The Continuum

 



In 1972, a physician by the name of John Travis developed the above scale to help identify levels of illness and wellness in individuals or groups. He believed that wellness was a process, not a static state of being, with individuals moving up and down the scale throughout their life spans.

 Travis was trying to incorporate a humanistic and psychosocial approach that went beyond a disease/ "physician in control" focus. I see a lot of merit in this scale but I also see some discrepancies due to the fact that it is still very much  based on  the medical model.  It basically describes illness (he just added mental illness into the pot)  that can be diagnosed and treated by a physician once disability, symptoms and signs become apparent.  Most of us know by now...that a lack of wellness is determined by much more than a disease (be it mental or physical) found in a medical manual and that high levels of wellness can be obtained and maintained despite a medical diagnosis.  I also do not agree with the suggestion that signs show up before symptoms on the road to disability.  In other words, this model proposes that despite what a patient is experiencing...unless the test results and what the physician determines as sufficient objective data show up... the patient is not disabled or ill.  Doctors are placed in a position where they and only they  can determine how well or how ill someone is.

What is missing from this model, then, is the priority of patient experience over other observation.  What is also missing from this model is a holistic approach with the patient at the center of the locus of control.  Treatment from the outside, with medical interventions, can begin only after signs are determined by the diagnosing physician.  The goal of treatment is to push the patient past the neutral point to awareness. As if to say...the patient is not aware of their experience prior to that point; the patient has no control of their experience when they are "unwell" until someone outside themselves says "This is what is wrong with you and I am going to tell you what to do about it!"  After treatment, the physician "enlightens" the patient and education can begin.  So we had diagnosing based on signs seen by the physician before the patient's subjective experience is questioned.  The patient is pushed by someone outside themselves to the neutral point and only from there  can they become aware enough to seek education from others ( proponents of the medical model) on how to stay well as they grow into a very limited and restricted version of health...which is simply determined by how far away from "disease' one is. The use of  "growth " is limited ironically by the limitations of disease.

The development of the continuum has definitely advanced us further.  It does have its merits. This was a big step in 1972...Our society had to step away from the focus on physical disease and to recognize the disability that mental health can cause in individuals lives.  Mental illness was not accepted or recognized, treated and healed the way it could have been up to that point. According to Travis, just because people do not have a diagnosable physical condition...they still may have a mental one.  So true.

Unfortunately, however, returning to wellness on this continuum  is still a physician controlled process.    It is  saying that patients below the neutral point...still need to be labelled according to their signs, and then their symptoms before disability is recognized and treated. If the label cannot be found in the pathophysiology text, it will be found in the DSM 5.  Wellness then is determined by the absence of physical or mental health. One or the other.   We are still focusing on the absence of disease, are we not?

 

Where I stand on this continuum

 

This continuum doesn't work for me.  I don't fit into any slot very easily. Where am I?...I believe my body is hovering along the yellow, feeling the orange but because others are not looking clearly enough...bypassing the green.  According to others...there is just not enough green to say I am on this side of neutral.  I see enough signs but in this model it is not about what I see and think, is it? My interpretation of my experience is not valued.  I am told I need someone with an MD behind their name to tell me there is enough signs to make my symptoms valid, to give me a label and render me physically disabled.  If I do not get that...I am more or less told I have no business being here and I better scoot my sorry ass up the continuum to at least neutral. If I insist that at least part of me is still struggling down in the green zone...then...it isn't a physical ailment leaving me there  but a mental one.  I must either be lying or  mentally ill if I have symptoms with a limited amount of approved signs.   Any professions of illness on my part have to be validated by a professional in order for others to accept my being where I am.

 

I strongly believe that if some physician was willing to spend the time in examining my family and myself  they would discover that many of us are physically on the orange ( at risk for premature death) and many have actually advanced to the red ( death) because of an inherited cardiovascular condition. I am speaking of my siblings as well as my paternal cousins.  Just in the last 12 years 6 family members including my own sister, under the age of 60, have died suddenly because of a cardiovascular crisis. My father  lost 4 brothers under 60 to sudden cardiovascular related death.  He himself had his first MI at 50.  My other surviving sisters had their MI's or cardiovascular events in their early 50's as well. (40-60 being the time frame in which this undiagnosed condition tends to manifest itself, with the exception of me.  I was much younger when I first started to get symptoms). At quick glance , however, it seems to be much easier for "others" to ignore this as coincidence and  slap me with a liar or  mental illness label to explain my symptomology, then it is for them to explore the possibility of inherited cardiovascular disease. Once that mental illness or dishonest  label is placed on an individual...all signs indicating otherwise seem to go unseen and unvalidated.

 

 

And what about the criteria on the other side of neutral?  Where do I fit there?  Mentally, emotionally, spiritually I am well above neutral.  I am actually very aware of my condition and myself.  I am more aware than most of what my body and my mind are doing.  I am seeking awareness on even higher levels of understanding.   If I am stuck on the other side under a mental illness label, how come I am so aware? No one has told me that my symptoms are real and no one has given me permission to be "disabled".   No one has told me exactly what was wrong and what to do about it.  Yet I am in the blue zone with my awareness.  In fact, I was always aware.  Am I educated?  I am very educated on the subject of physical and mental wellness and lack of. I educate on these subjects.  No one is educating me...because no one is validating the signs.  Does that make me any less educated?   No...far from it.  It spurs me on to learn more about myself and why my body is doing what it is doing. And I am growing over and beyond conventional understanding and this notion of limitation. I am obviously very much in the blue advancing toward high level wellness without "other" intervention.

 

So part of me is on one end of the spectrum and the other part of me...at the exact same time... is on the other.  How can that be?  There is much more to wellness than this continuum allows for. Despite my present (and temporary) physical limitations, I consider myself to be very healthy!

 

The Other Dimensions 





We need to examine the other dimensions of health?  In 1942, the World Health Organization defined health as "a state of  complete physical, mental and social well being and not merely the absence of disease or infirmity."   And to take it a step further and a step back to the health practices that have gone on long before Hippocrates, Health is balance between mind, body and spirit. Do we see these things on this continuum or in the medical model?  No

Complete well being is not placed on this model even though the importance of mental wellness is recognized. Why? Complete well being is fostered by the individual, controlled by the individual and obtained by the individual. Complete well being is a spiritual well being! Medicine cannot ensure that.  Oh they can help...for sure...remove symptoms and stop the body and possibly the mind from failing quickly but without inclusion of the spirit...there is no complete well being.

Spirit determines wellness and it tells us we are all in the blue zone.  We all are capable of high level wellness and beyond.  There really is no "disease' anywhere but in our thinking. The only thing bringing us down the continuum ...to the green, yellow, orange and red is our limiting belief systems and our reliance on models like this one.  :)

There are cases out there where people who knew this...people who believed this...people who owned this truth...were able to heal others and themselves.  They were able to go from the orange to the blue miraculously without the help of medical intervention.  Or they...despite what label was placed on their chart by a physician...never did suffer the symptoms or the disability expected. By putting our attention on "growth" through awareness and education ( the relearning of who and what we really are) we can soar into the place where we are meant to be. 

Yes...we travel up and down a continuum of well being. We are constantly learning and forgetting, believing and mistrusting, questioning and testing our beliefs as human beings.  It is for that reason we go up and down the continuum. It is faith and trust in life that keeps us in the blue...not a diagnosis or prescription.

All is well in my world!