health.
The first level you encounter is the lifestyle/behavioral level – what you eat, how you use and exercise your body, how you relax and let go of stress, and how you safeguard yourself from the hazards around you. Many of us follow lifestyles that we know are destructive, both to our own wellbeing and to that of our planet. Yet, we may feel powerless to change them. To understand why, we must look still deeper, to the cultural, psychological, and motivational levels. Here, we find what moves us to lead the lifestyle we've chosen. We learn how powerfully our cultural norms influence us, sometimes in negative and obsessive ways, such as convincing us to deny an overweight problem or that excessive thinness is required to be attractive.
We can learn, for example, what "payoffs" we get from being overweight, smoking, driving recklessly, or from eating well, being considerate of others, and getting regular exercise. We can become conscious of any psychological payoffs based on dysfunctional childhood experiences such as burying our feelings as a way to gain approval.
Exploring below, to the next deepest level, we encounter the spiritual, being, and meaning realm (depending on your beliefs, this can be described as transpersonal, philosophical, or metaphysical). Actually, it’s more a realm than a level, because it has no clear boundaries. It includes everything in the unconscious mind, as well as concerns such as your reason for being, the real meaning of your life, or your place in the universe. The way in which you address these questions, and the answers you choose for yourself, underlie and permeate all of the layers above including physical health. Ultimately, this deeper realm helps to determine whether the tip of the iceberg, representing your state of health, is one of disease or wellness.
KEY CONCEPT #3: WELLNESS ENERGY SYSTEM
We are all energy transformers, connected with the whole universe. All our life processes, including illness, depend on how we manage energy.
Let’s start with science: nonequilibrium thermodynamics —
it’s not as complex as it sounds!
In 1977, Professor Ilya Prigogene won a Nobel Prize for his theory of dissipative structures – open systems in which energy is taken in, modified (transformed), and then returned (dissipated) to the environment. Examples:
- A rock or a cold cup of coffee is a closed system because it doesn’t channel and transform energy in this way.
- A seed, which constructs a plant from soil, air, and light, is an open system. So is a town, one of Prigogene's favorite examples. In the town, raw materials are converted into other objects by factories. These manufactured goods are then sent out into the world. Information and experience are processed in the town's schools with the end result being educated minds that are then released to make their impact on the world.
Now, look in the mirror. A human being is an open system. We take in energy from all the sources around us, organize it, transform it, and return (dissipate) it to the environment around us. Dr. Travis based the Wellness Inventory, in part, on the efficient flow of energy essential to wellness. Disease can be seen as the result of any interference with this flow. This is true of energy usage in all life processes.
When the energy flow is balanced and smooth, you feel good. When there is interference at any point – the input, the output, or in between – you may feel empty, confused, pressured, or blocked. Illness can be the result.
You have at least three major sources for energy input around you all the time. These are: 1) oxygen (Breathing), 2) food (Eating), and 3) sensory stimulation (Sensing) such as physical touch, heat, light, sound, and other forms of electromagnetic radiation. In addition, there are the less tangible inputs: emotional/spiritual information such as attention, caring, enthusiasm, and love – all with psychological and physical implications for wellbeing. The three energy inputs are represented in the color wellness wheel below, along with the energy outputs.
You are the channel or the transformer of energy sources. For the human organism, the list of modifiers of energy is much greater. Your sex, blood type, the pigmentation of your skin, and other racial characteristics are your genetic inheritance; there isn't much you can do about them. Over other conditions, however, you have much more voluntary control. These include your education and beliefs, previous experience, the activity of your nervous system, your flexibility, strength, body weight, emotional development, muscle tension, general state of health, and functioning of organs. The less measurable factors of sensitivity, open-mindedness, and self-love are also up to you.
We use part of the energy we take in to maintain the channel, to build and repair the body itself and much of it occurs during our all-important sleep periods.
At the most elementary level, we use energy to maintain a narrow internal temperature range (around 98.6°F/37°C), as circulating blood brings heat to cold areas. We secrete digestive juices for breakdown and absorption of food. We synthesize chemicals that are sent to many different organs. We produce electrochemical impulses that travel throughout the nervous system.
Taking a step up in this energy transformation process, we replace worn tissue and blood cells, repairing cuts and scratches, and mending bones. We move muscles that control digestion, respiration, elimination, and reproduction.
And don't forget those less tangible expressions of energy – the generation of emotions, the internal dialog of your thinking processes, your intuition, dreams, and the creation of what may be spiritual insights and altered states of consciousness.
The outside world will also be affected by the ways you transform energy. You radiate heat and eliminate waste products in the form of urine, perspiration, carbon dioxide, and the shedding of dead skin. The rest of us will be affected by your touching, your physical work and play, your laughter and sadness. We will learn about you, and ourselves, through communication, the sharing of intellectual pursuits, and the expression of creativity.
The life-processes of Self-Responsibility and Love, Moving, Feeling, Thinking, Playing and Working, Communicating, Intimacy, Finding Meaning, and Transcending, make up the energy outputs of the Wellness Energy System.
You can't help but influence the planet by your interaction with the environment. And there is no doubt that your loving energy will change us all. Putting together the input and output, we have the complete Wellness Energy System of a human being as represented in the color wellness wheel. It’s amazing how all 12 dimensions impact our whole person wellbeing.