Quality of life philosophy: when life sparkles or can we make wisdom a science?
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Animals↗
Biomedical subjects
Joav Merrick
Publications and source records attributed to Joav Merrick.
Quality of life philosophy I. Quality of life, happiness, and meaning in life.
In the Danish Quality of Life Survey, we asked 10,000 people about their quality of life with the validated SEQOL questionnaire with more than 300 questions on their quality of life. How did they feel? How content were they with their lives? How happy were they? Did they feel their needs were fulfilled? And many more questions. We asked the questions we believed to be important for their quality of life (QOL). The results were quite surprising and forced us to recontemplate the following philosophical questions: What is quality of life, happiness, and meaning in life? What is a human being? Do we need a new biology? Is the brain the seat of consciousness? How do we seize the meaning of life and by doing so, will we become well again? What are the key concepts of quality of life? The meaning of life is connectedness and development. It is about realizing every opportunity and potential in one"s existence. The opportunities must be found and acknowledged. What do you find when you find yourself deep down? You find your real self and your purpose in life. You realize that you are already a part of a larger totality. Antonovsky called it "coherence". Maslow called it "transcendence". Frankl called it "meaning of life". We call it simply "being". To test if these philosophical questions are actually relevant for medicine, we looked at the consequences for patients being taught the quality of life philosophy. Quite surprisingly we learned from our pilot studies with "quality of life as medicine" that just by assimilating the basic concepts of the quality of life philosophy presented in this series of papers, patients felt better and saw their lives as more meaningful. The improvement of the patient"s personal philosophy of life seems to be the essence of holistic medicine, helping the patient to assume more responsibility for his or her own existence.
Denmark↗
Quality of life philosophy III. Towards a new biology: understanding the biological connection between quality of life, disease, and healing.
This paper addresses (in a philosophical way) the complex and enigmatic interface between matter, life, and consciousness in modern medical science. The problem today in understanding living matter is not at the molecular level, but at the macro level where all molecular activities in the individual cell are coordinated, and especially at a higher level, where the activities of all the organism"s cells are coordinated. Although we understand very much of the body"s chemistry, we have only just started to get the gist of the tremendous organization of living matter. We are just beginning to acknowledge the enormous flow of information that is needed to make everything function in a healthy organism, including consciousness, where every cell does exactly what it has to do to make the organs function. A concept that seems to be able to bridge the scientifically very different domains of matter, life, and consciousness seems to be "biological information". If a cell is seen as a liquid crystal in which the cell"s molecules constantly connect in firm mutual relationships only to dissolve again and become fluid and free, whenever the cell needs it, the backbone of the cell seems to be the information that organizes the cell. For example, in cell motion a cell is able to crawl with the help of a skeleton of fibers that can be created guided by biological information, whenever the cell needs the solidity provided by the fibers. The moment it has finished crawling or intends to crawl in another direction, these fibers will dissolve again. The fibers are made of millions of molecules that connect in an arranged pattern, and they dissolve when these molecules again let go of each other. How the cell precisely regulates such processes is today a complete mystery. How cells cocreate consciousness is also an enigma. All we can do is describe the cell and the organisms arising from its cells as filled with energy and information as well as an unbeatable ability to organize itself way down to the molecular level, where apparently the cell is in control of almost every single molecule. Our understanding today of how the information is stored and how it flows through living matter is still very limited. The source of the qualities (the qualia) characterizing the human being as a whole--like joy, love, motivation, consciousness, free will, wisdom, intuitive competence--is still practically unknown and scientifically unexplained, more than 50 years after science has turned itself towards these fundamental problems. We believe that we need a radically new biology and medicine to give the scientific explanations of the structure, dynamics, and quality of life, and of its consciousness.
Animals↗
Quality of life philosophy IV. The brain and consciousness.
In this article we look at the brain's structure and function from a philosophical perspective. Although the brain at micro-level, with its trillions of ultra-thin nerve fibers, is one of the most complicated structures in the known universe, you can still grasp its composition if you go up to the level of the cell. How this structure functions is not quite clear. You can understand its function at fiber level, because it is fairly simple, and you can understand it at cell level, but it is already vague. Roughly speaking, you can envision a single nerve cell as a tiny, independent computer whose behavior is dependent on continuous calculations of all input. At organ level, the function can be understood as an extremely complex pattern machine. Finally, the brain"s function can be understood at the cognitive level as what provides consciousness through its ability to keep order in our complicated reality. The superior function of the brain is to connect the real us, our higher self, to the surrounding world. The brain has been developed so that it can create all possible complex patterns. The connectivity seems to imply that the patterns of the human brain are 1000-dimensional. It is our vision that these complicated patterns arise from basic patterns in the quantum matter of which everything is created. In our opinion, our consciousness" special utilization of a patterned aspect of nature is what lies behind inscrutable statements like "Man is created in God"s image". We suggest that these patterns in matter are the basic, creative force that influences all living organisms. Unfortunately, science has only just begun to understand these patterns. The Bible's description of the origin of man is two people eating from the Tree of Knowledge and as punishment they are expelled from the Garden of Eden. What does that mean? It means that, as conscious creatures, we no longer were an unproblematic, harmonious part of the world around us. The great question is why this consciousness about the world, provided by the brain, is not a gift that makes life better instead of getting us expelled from the Garden of Eden. We think that our real problem is the fact that we are still not in control of our consciousness. Instead of it serving us, we have become its slaves. If we come to understand brain and consciousness in order to solve this basic problem of our existence, we shall again be able to become a coherent part of the world, both as individuals and as a species. We share the vision that such an understanding of the problems of consciousness will make medical science holistic and will bring quality of life, health, and the ability to function to its patients.
Animals↗
Quality of life philosophy V. Seizing the meaning of life and becoming well again.
This paper presents a positive philosophy of life developed to support and inspire patients to take more responsibility for their own lives and to draw more efficiently on their known or hidden resources. The idea is that everybody can become wiser, use themselves better, and thus improve quality of life, subjective health, and the ability to function. To be responsible means to see yourself as the cause of your own existence and state of being. To be the one who forms your own life to your liking, so that others do not shape it in the way they prefer to see you. Seen this way, taking responsibility in practice is one of the most difficult things to do. One of the greatest and most difficult things to do in this context is to be able to love. To be the one who loves, instead of being the one who demands love, care, awareness, respect, and acceptance from somebody else. Since almost all of us have had parents who maybe loved us too little and mostly conditionally, we all harbor a deep yearning to be loved as we are, unconditionally. A lot of our energy is spent trying to find recognition and acceptance, more or less as we did as children from our parents, who created the framework and defined the rules of the game. But today, reality is different. We have grown up and now life is about shaping our own existence. So we must be the ones who love. This is what responsibility is all about. Taking responsibility is, quite literally, moving the barriers in our lives inside ourselves. Taking responsibility for life means that you are willing to see that the real barriers are not all these external ones, but something that can be found within yourself. Of course there is an outside world that cannot be easily shaped according to your dreams. But a responsible point of view is that although it is difficult, the problem is not impossible; it is your real challenge and task. If there is something you really want, you can achieve it, but whether it happens depends on your wholehearted, goal-oriented, and continuous attempts. This paper describes the philosophy about seizing the meaning of life and becoming well again, even when there is little time left.
Animals↗
Quality of life philosophy VI. The concepts.
The about a hundred central concepts related to research in the global quality of life can, in a holistic medical frame of interpretation, be organized under ten abstract key concepts: existence, creation of the world, state of being, daily living, talents, relations, sex, health, personal development, and therapy with subthemes as discussed in this paper. The paper shows that the concepts in each group can be seen as related to each other in a quite intuitive and logical way, to give a coherent quality of life philosophy that allows the physician to encourage, inspire, and support his patient. In every consultation, one new concept and idea of existence can be taught to the patient, helping him or her to realize the meaning of life, the source of joy, and the reason for the actual suffering. In this way, we help the patient to mobilize hidden and known resources and to improve quality of life, subjective health, and the ability to function. The concepts were harvested in 2003 at a Nordic seminar on quality of life research, held in Sweden. Life does not only cohere on the inside, but also on the outside. The same power that ties together all the cells in our body, seems to tie us together in relationships and new wholeness. This power evolves into new kinds of relations that unite on more and more complex levels, with the global ecosystem as the highest known level. Our intentions come from this coherent matrix of life. In the beginning of our life, the web of life itself gave birth to our fundamental purpose of life. The abstract purpose determines the frame of interpretation of reality: How we will perceive ourselves throughout life, our inner life, and the world around us. The frame of interpretation is pitched in language and concepts, in fact it creates our perceptions. Based on these perceptions and our purposes of life, our behavior arises. Our consciousness evolves through the witnessing of our behavior and through the response caused by it. Through the slowly acquired mastering of our surrounding world, we obtain our power, which gives us success in life, when we use it responsibly and unite it in harmony with our deepest purpose of life. When many people experience not having success, it is because they are not conscious about their original purpose or the deepest meaning of their lives. They do not know themselves. They do not experience the world in that way and do not realize that they themselves are the cause. Therefore responsibility and self-knowledge, which add up to wisdom, are the ways to a good and successful life.
Animals↗
Quality of life philosophy II: what is a human being?
The human being is a complex matter and many believe that just trying to understand life and what it means to be human is a futile undertaking. We believe that we have to try to understand life and get a grip on the many faces of life, because it can be of great value to us to learn to recognize the fundamental principles of how life is lived to the fullest. Learning to recognize the good and evil forces of life helps us to make use of the good ones. To be human is to balance between hundreds of extremes. Sometimes we have to avoid these extremes, but at other times it seems we should pursue them, to better understand life. With our roots in medicine, we believe in the importance of love for better health. The secret of the heart is when reason and feelings meet and we become whole. Where reason is balanced perfectly by feelings and where mind and body come together in perfect unity, a whole new quality emerges, a quality that is neither feeling nor reason, but something deeper and more complete. In this paper, we outline only enough biology to clarify what the fundamental inner conflicts are about. The insight into these conflicts gives us the key to a great deal of the problems of life. To imagine pleasures greater than sensual pleasures seems impossible to most people. What could such a joy possibly be? But somewhere deep in life exists the finest sweetness, the greatest quality in life, the pure joy of being alive that emerges when we are fully present and life is in balance. This deep joy of life is what we call experiencing the meaning of life.
Adaptation, Psychological↗
Holistic medicine III: the holistic process theory of healing.
It is possible to understand the process of healing from a holistic perspective. According to the life mission theory, we can stretch our existence and lower our quality of life when we are in crises, to survive and adapt, and we can relax to increase our quality of life when we later have resources for healing. The holistic process theory explains how this healing comes about: Healing happens in a state of consciousness exactly opposite to the state of crises. The patient enters the "holistic state of healing" when the (1) patient and (2) the physician have a perspective in accordance with life, (3) a safe environment, (4) personal resources, (5) the patient has the will to live, (6) the patient and (7) the physician have the intention of healing, (8) the trust of the patient in the physician, and (9) sufficient holding. The holding must be fivefold, giving the patient (1) acknowledgment, (2) awareness, (3) respect, (4) care, and (5) acceptance. The holistic process has three obligatory steps: (1) to feel, (2) to understand, and (3) to let go of negative decisions. This paper presents a theory for the holistic process of healing, and lists the necessities for holistic therapy restoring the quality of life, health, and ability to function of the patient.
Holistic Health↗
Holistic medicine: scientific challenges.
The field of holistic medicine is in need of a scientific approach. We need holistic medicine--and we even need it to be spiritual to include the depths of human existence--but we need it to be a little less "cosmic" in order to encompass the whole human being. Many important research questions and challenges, empirical as well as theoretical, demand the attention from medical researchers. Like a number of other practitioners and researchers, our group at the Quality of Life Research Center in Denmark together with groups in Norway and Israel are trying to tackle the research challenge by using conceptual frameworks of quality of life. We have suggested that quality of life represents a third influence on health beyond the genetic and traumatic factors so far emphasized by mainstream medicine. In our clinical and research efforts, we attempt to specify what a clinician may do to help patients help themselves, by mobilizing the vast resources hidden in their subjective worlds and existence, in their hopes and dreams, and their will to live. The field of holistic medicine must be upgraded to fully integrate human consciousness, scientifically as well as philosophically. We therefore present a number of important research questions for a consciousness-based holistic medicine. New directions in healthcare are called for and we need a new vision of the future of the healthcare sector in the industrialized countries. Every person seems to have immense potentials for self-healing that we scarcely know how to mobilize. A new holistic medicine must find ways to tackle this key challenge. A healthcare system that could do that successfully would bring quality of life, health, and new ability of functioning to many people.
Existentialism↗
The square curve paradigm for research in alternative, complementary, and holistic medicine: a cost-effective, easy, and scientifically valid design for evidence-based medicine and quality improvement.
In this paper we present a new research paradigm for alternative, complementary, and holistic medicine--a low-cost, effective, and scientifically valid design for evidence-based medicine. Our aim is to find the simplest, cheapest, and most practical way to collect data of sufficient quality and validity to determine: (1) which kinds of treatment give a clinically relevant improvement to quality of life, health, and/or functionality; (2) which groups of patients can be aided by alternative, complementary, or holistic medicine; and (3) which therapists have the competence to achieve the clinically relevant improvements. Our solution to the problem is that a positive change in quality of life must be immediate to be taken as caused by an intervention. We define "immediate" as within 1 month of the intervention. If we can demonstrate a positive result with a group of chronic patients (20 or more patients who have had their disease or state of suffering for 1 year or more), who can be significantly helped within 1 month, and the situation is still improved 1 year after, we find it scientifically evidenced that this cure or intervention has helped the patients. We call this characteristic curve a "square curve". If a global, generic, quality-of-life questionnaire like QOL5 or, even better, a QOL-Health-Ability questionnaire (a quality-of-life questionnaire combined with a self-evaluated health and ability to function questionnaire) is administered to the patients before and after the intervention, it is possible to document the effect of an intervention to a cost of only a few thousand Euros/USD. A general acceptance of this new research design will solve the problem that there is not enough money in alternative, complementary, and holistic medicine to pay the normal cost of a biomedical Cochrane study. As financial problems must not hinder the vital research in nonbiomedical medicine, we ask the scientific community to accept this new research standard.
Complementary Therapies↗
Editorial--a new method for generic measuring of the global quality of life.
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Humans↗
Measurement of quality of life I. A methodological framework.
Despite the widespread acceptance of quality of life (QOL) as the ideal guideline in healthcare and clinical research, serious conceptual and methodological problems continue to plague this area. In an attempt to remedy this situation, we propose seven criteria that a quality-of-life concept must meet to provide a sound basis for investigation by questionnaire. The seven criteria or desiderata are: (1) an explicit definition of quality of life; (2) a coherent philosophy of human life from which the definition is derived; (3) a theory that operationalizes the philosophy by specifying unambiguous, nonoverlapping, and jointly exhaustive questionnaire items; (4) response alternatives that permit a fraction-scale interpretation; (5) technical checks of reproducibility; (6) meaningfulness to investigators, respondents, and users; and (7) an overall aesthetic appeal of the questionnaire. These criteria have guided the design of a validated 5-item generic, global quality-of-life questionnaire (QOL5), and a validated 317-item generic, global quality-of-life questionnaire (SEQOL), administered to a well-documented birth cohort of 7,400 Danes born in 1959-1961, as well as to a reference sample of 2,500 Danes. Presented in outline, the underlying integrative quality-of-life (IQOL) theory is a meta-theory. To illustrate the seven criteria at work, we show the extent to which they are satisfied by one of the eight component theories. Next, two sample results of our investigation are presented: satisfaction with one's sex life has the expected covariation with one's quality of life, and so does mother's smoking during pregnancy, albeit to a much smaller extent. It is concluded that the methodological framework presented has proved helpful in designing a questionnaire that is capable of yielding acceptably valid and reliable measurements of global and generic quality of life.
Humans↗
Measurement of quality of life II. From the philosophy of life to science.
We believe it should be possible to make operational the philosophical ideas of the good life in order to make it the object of scientific research. The Quality of Life Research Center in Copenhagen, Denmark has therefore spent the last several years with these questions and tried to find practical and evidence-based scientific solutions. This paper describes the theoretical road taken in moving from the abstract philosophy of life to the actual questionnaire. It presents an important aspect of our work with the quality-of-life (QOL) concept though the last decade. We have developed the quality-of-life philosophy; the SEQOL, QOL5, and QOL1 questionnaires; the quality-of-life theory; and the quality-of-life research methodology. We carried out quality-of-life population surveys and developed techniques for improving quality of life with the chronically sick patient. This paper presents the struggle to create a rating scale for the generic measurement of the global quality of life, based on quality-of-life theory, derived from quality-of-life philosophy. The developed rating scale is a ratio scale combining a Likert scale, a visual analogue scale, and a numerical scale, to a reduced combination scale. This allows for the extraction of as much information from the respondents as possible without exhausting them unduly or demanding more than can be reasonably expected.
Human Development↗
Measurement of quality of life III. From the IQOL theory to the global, generic SEQOL questionnaire.
The Danish Quality of Life Survey is based on the philosophy of life known as the integrative quality-of-life (IQOL) theory. It consists of eight different quality-of-life concepts, ranging from the superficially subjective via the deeply existential to the superficially objective (well being, satisfaction with life, happiness, meaning in life, biological order, realizing life potential, fulfillment of needs, and objective factors [ability of functioning and fulfilling societal norms]). This paper presents the work underlying the formulation of the theories of a good life and how these theories came to be expressed in a comprehensive, multidimensional, generic questionnaire for the evaluation of the global quality of life--SEQOL (self-evaluation of quality of life)--presented in full length in this paper. The instruments and theories on which the Quality of Life Survey was based are constantly being updated. It is an on-going process due to aspects such as human development, language, and culture. We arrived at eight rating scales for the quality of life that, guided by the IQOL theory, were combined into a global and generic quality-of-life rating scale. This was simplified to the validated QOL5 with only five questions, made for use in clinical databases. Unfortunately, the depth of human existence is to some extent lost in QOL5. We continue to aim towards greater simplicity, precision, and depth in the questions in order to explore the depths of human existence. We have not yet found a final form that enables us to fully rate the quality of life in practice. We hope that the several hundred questions we found necessary to adequately implement the theories of the Quality of Life Survey can be replaced by far fewer; ideally, only eight questions representing the eight component theories. These eight ideal questions have not yet been evaluated, and therefore they should not form the basis of a survey. However, the perspective is clear. If eight simple questions can accurately rate the quality of life as well as its depth, we have found an instrument of immense practical scope.
Health Status↗
Measurement of quality of life IV. Use of the SEQOL, QOL5, QOL1, and other global and generic questionnaires.
Quality-of-life (QOL) rating scales can be used to measure and describe the quality of life of a specific population or patient group. Many decisions can be taken and policies implemented when we know more about a group or population. The global quality-of-life concept may help in expressing the objective of the initiatives taken to benefit specific groups. The objective may be that we hope the efforts will increase their quality of life by a certain percentage. This explicit expectation will force the decision makers to stand by their noble intentions. They are obliged to evaluate their efforts and will have to learn something from it. A questionnaire thus constitutes a useful scientific instrument, as databases based on comprehensive and thorough questionnaire surveys that seek to encompass all aspects of life can provide valuable and precise information. The value of such a database depends on the correct use of the questionnaires and this paper examines some examples of how quality-of-life rating scales can be used. We identified at least ten ways to use the quality-of-life questionnaire: describing the quality of life of a population or patient group; formulating an objective for support, treatment, or care; screening or identifying individuals who need treatment; evaluating treatment and care; facilitating communication between physician and patients; involving the patient in the decision-making process; allocating resources; investigating the causal relation between the quality of life and ill health in prospective studies; creating an awareness of the quality of life and health promotion; and helping the practitioner to accumulate knowledge. Enhancing the quality of life is therefore a determining factor in the process of increasing awareness and responsible conduct in relation to the environment, natural resources, the working environment, and the structure of society. Putting the quality of life on the agenda inherently has a constructive and positive effect on the life and functioning of the individual and society.
Health Status↗
Measurement of quality of life VI. Quality-adjusted life years (QALY) is an unfortunate use of the quality-of-life concept.
The QALY (quality-adjusted life years) attempts to incorporate the dimension of quality of life into the evaluation by adjusting life years by a quality factor. In practice, this is based on discussing with people the progression of a number of hypothetical illnesses and their ensuing side effects. From this information, the person assesses how each state of health described compares with a theoretical maximum state of health. For example, 1 day with a certain condition might the equivalent of living only 0.5 days in good health. We believe that QALY value only represents a superficial impression of a person's quality of life. In short, the QALY does not express what it means for a person to live a life at reduced quality. We believe that if the patients were optimally informed and allowed to decide for themselves, they would more often reject high-tech expensive biomedical treatments that only serve to prolong life and do not increase its quality. The problem of priorities may then turn out to be far more simple and also more ethical: the focus will be on the quality of life, not on QALY, and the question of the meaning of life and death will achieve greater openness and respect.
Human Development↗
Measurement of quality of life V. How to use the SEQOL, QOL5, QOL1, and other global and generic questionnaires for research.
A survey can be divided into four phases: (1) planning, (2) distributing and collecting the questionnaires, (3) analysis, and (4) dissemination of the results. This paper provides step-by-step guidance on how the global and generic SEQOL (self-evaluated quality of life) and QOL5 questionnaires can be used in a large- or small-scale survey of quality of life (QOL). It covers what is required to conduct a survey and generate results that should be of interest to local politicians, decision makers, and representatives from the surveyed groups and should be published after it has been processed and edited. If the results are to be published in the scientific literature, it is necessary to seek the assistance of an expert in statistics and/or research and the dissemination of research results.
Humans↗
Quality of life theory I. The IQOL theory: an integrative theory of the global quality of life concept.
Quality of life (QOL) means a good life and we believe that a good life is the same as living a life with a high quality. This paper presents the theoretical and philosophical framework of the Danish Quality of Life Survey, and of the SEQOL, QOL5, and QOL1 questionnaires. The notion of a good life can be observed from subjective to the objective, where this spectrum incorporates a number of existing quality of life theories. We call this spectrum the integrative quality-of-life (IQOL) theory and discuss the following aspects in this paper: well being, satisfaction with life, happiness, meaning in life, the biological information system ("balance"), realizing life potential, fulfillment of needs, and objective factors. The philosophy of life outlined in this paper tries to measure the global quality of life with questions derived from the integrative theory of the quality of life. The IQOL theory is an overall theory or meta-theory encompassing eight more factual theories in a subjective-existential-objective spectrum. Other philosophies of life can stress other aspects of life, but by this notion of introducing such an existential depth into the health and social sciences, we believe to have taken a necessary step towards a new humility and respect for the richness and complexity of life.
Humans↗