This Can Be Our Health
But first: what is health, anyway?
I have a fraught relationship with the term “sexual health.”
I say this as someone who self-describes as a sexual health writer in social media bios and casual conversation. I’ve found this to be the most convenient way to explain my work, which is both highly specific to STIs and about so much more than pathogens. And if I’m being honest, it’s nice to have a way to reference what I write about without needing to explicitly mention STIs. I’m not always in the mood for raised eyebrows, awkward responses, or silent wonderings about my status.
Sometimes I say sexual health because there aren’t better words for what I want to say. But I am always looking — for more expansive language, for language less loaded with legacies of moralism and binarism. Healthy versus unhealthy, the former good and the latter bad.
When I think about sexual health, I can’t help but think of the posters on college campuses that demonize HPV to scare you into testing and condom usage. The credentialed clinicians I’ve seen who know less about herpes than I do. The sex educators who only address STIs by sharing how to detect and avoid them. Always in the name of health.
Filing my work under sexual health can feel like I’m aligning myself with a field that is largely unconcerned for — and sometimes even hostile towards — people like me. Despite growing acknowledgement that sexual health encompasses more than just issues of reproduction and STIs, mainstream discussions of STIs still typically promote the idea of health as the absence of infection. If health is the absence of infection, then does having herpes make me unhealthy? If health is the absence of infection, then is my interest in STIs an interest in sexual unhealth? What is health, anyway?!
Years ago, I read something that has stuck with me ever since. In her book Wild Health: Lessons in Natural Wellness from the Animal Kingdom, Cindy Engel writes: “Repeatedly, animals appear to be in good condition when blood and fecal tests show infection with pathogens or parasites. We have to conclude that it is normal — natural — to be infected with low levels of pathogens and parasites in the wild, but that somehow these are kept below symptomatic levels.”
She goes on to say: “Whether you consider such animals to be healthy or not depends on whether you think the presence of the pathogen is the same as the presence of the disease. In my view, it is not necessarily the same: to carry pathogens without showing symptoms might be considered a sign of extremely good health.”
Although Engel was speaking here about non-human animals, I remember reading these passages and thinking about the herpes simplex virus inhabiting my spinal ganglia. Was its presence an indication of poor health or its relative silence “a sign of extremely good health?”
I came across something similar in the book I’m currently reading, Inflamed: Deep Medicine and the Anatomy of Injustice by Rupa Marya and Raj Patel. The authors tell of the experiences of the Yanomami people in the Amazon rainforest with Chlamydia trachomatis, the bacterium that causes chlamydia. “Outside their community,” they write, “the organism is responsible for causing blindness, through repeated cycles of infection and inflammation. The Yanomami are widely infected, but they don’t suffer the inflammation, and they don’t go blind from it. Their coevolved relationships with the microbial ecology inside and around them have trained their immunity to not react with inflammation, even in the face of infection.”
As Marya and Patel explain, this example aligns with 19th century pathologist Rudolf Virchow’s hypothesis that “a bacterium doesn’t create a disease, but the body’s inflammatory reaction to it does.” (This concept — that the existence of a pathogen in the body and the impact of a pathogen on the body are two different things — accounts for the shift in terminology from STD to STI in recent decades. Disease refers to disorder in the structure or function of all or part of the body, whereas infection simply means that a pathogen is present.)
I am once again asking: 👏🏼 what 👏🏼 is 👏🏼 health?
Allow me to share some definitions from the web:
According to Oxford: “the state of being free from illness or injury” or “a person’s mental or physical conditions”
According to Merriam-Webster: (1) “the condition of being sound in body, mind, or spirit” or “the general condition of the body,” (2) “a condition in which someone or something is thriving or doing well” or “general condition or state”
According to the World Health Organization: “a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity”
Health as a state, health as an optimal state, and health as the absence of illness. None of these usages alone paints a sufficient picture, and even taken together, it’s still not clear what health actually entails. What does it mean to be “sound” in body, mind, or spirit? What constitutes well-being? If health is a state of “complete” well-being, is it something we ever
achieve experience, or is it an ideal/idea?
I used to study traditional western herbalism, whose approach to medicine is to seek to restore balance in the body. Balance implies relationship — between parts or units. Relationship isn’t evident in the above definitions, but I don’t think we can understand health without it.
That’s because nothing exists outside of relationships. The relationships between the bacteria in my body. The relationships between my organs. The relationships between me and everything I eat. The relationships between soil, fungus, and plant. The relationship between earth and sun. The relationships between me and you and you and you and you ad infinitum. I mean this spiritually, sure, but I also mean this on the most literal, material biological level. We sustain ourselves by inhaling, exhaling, drinking, peeing, eating, pooping. Everything we take in once belonged to another, and everything we expel returns to the commons. There is no viable individualism in a world like that.
The word “health” evolved from an Old English word for “wholeness,” which apparently comes from the same Proto-Indo-European source as the Old Norse word helge, meaning “holy, sacred.” In Hebrew, my mother tongue, the word for “health” (briyut) shares its root with “creation” (briya) and “creatures” (briyot).
Can we say that health is mutually life-affirming relationship between parts of a system? Can we say that what is healthy is that which brings us into deeper loving connection with other creatures and with life itself?
This kind of relational view of health would invite us to release the notion that things are intrinsically either “healthy” or “unhealthy.” It would ask us to approach collective problems with collective solutions (*cough* COVID *cough*). It would prompt us to embrace process, fluidity, and nuance. This can be our health, if we want it.
Or can it? Has “health” been weaponized out of commission? All in the name of health: eugenics, anti-fatness, HIV criminalization, the racist origins of gynecology, blood bans… the list goes on.